安徽省和甘肃省县级医院医生收治入院倾向影响因素分析  

Study on Influencing Factors of Decision-Making Behaviors of Admission to Hospitals of Doctors in County Hospitals

作　　者：姜迪[1] 陈迎春[1,2] 高红霞 张研[1] 李浩淼 施利群[3] 常静肼[1] 张慧 胡晓梅 雷诗寒[1] 叶清[1] Jiang Di(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,武汉430030 [2]湖北省人文社科重点研究基地农村健康服务研究中心,武汉430030 [3]华中科技大学同济医学院附属协和医院,武汉430000

出　　处：《医学与社会》2019年第5期34-38,共5页Medicine and Society

基　　金：国家自然科学基金项目"新型农村合作医疗中不合理入院成因的贡献测量与可控性研究";编号为71473096

摘　　要：目的:分析影响安徽省和甘肃省县级医院医生收治入院倾向的因素。方法:基于离散选择实验设计问卷,调查安徽省和甘肃省的两家县级医院共88名医生在各影响因素不同水平组合下的收治入院行为偏好。采用二分类Logistic回归方法分析数据。结果:影响因素按OR值由大到小分别是贫困户与否(7.264)、入院主动性(6.064)、人群类型(2.416)、支付能力(2.112)、薪酬制度(1.439)、便利程度(1.228)。社会支持影响不显著(P=0.229)。结论:在疾病病情确定的情况下,医生更倾向于收治来自贫困户或脆弱人群的患者;在医患沟通过程中,患者表示前来就诊不便、能够承担费用以及主动提出住院时,医生更倾向于收治其入院;医院的薪酬制度会对医生收治入院倾向产生影响;患者有无社会支持对其无影响。Objective:To analyze the influencing factors of decision-making behaviors of admission to hospitals of doctors in county hospitals.Methods:A questionnaire was designed based on the discrete choice experiment.88 doctors from A&B county hospitals in Anhui and Gansu Province were surveyed.Binary logistic regression analysis of SPSS 19.0 was used to analyze the data decision.Results:The influencing factors ranked by OR value were poor households or not(7.264),admission initiative(6.064),population type(2.416),ability to pay(2.112),salary system(1.439)and convenience(1.228).The OR of social support(P=0.229)was not significant.Conclusion:In the case of a certain illness,doctors are more inclined to make an recommendation when the salary they get is linked to the number of patients admitted to the hospital.And the patients,who come from a poor household,a vulnerable group,an inconvenience spots,who can bear the cost of hospitalization and who have an unsolicited hospitalization request,have more ratio to get the suggestion of inappropriate admission.The salary system of hospitals will affect the tendency of doctors to admit patients.There is no evidence to prove social support affect the decision-making process of a doctor.

关 键 词：县级医院 收治入院倾向 医生 离散选择实验 

分 类 号：R197.3[医药卫生—卫生事业管理]