广东省医师多点执业的现状分析——基于“广东医师多点执业2.0版”

从多点执业医师的人事管理,医疗质量,医师的收入分配、社会保险及法律责任承担等方面,对"广东医师多点执业2.0版"进行利弊分析,并借鉴国外医师多点执业的经验,为推进广东省医师多点执业提供建议和对策。     

医师多点执业中的法律问题探讨

本文从医师多点执业的定义、背景和该政策实施现状等出发,分析医师在现有法律体制下进行多点执业存在的身份合法性、可能承担"非法行医"责任、多点执业医师与各执业地点医疗机构之间的法律关系问题、竞业问题、法律监管问题等现实存在和可能出现的问题,针对这些问题,提出对《执业医师法》等法规进行修订、完善相关的规章制度等建议。     

医疗机构在《执业医师法》实施中权利义务和法律责任

《中华人民共和国执业医师法》的实施,给医院管理的理论研究和实际工作提出了新的问题,医疗机构作为医师执业的地点,具有集体办理医师资格认定和医师执业注册方面、注销医师执业注册的报告方面、保障医师实现权利义务和覆行执业规则方面、对医师的考核和培训等方面的权利和义务。如不覆行法定的权利义务,医疗机构可能将承担法律责任。文中分析了《中华人民共和国执业医师法》实施后医师与医疗机构之间的权利义务关系,医疗机构与     

论出台医师多点执业监管法律的必要性

医师多点执业一直是社会各界高度关注的问题,目前相关法律法规的制定滞后于现实的需求。文章梳理了医师多点执业的相关政策文件,从医师多点执业可优化资源配置、降低供需方成本、规范医师与医疗机构之间的关系等角度探讨出台医师多点执业监管法律的必要性,分析医师多点执业过程中可能存在的问题。     

医疗机构在《执业医师法》实施中的权利义务和法律责任

《中华人民共和国执业医师法》的实施,给医院管理的理论研究和实际工作提出了新的问题。医疗机构作为医师执业的地点,具有在集体办理医师资格认定和医师执业注册方面、注销医师执业注册的报告方面、保障医师实现权利义务和履行执业规则方面、对医师的考核和培训等方面的权利和义务。如不履行法定的权利义务,医疗机构可能将承担法律责任。文中分析了《中华人民共和国执业医师法》实施后医师与医疗机构之间的权利义务关系,医疗机构与卫生行政部门之间的权利义务关系,以及医疗机构、医师与患者之间的医患法律关系的变化,并指出《中华人民共和国执业医师法》的实施可能在医师的管理体制、医师的人才流动和医师队伍的优胜劣汰等方面促进医院管理体制的改革。     

医生视角下医师多点执业问题及对策研究——基于扎根理论

目的:应用扎根理论的方法,从医生视角探讨贵州省遵义市医师多点执业的问题并提出相应对策。方法:于2017年1—7月按照目的抽样并结合扎根理论研究方法对贵州省遵义市9家医疗机构可多点执业的43名医生进行半结构化访谈,经开放式编码、主轴编码、选择性编码对医师多点执业问题进行整合。结果:经过三级编码,最终梳理出与医师多点执业相关的105个概念,17个范畴,7个主范畴和5个核心范畴,形成医师多点执业的5条脉络:发展前景及医师意愿、发展促进因素、发展困境、相关配套政策、服务需求及执业条件。结论:绝大多数医生愿意开展多点执业,相关法律法规、具体实施细则、薪酬分配体系和医疗事故处理方案的完善、医疗机构管理者的支持、医疗机构管理模式的转变、第二执业点提供必要的医疗条件并充分考虑第二执业点的距离、交通条件和相应的团队协作支持是顺利实施医师多点执业的必要条件。     

