本文選題：醫(yī)療機(jī)構(gòu)　切入點(diǎn)：零膨脹Possion回歸　出處：《山西醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的隨著我國經(jīng)濟(jì)的飛速發(fā)展,醫(yī)療服務(wù)需求過快增長,醫(yī)療機(jī)構(gòu)呈多元化方向發(fā)展。為進(jìn)一步了解太原市醫(yī)療服務(wù)機(jī)構(gòu)工作現(xiàn)狀,針對(duì)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(jī)構(gòu)長效監(jiān)管機(jī)制、模式與方法,為制定地方性相關(guān)政策和標(biāo)準(zhǔn)提出建議。 方法本課題通過調(diào)查太原市區(qū)562所醫(yī)療機(jī)構(gòu)依法執(zhí)業(yè)現(xiàn)狀,按統(tǒng)一設(shè)計(jì)的《醫(yī)療機(jī)構(gòu)基本情況登記表》,由統(tǒng)一培訓(xùn)的醫(yī)療衛(wèi)生監(jiān)督員實(shí)施了分類登記,并對(duì)所獲資料統(tǒng)一建庫進(jìn)行分析。現(xiàn)場調(diào)查由接受過統(tǒng)一培訓(xùn)的醫(yī)療衛(wèi)生監(jiān)督員,親臨醫(yī)療機(jī)構(gòu)進(jìn)行現(xiàn)場詢問、調(diào)閱檔案文書及病歷等取證。二級(jí)以上醫(yī)院現(xiàn)場隨機(jī)抽查30名當(dāng)班醫(yī)務(wù)人員,抽取5份住院病案,藥房抽取前一日處方30張。一級(jí)醫(yī)院和民營醫(yī)院及不設(shè)床位的門診部、診所等醫(yī)療機(jī)構(gòu),督查全部在崗醫(yī)務(wù)人員,隨機(jī)抽取前一日處方或檢查治療單20張。 結(jié)果通過太原市2006至2010年登記在冊(cè)的市級(jí)醫(yī)療機(jī)構(gòu)5年連續(xù)監(jiān)測依法執(zhí)業(yè)情況分析,結(jié)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(jī)構(gòu)監(jiān)管模式不適,所轄醫(yī)療機(jī)構(gòu)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(jī)構(gòu)與非營利性醫(yī)療機(jī)構(gòu)相比,受到行政處罰的機(jī)會(huì)更多。2.醫(yī)療機(jī)構(gòu)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(jì)數(shù)。以醫(yī)療機(jī)構(gòu)5年內(nèi)行政處罰次數(shù)為應(yīng)變量,醫(yī)療機(jī)構(gòu)基本信息為自變量進(jìn)行零膨脹Poisson模型分析,ZIP結(jié)果顯示,在Poisson部分,各變量影響尚不能認(rèn)為有統(tǒng)計(jì)學(xué)意義(P0.05)；在logit部分,醫(yī)療機(jī)構(gòu)類別、所有制形式有統(tǒng)計(jì)學(xué)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(jī)構(gòu)比非營利性醫(yī)療機(jī)構(gòu)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(jī)構(gòu)5年內(nèi)使用非衛(wèi)生技術(shù)人員從事診療活動(dòng)次數(shù)為應(yīng)變量,醫(yī)療機(jī)構(gòu)基本信息為自變量分別進(jìn)行零膨脹Poisson模型分析,連接函數(shù)選擇logit函數(shù),ZIP結(jié)果顯示,在Poisson部分,醫(yī)師數(shù)差別有統(tǒng)計(jì)學(xué)意義,可見注冊(cè)醫(yī)師數(shù)越少的醫(yī)療機(jī)構(gòu),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(jì)學(xué)意義。 從行政處罰案件案山分析,超范圍開展診療活動(dòng),使用非衛(wèi)生技術(shù)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(jī)構(gòu)與非營利性醫(yī)療機(jī)構(gòu)相比,還是醫(yī)院與門診(衛(wèi)生所)相比,護(hù)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(cè)資金越多、醫(yī)師數(shù)越少、護(hù)士數(shù)越少、醫(yī)技人員數(shù)越多時(shí),在非注冊(cè)地點(diǎn)執(zhí)業(yè)的人員數(shù)量就越多；營利性醫(yī)療機(jī)構(gòu)比其他類型的醫(yī)療機(jī)構(gòu)更以出現(xiàn)違法發(fā)布醫(yī)療廣告行為。 問題與建議調(diào)查分析結(jié)果表明,部分醫(yī)療機(jī)構(gòu)尤其是營利性醫(yī)療機(jī)構(gòu),存在超范圍開展診療科目,聘用非衛(wèi)生技術(shù)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(shù)人員相對(duì)不足；我國現(xiàn)行的衛(wèi)生監(jiān)督法規(guī)體制相對(duì)滯后,不能適應(yīng)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(jī)構(gòu)監(jiān)管模式勢在必行。建議結(jié)合城市區(qū)域衛(wèi)生規(guī)劃,合理進(jìn)行行政許可；建立不良執(zhí)業(yè)檔案,針對(duì)性的采取不同的監(jiān)管頻次和處罰力度；齊抓共管,加強(qiáng)醫(yī)療廣告的監(jiān)督管理；完善現(xiàn)行的法律法規(guī)；轉(zhuǎn)變執(zhí)法方式,轉(zhuǎn)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(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R197.2

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5 陳恩東;中國醫(yī)療機(jī)構(gòu)藥品采購管理改革的目標(biāo)模式研究[D];復(fù)旦大學(xué);2004年

6 錢東福;甘肅省農(nóng)村居民就醫(yī)選擇行為研究[D];山東大學(xué);2008年

7 李曉林;我國醫(yī)療服務(wù)領(lǐng)域公平性分析[D];吉林大學(xué);2006年

8 陳正華;醫(yī)患關(guān)系的法律屬性及醫(yī)療過錯(cuò)構(gòu)成分析[D];廣州中醫(yī)藥大學(xué);2007年

9 軒志東;宏觀衛(wèi)生經(jīng)濟(jì)學(xué)的理論與實(shí)踐研究[D];華中科技大學(xué);2007年

10 佟s，

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