DRG支付制度下医生策略性行为的影响因素与发生机制  

Influencing factors and mechanism of physicians’strategic behavior under the DRG payment system

作　　者：罗爱静 王子健[2,3] 姜芬 常维夫[2,5] LUO Aijing;WANG Zijian;JIANG Fen;CHANG Weifu(Clinical Research Center for Cardiovascular Intelligent Healthcare in Hunan Province,Second Xiangya Hospital,Central South University,Changsha 410011;Key Laboratory of Medical Information Research(Central South University),College of Hunan Province,Changsha 410013;School of Public Administration,Central South University,Changsha 410075;Hospital Administration Department,Central South University,Changsha 410083;Medical Professional Ethics Office,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅二医院湖南省心血管智能医疗临床医学研究中心,长沙410011 [2]医学信息研究湖南省普通高等学校重点实验室(中南大学),长沙410013 [3]中南大学公共管理学院,长沙410075 [4]中南大学医院管理处,长沙410083 [5]中南大学湘雅三医院医疗行风办,长沙410013

出　　处：《中南大学学报(医学版)》2024年第11期1828-1839,共12页Journal of Central South University :Medical Science

基　　金：湖南省自然科学基金青年项目(2022JJ40734);湖南省教育厅科学研究项目(20K138)。

摘　　要：目的:医疗保险(以下简称“医保”)支付方式改革是深化医疗卫生体制改革的关键环节,分析疾病诊断相关分组(diagnosis related groups,DRG)支付制度中医生策略性行为的影响因素并探究其发生机制,对减少医疗资源浪费、提高医保基金使用效率具有重要的意义。方法:基于计划行为理论分析框架,通过扎根理论方法构建医生策略性行为的信念、行为态度、主观规范、知觉行为控制、行为意图和行为量表的内容条目,形成调查问卷,并采用结构方程模型开展实证分析。结果:医生策略性行为意向对其策略性行为影响最为显著(β=0.606,P<0.001)。医生对策略性行为的态度(β=-0.159,P<0.01)、主观规范(β=-0.093,P<0.05)和知觉行为控制(β=-0.120,P<0.05)是影响医生策略性行为意向的主要因素。医生的行为信念、规范信念和控制信念分别与策略性行为态度(β=0.554,P<0.001)、主观规范(β=0.383,P<0.001)和知觉行为控制(β=0.274,P<0.001)存在显著相关性。结论:行为意向是驱动医生实施策略性行为的主要预测变量,行为态度、主观规范和知觉行为控制均会显著影响医生的行为意向。Objective:Reforming medical insurance payment methods is a key part of deepening the healthcare system reform.Understanding the influencing factors and underlying mechanisms of physicians’strategic behaviors under the diagnosis-related groups(DRG)payment system is crucial for reducing medical resource waste and improving the efficiency of health insurance fund utilization.Methods:Based on the Theory of Planned Behavior,this study used grounded theory to construct a questionnaire encompassing belief,behavioral attitude,subjective norm,perceived behavioral control,behavioral intention,and behavior measurement items.Structural equation modeling was then used for empirical analysis.Results:Physicians’behavioral intention had the most significant impact on their strategic behavior(β=0.606,P<0.001).Physician’s attitude toward strategic behavior(β=−0.159,P<0.01),subjective norm(β=−0.093,P<0.05),and perceived behavioral control(β=−0.120,P<0.05)were major influencing factors of behavioral intention.Physicians’behavioral beliefs,normative beliefs,and control beliefs were significantly correlated with behavioral attitude(β=0.554,P<0.001),subjective norm(β=0.383,P<0.001),and perceived behavioral control(β=0.274,P<0.001),respectively.Conclusion:Behavioral intention is the primary predictor driving physicians to engage in strategic behavior.Attitudes toward the behavior,subjective norms,and perceived behavioral control all significantly affect physicians’behavioral intentions.

关 键 词：疾病诊断相关分组 支付制度 策略性行为 计划行为理论 发生机制 

分 类 号：G63[文化科学—教育学]