新农合支付方式改革背景下医患双方利益诉求满意度分析

Study on the doctor-patient interest demands satisfaction of the payment system reform in China＇s new rural cooperative medical care scheme

目的了解新型农村合作医疗（以下简称新农合）支付方式改革中医患双方利益诉求的满意度，并探究其影响因素。方法于2016年9月至2017年2月进行横断面调查。多阶段分层随机抽取我国东、中、西部地区3个省6个县进行问卷调查，采用Mann—Whitney H检验、二分类logistic多元回归法，分析满意度的影响因素。结果医患双方的总体利益诉求满意度较高（均〉3．00），但医务人员的收入和能力提升满意度（中位数为2．58）以及参合农民的受益度满意度（中位数为3．15）相对较低。医疗机构管理人员满意度影响因素有支付方式类型、文化程度和工作单位（均P〈0．05）；医务人员满意度影响因素有支付方式类型、工作单位和工作年限等（均P〈0．05）；参合农民满意度影响因素有支付方式类型、人均年收入和是否低保等（均P〈0．05）。结论改革应重视医患双方核心利益诉求，提高其诉求满意度；应重点研究和推广按病种付费，并适当结合其他支付方式；通过宣传和培训提高医患双方对支付方式改革的认识，获得其支持与配合。

Objective To study doctor-patient interest demands satisfaction and its influencing factors of the payment system reform of the new rural cooperative medical care scheme to provide reference for the reform. Methods Cross-sectional survey was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was used in six counties of three provinces in the eastern, middle and western regions of China, and mathematical statistics was applied to analyze the data. Results The doctorpatient overall interest demands satisfaction was high, but the satisfaction was lower both with the income and ability improvement of medical staff and with the benefits of farmers. The influencing factors of the satisfaction of managers in medical institutions included the type of payment, educational level and work unit （P 〈 0. 05 ）. The influencing factors of medical staff＇s satisfaction included the type of payment, work unit, and working years among others（ P 〈 0. 05 ）. The influencing factors of farmers＇ satisfaction included the type of payment and the average annual income, ete（ P 〈 0. 05 ）. Conclusions The core interest demands of both doctors and patients should be valued to enhance their satisfaction. Diseases related groups should be promoted and applied scientifically, and appropriately integrated with other methods of payment. Both doctors and patients＇ understanding of the payment reform should be improved by propaganda and training, to get their support and cooperation.