基于利益相关者视角的广东省医师多点执业现状研究

发布时间：2018-02-11 22:24

本文关键词： 医师多点执业现状利益相关者广东　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:自2010年起,广东省的医师多点执业政策已经执行七年了,对广东省医疗卫生事业发展、医师执业环境、各利益相关者都产生了一定的影响。通过对主要利益相关者的调查研究,分析全省医师多点执业现状,有助于为政府部门更好推进医师多点执业提供参考,为优化医师多点执业政策,建立实践路径,以及各利益相关者的应对策略提供建议。方法:1、采用文献归纳法、公共政策分析法,对国内外医师多点执业的研究的现状进行系统归纳,分析和总结不同国家、地区医师的执业模式特点和经验借鉴;在此基础上对广东省2010年-2016年医师多点执业相关的政策进行分析,总结广东省医师多点执业政策的亮点。2、运用问卷调查、深度访谈、第二手资料分析和统计学方法,对广东省医师多点执业政策所涉及的六个主要利益相关者开展调查分析。这六个主要利益相关者包括:政府部门、大型公立医院管理者、大型公立医院执业医师、基层医疗机构管理者或医师、民营医疗机构管理者或负责人以及广大患者。3、运用PEST分析法和利益相关者分析法,分别研究分析目前影响医师多点执业的宏观和微观因素,以便更好地对医师多点执业的推行提出相应建议。结果:1、广东省医师多点执业的政策是全国范围内最为开放、先进的,多点执业医师的流动也较为符合优质医疗人力资源流向基层医疗机构和促进社会办医的政策目标。2、省内大型公立医院的管理者对医师多点执业政策认识仍有不足,持包容态度但不主动积极;大型公立医院的执业医师对政策的支持度较高,但对政策制定和执行的满意度不高,认为推动提高医师技术劳务价值的体现是政策最为正面的影响,产生医疗风险责任问题是政策最为负面的影响,首选的多点执业方式是成立或参与医生工作室;基层医疗机构认为医师多点执业尚受到经济、设施设备、诊治对象不对称等问题的制约;民营医疗机构积极通过医师多点执业引进人才,完善管理机制,快速发展;患者目前选择医师的判断以医疗机构级别和医师职称为主,大病小病都希望能够获得专家诊治。结论:广东省医疗卫生事业所处的宏观环境对医师多点执业的影响较为积极,具有良好的政策环境,卫生服务需求处于增长阶段,信息技术的发展带来了远程医疗、合作医疗的便利,但是医疗收入结构仍不合理,需要改善。各微观利益主体对医师多点执业的影响则各有不同。针对发现的问题,建议通过以下方面进行完善:重视经济激励对医师行为的影响,改革公立医院管理制度,支持鼓励医师团队的多点执业模式,推进医疗责任保险制度,完善医师行业管理和监督,发展第三方检查检验,加大政府对医疗人才培养的投入,建立医师个人品牌。
[Abstract]:Objective: since 2010, the multi-point practice policy of doctors in Guangdong Province has been implemented for seven years. All stakeholders have had a certain impact. Through the investigation and study of the main stakeholders, the analysis of the status quo of doctors' multi-point practice in the province will be helpful for the government to better promote the practice of doctors' multi-point practice. In order to optimize the doctors' multi-point practice policy, establish the practical path, and the coping strategies of various stakeholders. Method: 1, using the method of literature induction, public policy analysis, This paper systematically summarizes the current situation of the research on multi-point practice of doctors at home and abroad, and analyzes and summarizes the characteristics and experience of doctors in different countries and regions. On this basis, this paper analyzes the related policies of doctors' multi-practice in Guangdong Province from 2010 to 2016, and summarizes the bright spot .2of doctors' multi-point practice policy in Guangdong Province, using questionnaires, in-depth interviews, second-hand data analysis and statistical methods. To investigate and analyze the six major stakeholders involved in the multi-point practice policy of doctors in Guangdong Province. The six main stakeholders include: government departments, managers of large public hospitals, practitioners of large public hospitals, The managers or doctors of primary medical institutions, the managers or responsible persons of private medical institutions and the vast number of patients. Using PEST analysis and stakeholder analysis, respectively, the macro and micro factors affecting doctors' multi-point practice are studied and analyzed. In order to better put forward corresponding suggestions for the implementation of multi-point practice of doctors. Results: 1. Guangdong Province's policy of multi-point practice of doctors is the most open and advanced in the whole country. The mobility of multi-point medical practitioners is also in line with the policy objective of the flow of high-quality medical human resources to primary medical institutions and the promotion of social health care. The managers of large public hospitals in the province still have insufficient understanding of the multi-point medical practice policy of doctors. The doctors in large public hospitals have a high degree of support for the policy, but are not satisfied with the policy formulation and implementation. They think that promoting the embodiment of the value of doctors' technical services is the most positive impact of the policy. The problem of medical risk liability is the most negative impact of the policy. The preferred multi-point practice mode is to establish or participate in a doctor's workroom. Primary medical institutions believe that doctors' multi-point practice is still economically and well equipped. Problems such as asymmetry of the objects of diagnosis and treatment; private medical institutions actively introduce talents through multi-point practice of doctors, perfect management mechanism, and develop rapidly; patients currently choose doctors mainly by the level of medical institutions and the professional titles of doctors. Conclusion: the macroscopical environment in Guangdong Province has a positive effect on doctors' multi-practice, has a good policy environment, and the demand for health services is growing. The development of information technology has brought about the convenience of telemedicine and cooperative medical treatment, but the income structure of medical treatment is still unreasonable and needs to be improved. The suggestions are as follows: pay attention to the impact of economic incentives on doctors' behavior, reform the management system of public hospitals, support the multi-point practice model to encourage doctors' teams, and promote the medical liability insurance system. Improve the management and supervision of physician industry, develop third-party inspection and inspection, increase government investment in medical personnel training, and establish individual doctor brand.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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