转诊制度对门诊患者就医满意度的影响分析

Impacts of the referral system on outpatient satisfaction： an analysis of propensity score analysis

目的分析我国实施分级诊疗的政策背景下，目前的转诊制度对门诊患者就医满意度的影响，为进一步改进转诊制度提出政策建议。方法基于“全国进一步改善医疗服务行动计划第三方评估”（2016-2017年）门诊患者就医满意度调查结果，采用倾向值匹配法，分析转诊与非转诊门诊患者就医满意度的差异。结果门诊转诊患者相比非转诊患者，本次就诊总体满意度得分低0．11分（P〈0．01，95％CI=-0．17～-0．06），就诊体验满意度得分低0．06分（P=0．03，95％CI：-0．11～-0．01）。结论目前的转诊制度对于提高转诊患者的满意度并未产生积极影响。为进一步完善分级诊疗制度，提高转诊患者满意度，应将转诊制度建设与公立医院改革有机结合，提高三级医院参与转诊制度建设的积极性；进一步规范和优化转诊流程，建立更加合理有效的转诊医保支付方式和报销政策；加大双向转诊制度宣传，提高群众知晓度，并切实提高基层医疗机构的诊疗水平。

Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system. Methods Based on the outpatient satisfaction survey results of the National Heahheare Improvement Initiative Third Party Assessment （2016 -2017）, the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred. Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower （ P 〈 0. 01, 95% CI = - 0.17, - 0.06）. The patient experience satisfaction score of the referred outpatients was 0. 06 points lower than that of the non-referred （ P = 0. 03, 95 % CI = - O. 11, -0.01 ）. Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction. To further improve the referral system and to raise patient satisfaction, there is a need to take following actions, to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system, to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system. In addition, it is critical to further regulate and optimize the referral procedures, so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy. Finally, it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system.