本文選題：醫(yī)師多點(diǎn)執(zhí)業(yè) + 深圳市��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:深圳市作為廣東省的重要試點(diǎn)城市,在政策的推行和配套措施的建設(shè)方面都具有較成熟的經(jīng)驗(yàn),本文通過(guò)分析深圳市地區(qū)政策實(shí)施的成效和不足,為深圳政策調(diào)整和其他地區(qū)的政策推廣提供參考意見(jiàn)。通過(guò)對(duì)深圳市某三甲公立醫(yī)院的利益相關(guān)方醫(yī)師和醫(yī)院管理者的多點(diǎn)執(zhí)業(yè)政策實(shí)施效果主觀態(tài)度和認(rèn)知進(jìn)行調(diào)查研究,運(yùn)用數(shù)據(jù)分析找出地區(qū)現(xiàn)階段的政策實(shí)施效果和不足,及主要阻礙因素和影響因素,為現(xiàn)階段政策實(shí)施提供現(xiàn)實(shí)可行方案,更好的推動(dòng)深圳市地區(qū)多點(diǎn)執(zhí)業(yè)政策環(huán)境的健康發(fā)展,通過(guò)引導(dǎo)政策順利實(shí)施形成優(yōu)質(zhì)的地區(qū)服務(wù)品牌。方法:運(yùn)用文獻(xiàn)分析法,收集國(guó)內(nèi)多點(diǎn)執(zhí)業(yè)政策條例、國(guó)內(nèi)外相關(guān)的理論、綜述、實(shí)證研究和實(shí)施現(xiàn)狀報(bào)告等資料進(jìn)行總結(jié)分析,分析目前國(guó)內(nèi)外多點(diǎn)執(zhí)業(yè)問(wèn)題研究現(xiàn)狀、前沿理論及有參考價(jià)值經(jīng)驗(yàn),并進(jìn)行國(guó)內(nèi)外研究的對(duì)比分析。通過(guò)文獻(xiàn)研究初步選定調(diào)查維度,對(duì)相關(guān)調(diào)查維度進(jìn)行篩選,通過(guò)預(yù)調(diào)查對(duì)問(wèn)卷進(jìn)行修改并對(duì)問(wèn)卷進(jìn)行信度和效度檢驗(yàn)形成有效問(wèn)卷。通過(guò)運(yùn)用問(wèn)卷調(diào)查法和訪談法對(duì)政策利益相關(guān)方進(jìn)行調(diào)查,對(duì)調(diào)查結(jié)果運(yùn)用方差分析和顯著性分析進(jìn)行分析整理,根據(jù)分析結(jié)果得出結(jié)論提出建議。結(jié)果:通過(guò)運(yùn)用問(wèn)卷法和訪談法對(duì)政策利益相關(guān)分進(jìn)行調(diào)查得出調(diào)查結(jié)果包括,以對(duì)多點(diǎn)執(zhí)業(yè)態(tài)度為因變量,阻礙因素為自變量進(jìn)行方差分析,得出的有統(tǒng)計(jì)學(xué)意義(p0.05)的阻礙因素按平均分排名依次為:經(jīng)濟(jì)收入、學(xué)術(shù)成果分配不明晰,醫(yī)師個(gè)人意愿,醫(yī)師的工作量超負(fù)荷;對(duì)政策實(shí)施優(yōu)缺點(diǎn)進(jìn)行調(diào)查顯示,最大優(yōu)點(diǎn)為增加醫(yī)師的收入,最大缺點(diǎn)為產(chǎn)生薪酬支付問(wèn)題;對(duì)政策受益和損益方進(jìn)行調(diào)查,統(tǒng)計(jì)結(jié)果顯示最大受益者為患者,損益者為醫(yī)院,醫(yī)師對(duì)自身的投票中受益者排第四,損益者排第二;以政策相關(guān)性總分為因變量,調(diào)查醫(yī)師個(gè)人情況為自變量進(jìn)行方差分析,得出年齡,職稱和執(zhí)業(yè)年限與相關(guān)性總分有統(tǒng)計(jì)學(xué)意義(p0.05),其中小于30歲,職稱為主治醫(yī)師,執(zhí)業(yè)年限10-20年的醫(yī)師群體與政策相關(guān)性較高;通過(guò)對(duì)影響因素進(jìn)行分類統(tǒng)計(jì),發(fā)現(xiàn)現(xiàn)階段與政策相關(guān)度最高的影響因素來(lái)自第二執(zhí)業(yè)單位的相關(guān)因素;通過(guò)對(duì)醫(yī)院管理者訪談內(nèi)容進(jìn)行編碼整理,應(yīng)用顯著性指數(shù)計(jì)算公式計(jì)算訪談內(nèi)容中涉及的影響因素,研究結(jié)論顯示現(xiàn)階段更好政策效益的體現(xiàn)是地區(qū)政策推廣的主要驅(qū)動(dòng)力。結(jié)論:深圳市多點(diǎn)執(zhí)業(yè)政策實(shí)施效果明顯,普遍認(rèn)為的醫(yī)院人事制度、責(zé)任風(fēng)險(xiǎn)、注冊(cè)管理等相關(guān)制度因素不利于政策的推廣的問(wèn)題,在深圳市現(xiàn)行政策推廣模式下得到了有效解決,這些政策推廣經(jīng)驗(yàn)值得其他地區(qū)的借鑒;通過(guò)調(diào)查得出醫(yī)師對(duì)政策的態(tài)度主要與主觀經(jīng)濟(jì)因素相關(guān),醫(yī)師在政策實(shí)施過(guò)程中未感受利益的明顯改善,多點(diǎn)執(zhí)業(yè)更多被認(rèn)為醫(yī)師的逐利行為,而未充分體現(xiàn)其政策公益性,可通過(guò)出臺(tái)配套薪酬制度對(duì)政策進(jìn)行管理;醫(yī)師與管理者對(duì)政策影響因素分析結(jié)果較一致,認(rèn)為政策驅(qū)動(dòng)力不足,需要通過(guò)更多的政策實(shí)施福利的體現(xiàn)來(lái)驅(qū)動(dòng)政策進(jìn)一步的落實(shí);通過(guò)調(diào)查研究分析認(rèn)為健全的初級(jí)衛(wèi)生服務(wù)網(wǎng)絡(luò)是多點(diǎn)執(zhí)業(yè)政策得以有效實(shí)施的必要條件,為促進(jìn)多點(diǎn)執(zhí)業(yè)政策更好落實(shí)需重視基層衛(wèi)生服務(wù)能力的建設(shè),積極引導(dǎo)患者的分流。
[Abstract]:Objective: Shenzhen City, as an important pilot city in Guangdong Province, has more mature experience in the implementation of policy and the construction of supporting measures. Through the analysis of the effectiveness and deficiency of the implementation of Shenzhen's regional policy, this paper provides a reference for the adjustment of the policy of Shenzhen and the promotion of policy in other regions. The subjective attitude and cognition of the implementation effect of multi-point practice policy of the stakeholders and hospital managers in the hospital are investigated, and data analysis is used to find out the effect and deficiency of the policy implementation at the present stage, and the main obstacles and influencing factors to provide practical and feasible plans for the implementation of the current policy and to promote the Shenzhen city better. The healthy development of the multi-point practice policy environment in the region, through guiding the smooth implementation of the policy to form a high quality regional service brand. Methods: using the literature analysis method, collecting domestic multi point practice policy