公立医院实行主诊医师负责制的实证研究

【作者】 王霞；

【导师】 赵普光；

【作者基本信息】 青岛大学 ， 公共管理， 2009， 硕士

【摘要】 主诊医师负责制的核心是由1位主诊医师率领的医疗小组全权负责对病人的全过程诊疗工作,是“病人选医生”的一种具体形式。主诊医师负责制要求评聘分开,即临床医师的专业技术职务评审、任命与使用分开,无论以往担任何种专业技术职务,参与主诊医疗组的工作,均需按基本资质和程序要求竞聘上岗。它最大的特点是实行按劳分配,多劳多得的利益分配方式。本文以潍坊市妇幼保健院为例,设计了五大类16个指标以考核主诊医师负责制的实施效果。结果显示,实施主诊医师负责制后医院的工作数量与质量、工作效率与效益都较前有了明显提升。特别是医师的工作积极性和责任心明显提高,医患关系得到了前所未有的改善。但是,潍坊市妇幼保健院在实施主诊医师负责制的过程中,暴露出了医师过度追求经济效益,加重病人负担的倾向,这显然违背了公立医院应遵循的公益性质和社会效益原则。同时,对经济效益的过度追求,导致医师的负荷过重,且科研精力投入不够,直接影响到医院的后继发展。因此,公立医院应改进并完善主诊医师负责制现有的绩效考核和利益分配方式,加大科研投入和学科建设,并用优秀的医院文化来正确的引导和规范医师的行为,推进主诊医师负责制在公立医院发扬光大。更多还原

【Abstract】 The mechanism of attending in charge is one form of "patients choosing doctors".The medical team leaded by an attending is in charge of the whole medical process. The mechanism of attending in charge requests every doctor to complete for the qualification working in the team no matter which titles he honours. The most prominent characteristic of the mechanism of attending in charge is the benefits assignment of the doctors which is the form of distribution according to work.This paper using the case of Mother and Child Care Courtyard in Weifang,designs sixteen targets belong to five groups to prove the effect of the mechanism of attending in charge. And the result shows that the quantity of patients,the quality and the efficiency of the whole medical process, the benefit of the hospital are all improved. Especially,the sense of responsibility and the enthusiasm of doctors have gteat progress, so the relationship between patients and doctors becomes better obviously than before. However, we have found out the inclination that the doctors run after economic effects excessively with the patients burdening much more than before. But the public hospital is the non-beneficial organization,it must defend public good first. At the same time, running after economic effects excessively will make the doctors burden so overweight that they have no energy to do searches,which is no good for the development of the hospital.So the public hospital should improve the current mechanisms of performance assessment and benefits assignment, enlarge the input for scientific research and discipline construction, and do the correct guidance to standard behaviors of doctors with excellent hospital culture. Then the mechanism of attending in charge will run better and have a greater development.更多还原