制约上海医疗联合体顺利推进的主要因素与对策分析

Analysis of main restricting factors and countermeasures for smoothly developing multihospital system in Shanghai

目的探究当前制约上海医疗联合体发展的主要因素,为其在更大范围上推广提供思路与改进方案。方法运用深度访谈、专家咨询、层次分析法构建出由目标层、准则层、方案层构成的上海医疗联合体制约因素层次结构模型,并使用Matlab 7.8软件对数据进行分析。结果将制约上海医疗联合体顺利推进的主要因素在准则层归结为政策、利益、管理、患者需求等4个方面,四者对目标层"上海医疗联合体顺利推进"的权重依次为38.69%、36.13%、19.36%、5.81%,说明前三大要素在推进本市医疗联合体的实践中应该得到足够重视。同时,尽管利益因素在准则层中的重要性排序屈居第二,但由于方案层对目标层权重贡献度最高的8个要素中,有7个都与其有关,需要把利益因素作为重要方面加以对待;患者需求因素权重较低,这可能与目前医疗服务仍由供方主导以及利益诉求表达渠道不畅通有关。结论利益因素已经成为决定本市医疗联合体能否顺利推进的核心要素,且与其他因素构成关联。为此,建议以利益驱动为核心,重塑医疗联合体在宏观与微观层面的运行机制,并有意识地关注患者需求,从而切实缓解居民看病难、看病贵的现状。

Objective To explore main factors that restrict the development of multihospital system in Shanghai and to provide ideas and improvement plans for broader promotion. Methods In-depth interview, analytic hierarchy process（ AHP） method, and Delphi method were adopted to establish the hierarchical structure model of restricting factors of the multihospital system in Shanghai, which consisted of the target layer, criterion layer,and solution layer. The data was analyzed by the Matlab 7. 8. Results There were 4 main factors that restricted the multihospital system in Shanghai in the criterion layer, i. e. policy, interest, management, and patient demand. Their weights of contribution to the target layer（ smooth development of the multihospital system in Shanghai） were 38. 69 %, 36. 13 %, 19. 36 %, and 5. 81 %, which meant that more attention should be paid to first 3 factors during the practice of promoting the multihospital system. Meanwhile, although the factor of interest was the second important factor in the criterion layer, 7 of the top 8 elements of the solution layer that contributed most to the target layer were relevant to it. So the factor of interest should be treated as an important factor. The weight of the factor of patient demand was low, which might be relevant to the domination of medical services by suppliers and the unsmoothness of expression channel for interest appeals.Conclusion The factor of interest has become the core element for smoothly developing the multihospital system in Shanghai and is relevant to other three factors. Therefore, it is advised to regard the factor of interestas core driving force, re-establish the operating mechanism of multihospital system at macro and micro levels,consciously pay more attention to the demands of patients, and effectively resolve the problem of inadequate and expensive medical services.