太原市医疗机构依法执业现状调查与分析

发布时间：2018-03-18 02:27

本文选题：医疗机构　切入点：零膨胀Possion回归　出处：《山西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的随着我国经济的飞速发展,医疗服务需求过快增长,医疗机构呈多元化方向发展。为进一步了解太原市医疗服务机构工作现状,针对性地找出存在的问题,规范医疗市场,探索各类医疗卫生机构长效监管机制、模式与方法,为制定地方性相关政策和标准提出建议。方法本课题通过调查太原市区562所医疗机构依法执业现状,按统一设计的《医疗机构基本情况登记表》,由统一培训的医疗卫生监督员实施了分类登记,并对所获资料统一建库进行分析。现场调查由接受过统一培训的医疗卫生监督员,亲临医疗机构进行现场询问、调阅档案文书及病历等取证。二级以上医院现场随机抽查30名当班医务人员,抽取5份住院病案,药房抽取前一日处方30张。一级医院和民营医院及不设床位的门诊部、诊所等医疗机构,督查全部在岗医务人员,随机抽取前一日处方或检查治疗单20张。结果通过太原市2006至2010年登记在册的市级医疗机构5年连续监测依法执业情况分析,结果表明：1.太原市10县(市、区)卫生资源分布不均衡,医疗机构监管模式不适,所辖医疗机构平均行政处罚0.368次。经医院与门诊(卫生所)、营利性医疗机构与非营利性医疗机构相比,受到行政处罚的机会更多。2.医疗机构受到行政处罚的极少,平均次数为0.268,产生大量的零计数。以医疗机构5年内行政处罚次数为应变量,医疗机构基本信息为自变量进行零膨胀Poisson模型分析,ZIP结果显示,在Poisson部分,各变量影响尚不能认为有统计学意义(P0.05)；在logit部分,医疗机构类别、所有制形式有统计学意义(P0.05),表明医院比门诊(卫生所)更可能出现违法执业行为,更可能受到行政处罚；营利性医疗机构比非营利性医疗机构更可能出现违法执业行为,更可能受到行政处罚。以医疗机构5年内使用非卫生技术人员从事诊疗活动次数为应变量,医疗机构基本信息为自变量分别进行零膨胀Poisson模型分析,连接函数选择logit函数,ZIP结果显示,在Poisson部分,医师数差别有统计学意义,可见注册医师数越少的医疗机构,使用非卫技人员行医受惩罚事件发生的次数越多；在logit部分,尚未发现各变量差别有统计学意义。从行政处罚案件案山分析,超范围开展诊疗活动,使用非卫生技术人员,违法发布医疗广告,执业医师异地执业等,是案由的前4位原因,是太原市卫生行政执法问题中多见的缘由。无论是营利性医疗机构与非营利性医疗机构相比,还是医院与门诊(卫生所)相比,护士数越少,医技数越多,越有可能出现超范围行医事件的次数；注册资金越多、医师数越少、护士数越少、医技人员数越多时,在非注册地点执业的人员数量就越多；营利性医疗机构比其他类型的医疗机构更以出现违法发布医疗广告行为。问题与建议调查分析结果表明,部分医疗机构尤其是营利性医疗机构,存在超范围开展诊疗科目,聘用非卫生技术人员,非法发布医疗广告等问题；医疗资源配置不均衡,医疗技术人员相对不足；我国现行的卫生监督法规体制相对滞后,不能适应医疗卫生监督的需求；改变太原市现行的医疗机构监管模式势在必行。建议结合城市区域卫生规划,合理进行行政许可；建立不良执业档案,针对性的采取不同的监管频次和处罚力度；齐抓共管,加强医疗广告的监督管理；完善现行的法律法规；转变执法方式,转变执法理念。
[Abstract]:With the rapid development of China's economy, rapid growth in demand for medical services, medical institutions was diversified development. In order to further understand the status quo of Taiyuan City medical service agencies, to identify problems, regulate the health care market, explore the long-term regulatory mechanisms of various medical and health institutions, mode and method, put forward suggestions for the development of local relevant policies and standards.
Methods in this study, through the investigation of Taiyuan city in 562 medical institutions in accordance with the law practice of the registration form > according to the basic medical institutions unified design ", by trained health supervisors implement classification registration, and the obtained data were analyzed. The unified database establishment survey by the received training of health supervisors in medical institutions on-site inquiry, access to archives documents and medical evidence. More than two hospitals were randomly selected 30 on-site medical staff on duty, selected 5 medical records, pharmacy from the day before the 30 prescriptions. A hospital and private hospital beds and clinics, clinics and other medical institutions, all in the post supervision the medical personnel were randomly selected, the day before the examination and treatment of single prescription or 20.
The results of the medical institutions of Taiyuan city from 2006 to 2010 registered continuous monitoring for 5 years of practicing law analysis, the results showed that: 10 1. Taiyuan county (city, district) the uneven distribution of health resources, supervision of medical institutions discomfort, medical institutions under the jurisdiction of the average administrative penalty 0.368 times. The hospital and outpatient department (sanitation), for-profit medical institutions compared with the non-profit medical institutions, subject to administrative punishment more opportunities for.2. medical institutions by little administrative punishment, the average number of 0.268, a large number of zero counts. The medical institutions of administrative punishment within 5 years the number of variable, the basic information of medical institutions as independent variables for zero inflation Poisson model ZIP analysis results showed that in the Poisson section, the influence of different variables are not considered statistically significant (P0.05); in part logit, medical institutions category, significant ownership form (P0.05) It shows that hospitals are more likely to appear illegal practice than outpatients, and are more likely to be punished by administrative punishment. For-profit medical institutions are more likely to appear illegal practices than non-profit medical institutions, and are more likely to be subject to administrative penalties.
In medical institutions within 5 years of non health technical personnel engaged in medical activities as the dependent variable, the basic information of medical institutions as the independent variable zero expansion Poisson model were analyzed, the connection function of Logit function, ZIP results showed that in the Poisson section, there was statistical significance difference between the number of physicians, visible registered medical institutions is few. The use of non health technical personnel practice by the number of penalty incident occurred; in part logit, has not been found to have significant difference between the variables.
From the analysis of administrative penalty cases, treatment activities carried out over the range, the use of non health technical personnel, illegal medical advertisements published, practicing physicians practicing in different places, is the 4 cause of the former, reason is rare in Taiyuan health administrative law enforcement problems. Both for-profit medical institutions compared with the non-profit medical institutions, or hospital and clinics (Health) compared to the number of nurses less medical number, the more likely the number of events beyond the scope of practice; the registered capital of more, the less the number of physicians, nurses, medical technicians are few, the number of the more a long time, the practice place of registration of the number of personnel in non profit medical institutions more; compared to other types of medical institutions to illegal behavior release medical advertisements.
Problems and suggestions on the results of investigation indicate that some medical institutions especially for-profit medical institutions, there is scope to carry out medical subjects, employ non-medical personnel, illegal medical advertisements published and so on; the allocation of medical resources is not balanced, the relative lack of medical technical personnel; China's current health supervision regulations system is lagging behind, can not adapt to the medical health supervision needs; change the existing medical institutions of Taiyuan city supervision mode is imperative. Combining with city regional health planning and reasonable administrative license; the establishment of bad practice files, then take different supervision frequency and punishment; make concerted efforts to strengthen the supervision and administration of medical advertisements; improve the existing laws and regulations; change the way of law enforcement, changing the concept of law enforcement.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R197.2

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