上海市医师多点执业现状与对策分析

目的：对上海市医师多点执业现状进行分析,为多点执业政策提出相关建议。方法：抽取上海9家医疗机构中的400名中级职称以上医师进行问卷调查。结果：上海市医师多点执业81．31％为单位委派,社会办医疗机构中医师多点执业比例最高,占54．05％,“医师走穴”占到多点执业的10％以上,多点执业医师的风险意识较高。结论：医师多点执业政策应当避免设定过多限制措施,而重点设置保障和监管措施,才能避免遭到冷遇。     

江苏省某市医师多点执业现状研究

目的：研究医师多点执业政策中存在的问题及成因，提出推动医师多点执业政策执行的建议。方法：通过分析江苏省某市医师多点执业和未参与多点执业的数据，采用定量问卷调查法和定性访谈法，研究该市医师多点执业政策执行的现状。结果：医师多点执业政策宣传力度和配套措施缺乏；医师和医疗机构的参与度不高；人事制度改革缓慢并缺乏经济支持。结论：完善医师多点执业政策体系，提高政策可行性；卫生行政部门要加强对医疗机构的监管，提供高效优质的服务；医师要强化自身能力建设，以团队形式参与多点执业；医疗机构要主动探索，加强人才培养体系建设。     

论医师多点执业侵权责任制度的完善

<卫生部关于医师多点执业有关问题的通知>只解决了多点执业医师与受聘医院内部责任的分担问题,并没有解决医师对外是否要承担民事责任问题.文章针对多点执业侵权责任制度的缺陷,借鉴了其他国家和地区的实践,对多点执业侵权责任制度的完善提出了一些建议.希望通过合理的完善,使多点执业政策能顺利实施.     

医师多点执业影响因素调查与研究

目的：通过对江苏省医师多点执业影响因素的调查与分析，提出进一步推进医师多点执业的建议。方法：选取南京市和泰州市共14所医疗机构作为抽样单位，从中随机选取552名已取得执业资格的医师为调查对象进行问卷调查，通过SPSS20.0软件对结果进行统计学分析。结果：（1）医师学历、年龄、职称、科室对医师多点执业意愿存在显著影响；医师性别、所在医疗机构等级、从业年限和月收入对医师多点执业意愿无显著影响。（2）政策因素、组织因素和个人因素都与医师多点执业意愿呈显著正相关，按照影响程度由高到低排序依次是政策因素、个人因素和组织因素。结论：为进一步推进医师多点执业，相关部门需要站在立法高度上完善医师多点执业激励、风险、准入、财政和监管等规定；二、三级公立医院和基层医疗机构管理者也要及时转变观念，积极鼓励、支持医师多点执业，完善人事制度；医师自身也要重新定位角色，以更好的状态积极参与多点执业。     

医疗保障基金监管的问题检视与法律优化研究

医保基金监管具有重要的政策基础与法律依据,加强医保基金监管是国家和地方各级医保行政部门的共同法定职责.当前,医保基金监管存在执法依据不统一、监督意识不牢固、内部监管责任不到位、监督基础投入不合理、行政执法力量不匹配等诸多问题.面对新的医保改革形势,建议加强法治适用、强化监管意识、落实医药机构责任、保证执法投入、创新协议...     

Health technology assessment in France

The French healthcare system combines freedom of medical practice with nationwide social security. It is compulsory for every legal resident. A range of public and private institutions provide care, and patients have free access to physicians. The health coverage system is characterized by solidarity and universal responsibility. Although the French system is highly regulated, funding of health-related expenses is a chronic social problem. Since the 1996 healthcare reform, the national objective for reimbursed healthcare expenditures is voted by the parliament, and the annual increase of hospital funding is controlled at the regional level. An agency for hospitals has been established in every region, and it quantifies needs indexes for future equipment and beds. However, establishing appropriate reference ratios based on objective assessment is difficult. The idea of basing policy and practice decisions on objective assessment grew for years, until the National Agency for the Development of Medical Evaluation was established in 1989. The 1996 healthcare reform expanded this agency to encompass hospital accreditation and renamed it the National Agency for Accreditation and Evaluation in Health. In March 1999, the National Agency for Health Products was established. It controls the safety of medical products and evaluates products' medical benefits before reimbursement decisions. Health technology assessment is now related to virtually every health policy process in France, and its role increases continually.     

