从基层医疗卫生机构医务人员的视角看一般诊疗费的实施  

Implementation of General Medical Fee:Viewing from the Perspective of Medical Staff

作　　者：张丽芳[1] 刘彩玲[2] 李婧[2] 王丽坤[2] 秦江梅[1] 张艳春[1] 

机构地区：[1]卫生部卫生发展研究中心,北京市100191 [2]石河子大学

出　　处：《中国全科医学》2014年第23期2768-2771,共4页Chinese General Practice

基　　金：中国社区卫生协会社区卫生科研基金(2012-2-22)

摘　　要：目的从医务人员的视角反映基层医疗卫生机构实施一般诊疗费的成效和问题。方法于2013年8—9月,按照整群抽样的方法分别在东、中、西部各选择2个已经实施一般诊疗费的城市作为调研城市,分别为苏州、无锡、武汉、合肥、银川和中卫,采用随机数字表法在每个调研城市抽取2个区,每个区由当地卫生局推荐2个基层医疗卫生机构,以当天在岗的医务人员作为调查对象,共740名医务人员,其中苏州106名、无锡135名、武汉181名、合肥196名、银川45名和中卫77名。采用自行设计的基层医务人员对实施一般诊疗费的认知情况调查表,主要内容包括:医务人员的一般情况,对一般诊疗费的知晓情况,感觉一般诊疗费的实施对自身的影响,认为实施一般诊疗费取得的成效,认为实施一般诊疗费存在的问题等。结果在调查的740名医务人员中,男178名(24.1%),女562名(75.9%)。98名(13.2%)对一般诊疗费非常了解,234名(31.6%)比较了解,249名(33.6%)了解一点,159名(21.5%)不了解。剔除对一般诊疗费不了解的159名医务人员,询问其余581名医务人员感觉一般诊疗费的实施对自身的影响,实施一般诊疗费是否体现技术劳务价值,118名(20.3%)不清楚,206名(35.5%)认为可以体现,257名(44.2%)认为不能体现;实施一般诊疗费是否面临分解处方的压力,168名(28.9%)不清楚,254名(43.7%)认为有压力,159名(27.4%)认为没有压力。认为实施一般诊疗费取得的成效位居前四位的分别是患者费用负担减轻(58.3%)、患者就诊程序减少(44.4%)、引导居民积极参加医保(36.0%)、促进合理诊疗和用药(22.9%)。认为实施一般诊疗费存在的问题位居前五位的分别是门诊统筹预算的总额较低(37.2%)、容易造成分解处方(36.8%)、注射费合并不合理(32.9%)、宣传和解释不够(32.0%)、没有区分就诊患者种类(31.8%)。结论实施一般诊疗费可以使患者受益,减轻其负担;但Objective To see the effect and problems of the implementation of general medical fee in primary medical and health institutions from the perspective of medical staff. Methods A total of 740 medical professionals were chosen from 24 primary medical and health institutions of 6 cities in which general medical fee was implemented,including 106 in Suzhou,135 in Wuxi,181 in Wuhan,196 in Hefei,45 in Yinchuan,77 in Zhongwei. A self-made questionnaire was used to know medi-cal professionalsˊgeneral information,their awareness of general medical fee,its effects on themselves,the effectiveness that it gained and the existing problems. ResUlts In 740 medical professionals,there was 178 males（24. 1%）,562 females （75. 9%）;98（13. 2%）were very familiar with general medical fee,234（31. 6%）familiar,249（33. 6%）a little famil-iar,159（21. 5%）not familiar. Excluding the 159 who were not familiar with general medical fee,we asked the rest 581 pro-fessionals about its effects on themselves and whether it could embody their technical service values,and 118 answered＆quot; I donˊt know＆quot;（20. 3%）,206 answered＆quot; yes＆quot;（35. 5%）,257 answered＆quot; no＆quot;（44. 2%）. To the question＆quot; Whether you face the pressure of decomposing prescription？＆quot;,168 professionals answered ＆quot; I donˊt know＆quot; （ 28. 9%）,254 answered ＆quot; yes＆quot;（43. 7%）,159 answered ＆quot; no＆quot; （27. 4%）. The top 4 effects it gained were：reduced cost burden on patients（37. 2%）,＆amp;nbsp;decreased visiting procedure（44. 4%）,guiding people to participated actively in health insurance（36. 0%） and promoting ra-tional diagnosis/treatment and medication （ 22. 9%）. The top 5 problems were low total amount of outpatient co -ordination budget （ 37. 2%）, leading easily to prescription decomposition （ 36. 8%）, unreasonable combination of injection fee （32. 9%）,inadequate advocacy,explanation（32. 0%）,not distinguishing patientsˊ types（31. 8%�

关 键 词：医务人员 基层医疗卫生机构 一般诊疗费 

分 类 号：R197.1[医药卫生—卫生事业管理]