乡镇卫生院改革对其医患信任的影响及原因分析  

The Impaut of Township Hospital on the Doctor-patient Trust and Reason Analysis

作　　者：刘一[1] 于鲁明 王晓燕[1] 彭迎春[1] 杨佳[1] 刘洋[1] 

机构地区：[1]首都医科大学卫生管理与教育学院,北京100069 [2]北京市医院管理局,北京100053

出　　处：《中国初级卫生保健》2014年第5期22-25,共4页Chinese Primary Health Care

基　　金：北京市哲学社会科学规划重大项目"医改背景下的首都农村卫生人力资源配置研究"(11 ZDA 05);北京市属高等学校教学创新人才-教学名师项目(PHR 201106207)

摘　　要：目的了解乡镇卫生院在不同时期卫生政策的颁布与实施对医患信任的影响并分析原因,提出相关对策建议。方法对北京市北部某远郊区3所乡镇卫生院进行为期3天的实地观察,对4位乡镇卫生院医务人员进行第二次个人深入访谈,了解并分析乡镇卫生院在管理体制和运行机制改革中存在的问题及对医患信任产生的影响。结果乡镇卫生院医患信任受卫生政策的影响,在改革的不同时期信任水平不同,第一阶段(1949—1983年)医患信任情况较好,主要是受卫生院的公益性质和合作医疗影响,第二阶段(1983—2003年)医患信任程度下降,主要是由于政府投入不足,乡镇卫生院逐步市场化,第三阶段(2003年至今)医患信任逐渐提高,主要受收支两条线、基本药物制度和人才培养等政策影响,但仍存在一些问题。结论乡镇卫生院须在坚持公益性质和保障财政投入的基础上,完善绩效考核制度和保障公共卫生服务,同时加强医德医风建设,从而提高医患信任。OBJECTIVE To understand the impact on doctor-patient trust of the health clinics in towns in health policy in different periods of the promulgation and implementation, and analyze the reasons, put forward the related countermeasure proposal. METHODS Observing 3 day to the three township health centers in a suburb north of Beijing with interviewing 4 medical staff, understanding and analysis of the existing problems in the reform of the management system and operation mechanism of the medical institutions and the influence on patient trust. RESULTS The township hospital trust affected by health policy in different periods（1949 — 1983）, the doctor-patient trust situation was better, mainly due to the nature of public hospitals and the cooperative medical care（1983—2003）, the doctor-patient trust degree decreased, mainly due to the lack of government investment, after the reform of medical system（2003—now）,the doctor-patient trust gradually increased, mainly by the two lines of revenue and expenditure, the policy effects of essential drugs system and the cultivation of talents, but there were still some problems. CONCLUSION The township hospital should adhere to the basic nature of public welfare and security of financial investment, improve the performance appraisal system and safeguard the public health service, strengthen medical ethics construction, so as to improve the doctor-patient trust.

关 键 词：乡镇卫生院 医患信任 卫生改革 

分 类 号：R127[医药卫生—环境卫生学]