Educating about biomedical research ethics

This article examines the global and worsening problem of research misconduct as it relates to bio-medico-legal education. While research misconduct has serious legal implications, few adequate legal remedies exist to deal with it. With respect to teaching, research ethics education should be mandatory for biomedical students and physicians. Although teaching alone will not prevent misconduct, it promotes integrity, accountability, and responsibility in research. Policies and law enforcement should send a clear message that researchers should adhere to the highest standards of ethics in research. It is vital that researchers and physicians understand basic aspects of law and the legal system in order to develop understanding of the medico-legal issues not just in the legal context, but with a sound grounding in ethics, social and theoretical contexts so that they can practice good medicine. Routine and holistic research ethics education across the curriculum for medical students and resident physicians, and continuing medical education for practicing doctors, are probably the best ways to accomplish this goal.     

中国医保医师制度建设可行性分析

随着我国全民医保制度不断完善,对医保基金使用的监管提出更高要求。中国医保医师制度建设具有逻辑可行性、政策可行性与法理可行性,表现在:逻辑层面,中国医保医师制度是执业医师制度的延伸;政策层面,中国医保医师制度的建立已有政策铺垫及其改革基础;法理层面,医保监管从医疗机构延伸到医师合理合法。建立与实施中国医保医师制度,需健全医保经办机构、医疗机构的职能职责,建立全方位监管体系并与现行政策制度相互配合、综合施策,将有力促进监管对象从医疗机构延伸至医务人员,打破地区间医保医师的管理壁垒,对于增强医师行为监管的连续性,提高医保基金使用效率,实现资源有机整合与综合有效监管,推动医疗、医保、医药、医师四方联动,提供价值医疗服务具有重要意义。     

以社会责任为目标引领我国医疗服务机构改革

在深化改革中，我国医疗服务机构片面引入企业经营经验和套用企业运作模式，片面强调规避经营风险和过度地张扬唯利主义思潮，直接或间接地伤害了公众享有医疗保健的权益，谈化了医疗机构对公众应当具有的社会责任，直接导致了医疗行业间的亚性竞争。因此，在将改革推向纵深的过程中，如何引领医疗服务行业确立社会责任，重塑社会诚信，履行医疗行业为公众健康服务的宗旨，正确处理医疗机构内部事务及高速雇用关系，协调医疗服务机构与社会公众健康利益的关系，在医疗服务市场中提倡竞争、合作与共同创造，已是每一个医疗机构面临的重要课题。     

Risk management in health care systems: the new legislative orientations in medical civil responsibility

The recent radical change in the relationships between physicians and patients has increased the frequency of malpractice. Consequently, on one hand, many physicians got used to avoiding any possible risk of denunciation by applying the so called "defensive medicine", while on the other hand, the insurance companies raised the prices of their premiums for policies concerning civil responsibility of health operators. In order to avoid this "vicious circle", some health structures created Units for the Risk Management related to malpractice, while others took advantage of the collaboration of Associations for Patients' Rights to create database about the most frequent medical mistakes. The need for a legislative change has been accepted by the Parliament which expects with the proposal n.108 (approved in spring 2002 by the Commission for Hygiene and Health of the Senate) to attribute the civil responsibility of the physicians to the hospitals (both private and public) for which they work, to constitute a Register of experts and to accelerate the legal disputes. The problem is complex and still to be solved, but it seems that time for a strong intervention in order to improve the situation has to come.     

