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

【摘要】：目的:深圳市作為廣東省的重要試點城市,在政策的推行和配套措施的建設方面都具有較成熟的經(jīng)驗,本文通過分析深圳市地區(qū)政策實施的成效和不足,為深圳政策調整和其他地區(qū)的政策推廣提供參考意見。通過對深圳市某三甲公立醫(yī)院的利益相關方醫(yī)師和醫(yī)院管理者的多點執(zhí)業(yè)政策實施效果主觀態(tài)度和認知進行調查研究,運用數(shù)據(jù)分析找出地區(qū)現(xiàn)階段的政策實施效果和不足,及主要阻礙因素和影響因素,為現(xiàn)階段政策實施提供現(xiàn)實可行方案,更好的推動深圳市地區(qū)多點執(zhí)業(yè)政策環(huán)境的健康發(fā)展,通過引導政策順利實施形成優(yōu)質的地區(qū)服務品牌。方法:運用文獻分析法,收集國內(nèi)多點執(zhí)業(yè)政策條例、國內(nèi)外相關的理論、綜述、實證研究和實施現(xiàn)狀報告等資料進行總結分析,分析目前國內(nèi)外多點執(zhí)業(yè)問題研究現(xiàn)狀、前沿理論及有參考價值經(jīng)驗,并進行國內(nèi)外研究的對比分析。通過文獻研究初步選定調查維度,對相關調查維度進行篩選,通過預調查對問卷進行修改并對問卷進行信度和效度檢驗形成有效問卷。通過運用問卷調查法和訪談法對政策利益相關方進行調查,對調查結果運用方差分析和顯著性分析進行分析整理,根據(jù)分析結果得出結論提出建議。結果:通過運用問卷法和訪談法對政策利益相關分進行調查得出調查結果包括,以對多點執(zhí)業(yè)態(tài)度為因變量,阻礙因素為自變量進行方差分析,得出的有統(tǒng)計學意義(p0.05)的阻礙因素按平均分排名依次為:經(jīng)濟收入、學術成果分配不明晰,醫(yī)師個人意愿,醫(yī)師的工作量超負荷;對政策實施優(yōu)缺點進行調查顯示,最大優(yōu)點為增加醫(yī)師的收入,最大缺點為產(chǎn)生薪酬支付問題;對政策受益和損益方進行調查,統(tǒng)計結果顯示最大受益者為患者,損益者為醫(yī)院,醫(yī)師對自身的投票中受益者排第四,損益者排第二;以政策相關性總分為因變量,調查醫(yī)師個人情況為自變量進行方差分析,得出年齡,職稱和執(zhí)業(yè)年限與相關性總分有統(tǒng)計學意義(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)師群體與政策相關性較高;通過對影響因素進行分類統(tǒng)計,發(fā)現(xiàn)現(xiàn)階段與政策相關度最高的影響因素來自第二執(zhí)業(yè)單位的相關因素;通過對醫(yī)院管理者訪談內(nèi)容進行編碼整理,應用顯著性指數(shù)計算公式計算訪談內(nèi)容中涉及的影響因素,研究結論顯示現(xiàn)階段更好政策效益的體現(xiàn)是地區(qū)政策推廣的主要驅動力。結論:深圳市多點執(zhí)業(yè)政策實施效果明顯,普遍認為的醫(yī)院人事制度、責任風險、注冊管理等相關制度因素不利于政策的推廣的問題,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)驗值得其他地區(qū)的借鑒;通過調查得出醫(yī)師對政策的態(tài)度主要與主觀經(jīng)濟因素相關,醫(yī)師在政策實施過程中未感受利益的明顯改善,多點執(zhí)業(yè)更多被認為醫(yī)師的逐利行為,而未充分體現(xiàn)其政策公益性,可通過出臺配套薪酬制度對政策進行管理;醫(yī)師與管理者對政策影響因素分析結果較一致,認為政策驅動力不足,需要通過更多的政策實施福利的體現(xiàn)來驅動政策進一步的落實;通過調查研究分析認為健全的初級衛(wèi)生服務網(wǎng)絡是多點執(zhí)業(yè)政策得以有效實施的必要條件,為促進多點執(zhí)業(yè)政策更好落實需重視基層衛(wèi)生服務能力的建設,積極引導患者的分流。
[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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