本文關(guān)鍵詞： 醫(yī)師 多點執(zhí)業(yè) 現(xiàn)狀 利益相關(guān)者 廣東　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:自2010年起,廣東省的醫(yī)師多點執(zhí)業(yè)政策已經(jīng)執(zhí)行七年了,對廣東省醫(yī)療衛(wèi)生事業(yè)發(fā)展、醫(yī)師執(zhí)業(yè)環(huán)境、各利益相關(guān)者都產(chǎn)生了一定的影響。通過對主要利益相關(guān)者的調(diào)查研究,分析全省醫(yī)師多點執(zhí)業(yè)現(xiàn)狀,有助于為政府部門更好推進醫(yī)師多點執(zhí)業(yè)提供參考,為優(yōu)化醫(yī)師多點執(zhí)業(yè)政策,建立實踐路徑,以及各利益相關(guān)者的應對策略提供建議。方法:1、采用文獻歸納法、公共政策分析法,對國內(nèi)外醫(yī)師多點執(zhí)業(yè)的研究的現(xiàn)狀進行系統(tǒng)歸納,分析和總結(jié)不同國家、地區(qū)醫(yī)師的執(zhí)業(yè)模式特點和經(jīng)驗借鑒;在此基礎上對廣東省2010年-2016年醫(yī)師多點執(zhí)業(yè)相關(guān)的政策進行分析,總結(jié)廣東省醫(yī)師多點執(zhí)業(yè)政策的亮點。2、運用問卷調(diào)查、深度訪談、第二手資料分析和統(tǒng)計學方法,對廣東省醫(yī)師多點執(zhí)業(yè)政策所涉及的六個主要利益相關(guān)者開展調(diào)查分析。這六個主要利益相關(guān)者包括:政府部門、大型公立醫(yī)院管理者、大型公立醫(yī)院執(zhí)業(yè)醫(yī)師、基層醫(yī)療機構(gòu)管理者或醫(yī)師、民營醫(yī)療機構(gòu)管理者或負責人以及廣大患者。3、運用PEST分析法和利益相關(guān)者分析法,分別研究分析目前影響醫(yī)師多點執(zhí)業(yè)的宏觀和微觀因素,以便更好地對醫(yī)師多點執(zhí)業(yè)的推行提出相應建議。結(jié)果:1、廣東省醫(yī)師多點執(zhí)業(yè)的政策是全國范圍內(nèi)最為開放、先進的,多點執(zhí)業(yè)醫(yī)師的流動也較為符合優(yōu)質(zhì)醫(yī)療人力資源流向基層醫(yī)療機構(gòu)和促進社會辦醫(yī)的政策目標。2、省內(nèi)大型公立醫(yī)院的管理者對醫(yī)師多點執(zhí)業(yè)政策認識仍有不足,持包容態(tài)度但不主動積極;大型公立醫(yī)院的執(zhí)業(yè)醫(yī)師對政策的支持度較高,但對政策制定和執(zhí)行的滿意度不高,認為推動提高醫(yī)師技術(shù)勞務價值的體現(xiàn)是政策最為正面的影響,產(chǎn)生醫(yī)療風險責任問題是政策最為負面的影響,首選的多點執(zhí)業(yè)方式是成立或參與醫(yī)生工作室;基層醫(yī)療機構(gòu)認為醫(yī)師多點執(zhí)業(yè)尚受到經(jīng)濟、設施設備、診治對象不對稱等問題的制約;民營醫(yī)療機構(gòu)積極通過醫(yī)師多點執(zhí)業(yè)引進人才,完善管理機制,快速發(fā)展;患者目前選擇醫(yī)師的判斷以醫(yī)療機構(gòu)級別和醫(yī)師職稱為主,大病小病都希望能夠獲得專家診治。結(jié)論:廣東省醫(yī)療衛(wèi)生事業(yè)所處的宏觀環(huán)境對醫(yī)師多點執(zhí)業(yè)的影響較為積極,具有良好的政策環(huán)境,衛(wèi)生服務需求處于增長階段,信息技術(shù)的發(fā)展帶來了遠程醫(yī)療、合作醫(yī)療的便利,但是醫(yī)療收入結(jié)構(gòu)仍不合理,需要改善。各微觀利益主體對醫(yī)師多點執(zhí)業(yè)的影響則各有不同。針對發(fā)現(xiàn)的問題,建議通過以下方面進行完善:重視經(jīng)濟激勵對醫(yī)師行為的影響,改革公立醫(yī)院管理制度,支持鼓勵醫(yī)師團隊的多點執(zhí)業(yè)模式,推進醫(yī)療責任保險制度,完善醫(yī)師行業(yè)管理和監(jiān)督,發(fā)展第三方檢查檢驗,加大政府對醫(yī)療人才培養(yǎng)的投入,建立醫(yī)師個人品牌。
[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.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1

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