供方视角下我国分级诊疗实施效果影响因素研究

Study on the Influencing Factors of the Implementation Effect of Graded Diagnosis and Treatment in OurCountryfrom thePerspective of Suppliers

目的:通过从供方视角对分级诊疗实施效果影响因素进行研究,为完善分级诊疗制度提供建议。方法:确定影响分级诊疗实施效果的因素,设计调查问卷进行专家咨询,利用DEMATEL法识别关键影响因素。结果:DEMATEL法分析结果显示,配套的补偿机制和奖惩制度、医务人员的薪酬水平、医院对医生和患者的虹吸现象、医院规模扩张情况、医院内部考评、基层医疗机构设施设备条件、基层医疗机构信息平台建设情况、医院信息平台建设情况、医保报销比例是分级诊疗实施效果的关键影响因素。结论:建议完善医保报销比例,推进医保支付制度改革;加大财政补偿力度,提升基层医疗服务水平;加强信息化平台建设,实现医疗资源的互通共享;制定合理的医生薪酬制度,完善医疗机构内部考评机制,从而完善分级诊疗制度,提升医疗服务效率。

Objective:To provide suggestions for improving the hierarchical diagnosis and treatment system by studying the factors affecting the implementation effect of hierarchical diagnosis and treatment from the perspective of suppliers.Methods:First,determine the factors that affect the implementation effect of graded diagnosis and treatment,and then conduct expert consultation by designing a questionnaire,and use the DEMATEL method to identify key influencing factors.Results:The analysis results of the DEMATEL meth⁃od showed that the supporting compensation mechanism and reward and punishment system,the salary level of medical staff,the si⁃phon phenomenon of the hospital to doctors and patients,the expansion of the hospital scale,the internal evaluation of the hospital,the facilities of the primary medical institution,the equipment conditions,the primary medical institution Information platform construc⁃tion,hospital information platform construction,and medical insurance reimbursement ratio are the key influencing factors that affect the implementation of hierarchical diagnosis and treatment.Conclusion:Promote the reform of the medical insurance payment system by improving the medical insurance reimbursement ratio;increase financial compensation to improve the level of primary medical ser⁃vices;strengthen the construction of information platforms to realize the exchange and sharing of medical resources;formulate a reason⁃able salary system for doctors and improve the internal medical institutions Evaluation mechanism.To improve the hierarchical diagno⁃sis and treatment system and improve the efficiency of medical services.