上海市医疗机构聘用非卫生技术人员现状及监管对策探讨

作者通过对上海市近三年来医疗机构聘用非卫生技术人员处罚案件进行分析，对医疗机构违法行为的类型、缘由等进行研究，探讨对医疗机构聘用非卫生技术人员的监管对策。处罚案件资料显示，在公立医疗机构或民办医疗机构中均有聘用非卫生技术人员的现象，且被处罚的医疗机构数大致相当；对聘用非卫生技术人员的违法类型进行分析，发现以医疗机构聘用未取得《医师执业证书》的医学专业毕业生独立开展医疗活动及医技人员跨专业执业现象较多，但两类医疗机构违法的缘由有本质区别。提出针对医疗机构、各级医务人员及医学院校毕业生应及时开展各类医疗卫生法制教育，提高其依法执业的自觉性；针对不同性质的医疗机构，不断创新监管手段，探索教育、服务、处罚有机结合的分类监管方式；同时，应不断提高卫生监督人员专业执法技能水平，提高执法效率与质量的对策。     

海口市不同级别公立医疗机构门诊患者公益性评价

目的了解海口市不同级别公立医疗机构门诊患者的满意度, 提出有关公益性评价的政策建议。方法采用典型抽样的方法,分别选取海口市一级、二级、三级医疗机构共9家,进行门诊患者满意度问卷调查。问卷具体化为3 个维度（服务质量、服务适宜性、职业道德维度）和 12 个指标。结果三类医疗机构接受调查的患者在年龄、居住地、医保情况、职业、自报月收入和医疗服务方式等方面存在差异。门诊患者对医疗机构的公益性的综合评价得分为1.77±0.837分,不同级别公立医疗机构总体公益性评价得分,以及公益性评价子项目差异均有统计学意义（P<0.05）。患者对公立医疗机构的公益性评价在服务质量维度、服务适宜性维度方面,三级公立医疗机构要低于一、二级公立医疗机构。结论门诊患者对不同级别医疗机构的公益性评价存在差异,加强公立医院的公益性应该着重提高医疗服务的适宜性和公平性。在患者对公益性评价的服务质量维度中,建议增加“诊疗时间、医患沟通质量”评价指标,以体现对患者的“尊重与关心”,从而彰显“以人为中心”的诊疗模式和个体化医疗精神。公立医疗机构公益性回归是政府良治的迫切需求。     

基于新公共行政理论的政府补偿与监管机制改革评价

目的 以新公共行政理论为指导,分析闵行区公立医疗卫生机构管理者对政府补偿与监管机制改革政策的评价。方法 对闵行区所有公立医疗卫生机构进行问卷调查,并对部分医疗机构管理者进行问卷调查和定性访谈。结果 医疗机构和管理者认为补偿与监管机制改革政策在促进社会公平、提高机构反应性、代表公众利益、机构代表参与以及体现社会责任五个维度均有一定体现。结论 政府补偿与监管机制改革未来需要关注特需医疗服务和基本药物制度的政策导向,以保障公立医疗卫生机构公益性的实现。     

An analysis of medical students' residency and specialty choices

The contemporary geographic maldistribution of physicians and shortages in some specialty areas is a persistent problem facing United States federal and state wide health planners. This paper attempts to illustrate some of the formal and informal processes of the selection of specialties and residency programs based on a survey of senior students of 37 selected American medical schools at the time of the National Residency Matching Program in 1982. Results of a factor analysis on influences on specialty choice produced two major clusters of medical students; those predominantly influenced in specialty choice by the faculty and other senior physicians (sponsorship), and those predominantly influenced by the social dimension of the physicians' role (social responsibility). These medical specialty choice orientations were also systematically related to either choice of specialty vs primary care medicine, to a life-style or status related choice of residency program, and to students' perceptions regarding a program's evaluation of a candidate. The results of the survey suggested that students who chose primary care were more apt to be influenced by sources outside of the medical school. These findings raise questions regarding the efficacy of medical school curriculum in motivating career choices in primary care. This is particularly important in view of the stated need to increase the proportion of medical school graduates choosing primary care careers.