本文選題：醫(yī)療機構　切入點：零膨脹Possion回歸　出處：《山西醫(yī)科大學》2012年碩士論文　論文類型：學位論文

【摘要】：目的隨著我國經(jīng)濟的飛速發(fā)展,醫(yī)療服務需求過快增長,醫(yī)療機構呈多元化方向發(fā)展。為進一步了解太原市醫(yī)療服務機構工作現(xiàn)狀,針對性地找出存在的問題,規(guī)范醫(yī)療市場,探索各類醫(yī)療衛(wèi)生機構長效監(jiān)管機制、模式與方法,為制定地方性相關政策和標準提出建議。 方法本課題通過調查太原市區(qū)562所醫(yī)療機構依法執(zhí)業(yè)現(xiàn)狀,按統(tǒng)一設計的《醫(yī)療機構基本情況登記表》,由統(tǒng)一培訓的醫(yī)療衛(wèi)生監(jiān)督員實施了分類登記,并對所獲資料統(tǒng)一建庫進行分析�，F(xiàn)場調查由接受過統(tǒng)一培訓的醫(yī)療衛(wèi)生監(jiān)督員,親臨醫(yī)療機構進行現(xiàn)場詢問、調閱檔案文書及病歷等取證。二級以上醫(yī)院現(xiàn)場隨機抽查30名當班醫(yī)務人員,抽取5份住院病案,藥房抽取前一日處方30張。一級醫(yī)院和民營醫(yī)院及不設床位的門診部、診所等醫(yī)療機構,督查全部在崗醫(yī)務人員,隨機抽取前一日處方或檢查治療單20張。 結果通過太原市2006至2010年登記在冊的市級醫(yī)療機構5年連續(xù)監(jiān)測依法執(zhí)業(yè)情況分析,結果表明：1.太原市10縣(市、區(qū))衛(wèi)生資源分布不均衡,醫(yī)療機構監(jiān)管模式不適,所轄醫(yī)療機構平均行政處罰0.368次。經(jīng)醫(yī)院與門診(衛(wèi)生所)、營利性醫(yī)療機構與非營利性醫(yī)療機構相比,受到行政處罰的機會更多。2.醫(yī)療機構受到行政處罰的極少,平均次數(shù)為0.268,產(chǎn)生大量的零計數(shù)。以醫(yī)療機構5年內行政處罰次數(shù)為應變量,醫(yī)療機構基本信息為自變量進行零膨脹Poisson模型分析,ZIP結果顯示,在Poisson部分,各變量影響尚不能認為有統(tǒng)計學意義(P0.05)；在logit部分,醫(yī)療機構類別、所有制形式有統(tǒng)計學意義(P0.05),表明醫(yī)院比門診(衛(wèi)生所)更可能出現(xiàn)違法執(zhí)業(yè)行為,更可能受到行政處罰；營利性醫(yī)療機構比非營利性醫(yī)療機構更可能出現(xiàn)違法執(zhí)業(yè)行為,更可能受到行政處罰。 以醫(yī)療機構5年內使用非衛(wèi)生技術人員從事診療活動次數(shù)為應變量,醫(yī)療機構基本信息為自變量分別進行零膨脹Poisson模型分析,連接函數(shù)選擇logit函數(shù),ZIP結果顯示,在Poisson部分,醫(yī)師數(shù)差別有統(tǒng)計學意義,可見注冊醫(yī)師數(shù)越少的醫(yī)療機構,使用非衛(wèi)技人員行醫(yī)受懲罰事件發(fā)生的次數(shù)越多；在logit部分,尚未發(fā)現(xiàn)各變量差別有統(tǒng)計學意義。 從行政處罰案件案山分析,超范圍開展診療活動,使用非衛(wèi)生技術人員,違法發(fā)布醫(yī)療廣告,執(zhí)業(yè)醫(yī)師異地執(zhí)業(yè)等,是案由的前4位原因,是太原市衛(wèi)生行政執(zhí)法問題中多見的緣由。無論是營利性醫(yī)療機構與非營利性醫(yī)療機構相比,還是醫(yī)院與門診(衛(wèi)生所)相比,護士數(shù)越少,醫(yī)技數(shù)越多,越有可能出現(xiàn)超范圍行醫(yī)事件的次數(shù)；注冊資金越多、醫(yī)師數(shù)越少、護士數(shù)越少、醫(yī)技人員數(shù)越多時,在非注冊地點執(zhí)業(yè)的人員數(shù)量就越多；營利性醫(yī)療機構比其他類型的醫(yī)療機構更以出現(xiàn)違法發(fā)布醫(yī)療廣告行為。 問題與建議調查分析結果表明,部分醫(yī)療機構尤其是營利性醫(yī)療機構,存在超范圍開展診療科目,聘用非衛(wèi)生技術人員,非法發(fā)布醫(yī)療廣告等問題；醫(yī)療資源配置不均衡,醫(yī)療技術人員相對不足；我國現(xiàn)行的衛(wèi)生監(jiān)督法規(guī)體制相對滯后,不能適應醫(yī)療衛(wèi)生監(jiān)督的需求；改變太原市現(xiàn)行的醫(yī)療機構監(jiān)管模式勢在必行。建議結合城市區(qū)域衛(wèi)生規(guī)劃,合理進行行政許可；建立不良執(zhí)業(yè)檔案,針對性的采取不同的監(jiān)管頻次和處罰力度；齊抓共管,加強醫(yī)療廣告的監(jiān)督管理；完善現(xiàn)行的法律法規(guī)；轉變執(zhí)法方式,轉變執(zhí)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.

【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R197.2

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