基于史密斯模型的公立医院预约诊疗制度执行问题研究

Study on the problems in implementing the appointment registration system at public hospitals based on the Smith-Model

目的分析新形势下我国公立医院预约诊疗制度执行中的问题,为该制度的完善与发展提供参考。方法利用中国知网、万方、维普等数据库和国家卫生健康委员会等官方网站收集2020年12月31日前发布的预约诊疗相关文件,以史密斯模型为主要分析框架,结合对相关管理人员、医生及居民的定性访谈及PEST分析等方法对公立医院预约诊疗制度执行情况进行系统梳理与分析。结果公立医院预约诊疗制度及政策本身的理想化程度较高,但在体系标准、执行效力、配套制度等方面仍存在政策缺陷;相关执行机构和目标群体对政策的认知、接受、执行等方面存在一系列问题;政治法律、经济、社会文化和技术等环境因素也对政策的执行产生影响。结论公立医院预约诊疗制度执行中仍存在体系标准不健全、各地执行力度各异、激励及经济补偿机制等不完善、居民传统观念改变难等问题,应从政策制定者、卫生行政部门、业务机构、患者及环境因素等方面采取针对性策略与措施,保障该制度持续有效执行。

Objective To analyze problems found in the implementation of the appointment registration system at public hospitals in China under the new situation,and provide a reference for the improvement and development of the system.Methods Documents on appointment registration system published before December 31,2020 were collected through the databases of CNKI,Wanfang,VIP and other official websites such as the National Health Commission.The Smith-Model was used as the main analysis framework in a systematical sorting and analysis of the implementation of the appointment registration system of public hospitals,in such means as qualitative interviews with relevant managers,doctors and residents and PEST analysis method.Results The appointment registration system of public hospitals was highly idealized in its design,but there existed policy deficiencies in system standards,implementation effectiveness and supporting systems;and there were various problems in policy cognition,acceptance and implementation with its implementation agencies and target groups.Environmental factors such as politics,laws,economy,social culture and technology also posed negative effects on the implementation of policies.Conclusions There were still some problems in the implementation of the appointment registration system in public hospitals,such as imperfect system standards,different implementation efforts in different regions,imperfect incentive and economic compensation mechanisms,and it was difficult to change residents'traditional ideas.Targeted strategies and measures should be taken regarding the policy makers,health administrative departments,business institutions,patients and environmental factors to ensure the continuous and effective implementation of the system in the future.