风险态度视角下深圳市龙华区医联体医生下转患者意愿与经济激励效应  

Study on the Impact of Economic Incentives on the Willingness of Doctors in Medical Consortia of Longhua District in Shenzhen to Refer Patients Downward from the Perspective of Risk Attitude

作　　者：陈知禾 李璐 钟正东 林坤河[1] 熊英贝 姚轶凡 周津 项莉[1,3] Chen Zhihe(School of Medical and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,P.R.China)

机构地区：[1]华中科技大学同济医学院医药卫生管理学院,湖北武汉430030 [2]广州医科大学卫生管理学院 [3]国家医疗保障研究院华科基地

出　　处：《中国卫生事业管理》2024年第5期506-510,共5页Chinese Health Service Management

基　　金：国家自然科学基金面上项目“基于‘价值’导向的支付方式对医联体激励约束机制和政策优化研究”(71874058);国家自然科学基金面上项目“竞合视角下区域点数法总额预算对县域价值医疗服务体系激励机制研究”(72174068)。

摘　　要：目的:在深圳市龙华区医疗联合体出台定额向下转诊患者经济激励政策背景下,探讨政策认知和风险态度对医生下转意愿的影响机制与经济激励效应。方法:采用随机抽样方法对龙华区医联体2家牵头医院的医生进行问卷调查,运用相对风险规避系数测算医生的风险态度类型,对数据进行描述性分析、采用χ^(2)检验分析不同特征的医联体医生下转意愿的差异与二元logistic回归模型分析医联体医生下转意愿的影响因素。结果:共回收有效问卷254份,有效回收率为90.7%。其中,181人表示愿意下转(71.26%),201人了解下转经济激励政策(79.13%),226人重视下转经济激励政策(88.98%),110人属于风险厌恶型(43.31%);对下转经济激励政策了解与重视程度、风险态度类型是医生下转意愿的影响因素(P<0.05)。结论:当前龙华区医联体医生下转意愿处于中高水平,经济激励效应明显;医生对经济激励政策认知情况较好,降低了其下转决策不确定性;风险偏好型医生下转意愿更强。提示应完善医联体内下转经济激励与绩效考核政策设计;加强政策宣传,提高医联体医生对下转政策的认知,利用有限的经济激励获得最大化的下转激励效果。Objective To explore the mechanism and economic incentive effect of policy perceptions and risk attitudes on physicians'willingness to transfer downward in the context of the introduction of economic incentive policy of a fixed amount of downward patient referral in medical consortium in Longhua District of Shenzhen.Methods A random sampling method was used to conduct a questionnaire survey among physicians in two leading hospitals of Longhua District Medical Consortium,the relative risk avoidance coefficient was used to measure the types of physicians'risk attitudes,and the data were analyzed by descriptive analysis,x^(2) test and binary logisticregresion model.Results Atotalof254 validquestionnaires were collected,and the ffective recovery rate was 90.7%.Among which,181 expressed willingness to transfer(71.26%),201 understood the financial incentive policy for transfer(79.13%),226 valued the financial incentive policy for transfer(88.98%),and 110(43.31%)were risk averse.The degree of understanding and valuing the financial incentive policy for transfer and type of risk attitude were the influencing factors to doctors'willingness to transfer(P<0.05).Conclusion At present,the doctors willingness to transfer downward in Longhua District Medical Union is at a medium to high level,and the economic incentive effect is obvious.Doctors knowledge of economic incentive policy is better,which reduces their uncertainty of downward transfer decision.Risk-averse doctors'willingness to transfer is stronger.It is suggested to improve the design of economic incentive and performance assessment policies for downward transfer within the medical association,strengthen the policy publicity,improve the doctors'awareness of downward transfer policies in the medical association,and obtain maximum downward transfer incentive effects by limited economic incentives.

关 键 词：医疗联合体 经济激励 风险态度 相对风险规避系数 

分 类 号：R197.32[医药卫生—卫生事业管理]