总额预付背景下公立医院医疗服务质量与效率的形成机制研究——基于扎根理论分析

Research on the Formation Mechanism of the Quality and Efficiency of the Medical Service in Public Hospitals Against the Background of Globe Budget: Based on Grounded Theory Analysis

为了探讨总额预付背景下公立医院医疗服务质量与效率的形成机制,分析医疗服务质量和效率变化,对已实施总额预付的医疗机构中70名专家运用半结构式访谈提纲开展一对一访谈,并将收集到的访谈资料进行分析,经开放式编码、主轴性编码和选择性编码,按前提条件、行动策略和医疗服务结果的故事线构建总额预付背景下公立医院医疗服务质量和效率的形成机制。从宏观、中观和微观层面揭示了其内在作用机制,外部的总额预付制度通过影响医院的资源投入或精细化管理手段,包括费用控制、住院日控制、成本控制和质量控制策略直接影响医疗服务行为,也通过影响医务人员工作积极性间接影响医疗服务行为,从而得到不同的医疗服务质量和效率。这一结果为医保部门完善支付方式改革提供政策建议,也为进一步提高医院医疗服务质量和效率提供了参考依据。

In order to study the formation mechanism of the quality and efficiency of the medical service in public hospitals against the background of globe budget as well as analyze the changes in the quality and efficiency of the medical service, this paper reports the one-to-one interviews with seventy key informants in the medical institutions that have implemented globe budget. And the seventy semi-structured interview materials therein are analyzed with the grounded theory. The formation mechanism of the quality and efficiency of the medical service in public hospitals against the background of globe budget is constructed according to the story lines of preconditions, action strategies and medical service results through open coding, main axis coding as well as selective coding. This research reveals its internal mechanism at the macro, meso and micro levels. The external globe budget affects the quality and efficiency of the medical service by influencing the resource input or the refined management methods in the hospitals, including expenditure control, hospitalization control, cost control and quality control strategies, while the service results are also indirectly affected by the enthusiasm of the medical staff showing towards their work. The study results provide policy recommendations for the medical insurance departments in improving their reform in the payment methods, and also provide reference for further improving the quality and efficiency of the hospital service.