医事服务费试点对医生薪酬及工作的影响研究

Influence of Medical Service Charge on Doctors' Remuneration and Work

目的了解医事服务费试点后医生在薪酬和工作方面发生的变化。方法选择北京市某三级甲等综合医院作为研究现场,该院自2012年9月启动"医药分开"试点。依据滚雪球法确定样本,按照信息饱和原则决定访谈样本量,采用个人深入访谈法,对1名医院中层管理者和14名医护人员进行访谈。访谈核心内容包括医事服务费试点前后院科薪酬分配方式、个人薪酬构成、试点后薪酬增长量;试点前后被访者日常工作内容、工作量方面发生的改变以及对当前薪酬与工作量的匹配程度、对医生劳动价值的体现程度等个人看法。采用MAXQDA10对访谈资料进行编码分析。结果试点后,医生薪酬构成中增加医事服务费一项,其每月薪酬总数增加,门诊量大、职称高的医生薪酬增加幅度较大。以药物治疗为主的内科诊室门诊量增长明显,以技术治疗为主的外科和口腔科,门诊量变化不大。在其他政策并行推进后,大处方、不合理处方现象得到改善。结论医事服务费的设立使医生薪酬数量增加,体现医生劳动价值;规范医生诊疗行为的同时,也使不同科室医生的工作量发生改变。

Objective To investigate the changes in doctors＇ remuneration and work after the setting of medical service charge. Methods We chose a third- grade class A general hospital in Beijing as the researching spot. The hospital was designated as a pilot of ＂ service and medication separation ＂. We determined the samples by the snowball method, and determined the sample volume for interviews according to the information saturation principle. By in- depth individual interview method,we conducted interviews with a middle manager and 14 health workers. The interview content included the changes of remuneration distribution pattern and individual remuneration makeup after pilot program began,remuneration increment after pilot program began,changes of daily work content and work volume after pilot program began,the matching degree between remuneration and work volume and the realization degree of doctors＇ value. The data from interviews were coded and analyzed by MAXQDA10. Results After the pilot program began,the remuneration items of doctor were added with medical service charge,monthly remuneration of doctor increased,outpatient service volume increased,and the doctors with highest professional titles had the largest increasing range in remuneration. Internal medicine departments with drug therapy as the main service content had the largest increase in outpatient service volume,and the departments of surgery and stomatology with technical therapy as the main service content had little change in outpatient service volume. With the concurrent implementation of other policies,extraordinary prescription and unreasonable prescription were curbed to some extent. Conclusion The setting of medical service charge can increase the remuneration of doctors,realize the value of doctors,standardize the diagnosis and treatment behaviors of doctors and bring changes to the work volume of doctors in different departments.