and regulations, domestic and foreign related theories, summary, empirical research and implementation of the status report and other data to analyze and analyze the current domestic and foreign multi point implementation. The research status of the industry, the frontier theory and the reference value experience, and the comparative analysis of the domestic and foreign research. Through the literature study, the preliminary selection of investigation dimension is selected, the related investigation dimensions are screened, the questionnaire is modified and the reliability and validity of the questionnaire is formed to form an effective questionnaire. The questionnaire survey method is used. And interview method to investigate the stakeholder of policy, analyze and analyze the result of variance analysis and significance analysis, and draw some suggestions according to the result of the analysis. The obstacle factors are the variance analysis of the independent variables, and the statistical significance (P0.05) is ranked as the economic income, the academic achievement is not clear, the physician's personal will and the workload of the doctor are overloaded; the best advantage is to increase the doctor's income and the biggest shortage. The point is the issue of pay and payment; the policy benefit and the profit and loss party are investigated. The statistical results show that the biggest beneficiaries are patients, the profit and loss are the hospitals, the doctors have fourth of the beneficiaries in their own voting and second of the profit and loss. Age, professional title and practice years and correlation total score has statistical significance (P0.05), which is less than 30 years old, the professional title is the chief physician, and the physician group with 10-20 years of practice has a higher correlation. By classifying the influencing factors, it is found that the most influential factors of the current stage with the policy are related to the related causes of the second practice units. By coding the interview contents of the hospital managers and calculating the influence factors involved in the interview, the conclusion shows that the embodiment of the better policy benefit at the present stage is the main driving force of the regional policy promotion. Conclusion: the implementation effect of the multi point practice policy in Shenzhen is obvious and generally believed. Hospital personnel system, responsibility risk, registration management and other related institutional factors are not conducive to the promotion of policy. It is effectively solved in the current policy promotion mode of Shenzhen. These policies are worthy of reference in other areas. Through investigation, the attitude of doctors to the policy is mainly related to the subjective economic factors. In the process of implementing the policy, there is no obvious improvement in the benefit of the policy, and more practice is considered to be more beneficial to the doctor, but not fully reflected in the public welfare of the policy. It can manage the policy through the introduction of the supporting compensation system; the results of the analysis of the factors influencing the policy factors are more consistent, and the lack of policy driving force needs to pass through more. Many policies to implement the welfare of the embodiment to drive the implementation of the policy further; through investigation and analysis, a sound primary health service network is the necessary condition for the effective implementation of the multi point practice policy. In order to promote the better implementation of the multi point practice policy, we should attach importance to the construction of the basic health service capacity and actively guide the shunt of the patients.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1

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