病人择医满意度调查研究

病人择医是以病人为中心、病人享有就医自主权的体现。本课题将探讨病人择医实施现状。病人择医满意度及相关问题的解决对策,为病人择医的顺利进行提供建议。在成都市选择具有代表性的省级医院2个、市级医院3个、区级医院3个,对其部分病人进行问卷采访,用SPSS8.0软件分析所得数据,满意度比较用Kruskal-Wallis秩和检验。回收问卷280份,有效问卷270份,有效率为96.43%,调查结果显示,病人对医生的选择率为50.73%,病人未选择医生的原因主要是想选但不了解、不需选、不会选;选择医生的病人与未选择医生的病人对医生的满意度之间有显著性差异（P=0.003),选择医生的病人满意度高于未选择的病人;病人对不同级别医院、医生的满意度之间差异均无显著性,病人认为医院当前存在的主要问题依次是：收费过高、手续繁多、收费不清楚、对待诊医生介绍不全面,由此可见,开展病人选择医生有意义,应继续下去;要提高病人对医生的选择率;鼓励分流病情轻的病人;加强医院管理,尽快解决目前医院存在的主要问题。     

病人选择医生对军队医院建设的影响

病人选择医生是国家适宜医疗市场病人就医心理需求的一项改革举措，针对目前国内医疗择医体系不完善，医院内部运行机制不配套，以及此地军队医院产生的负面影响等问题，为确保医院在改革中求得发展，必须建立其病人择医发展相应的对策。     

“流失”的病人回来了——北大首钢医院直通车驶入一体化社区

2003年，医保政策实行，患者可以自主择医，北大首钢医院包括所属社区经历了一次大幅度的病人流失过程。然而一年后，这种病人外流的势头便有所扭转。     

今天,我们怎样看病

过去,人们看病往往只能在指定的几家医院;现在,在推行医疗保险的许多大中城市里,随着纳入医保网络的医疗服务单位不断增加,已经形成"一卡在手任你行"的可喜形势,同时也遇到了如何合理择医的问题.在一些地方,尤其是医疗条件较好的大城市,大医院门庭若市,应接不暇,小医院门可罗雀是一种常见的现象,一些病人不管大病小病,一味地到大医院,找专家看病,其实已步入择医的误区.     

以量化考核为切入点推进医院人事制度改革

为了进一步深化医院内部改革,在医院内部逐步建立人员能进能出、职务能上能下、收入能高能低的新的用人机制,充分调动医院工作人员的积极性,为病人提供优质高效的服务,我院从2000年开始,以病人择医和工作业绩量化考核为切入点,推进医院人事分配制度的改革,收到了较好的效果.     

医院服务营销的思考与探索

医疗卫生是社会公益．性事业，不能单纯以盈利为目的。但是，医院占有很多社会资源，如何提高资源的利用率，充分发挥既有资源的作用，如何为更多的病人和社会人群服务，为社会健康事业作出更大贡献，则是医院综合评价的基本内容，也是医院经营的主要目标。随着病人自主择医的实现，一方面医院既有资源还有很大潜力没有挖掘，有很多健康服务需求没有得到满足.     

从医德医风建设看病人选医生

改革开放以来，我们在医德医风建设方面虽然作出了很大努力，但是医德医风至今尚未根本好转。主要的经验教训有二：一是“治军不严”；二是没有引入竞争机制。实行病人自主择医，就是在医德医风建设中引入竞争机制，真正体制“以病人为中心”，从而开创医德医风建设的新局面。     

医保政策对社区卫生服务利用的影响研究

通过分析2005年以来浙江省医疗保险参保人员对社区卫生服务的利用情况，并结合随机偶遇调查，分析参保人员择医行为的主要影响因素，发现：构建社区卫生服务体系的核心是要提高其医疗水平。为此建议：要科学系统地制定社区卫生服务体系构建的规划，进一步建立健全全科医生制度及其培训制度，多方引导参保人员适时调整择医行为，引导参保人员前往社区卫生服务机构就诊。     

影响大学生性健康就医行为因素分析

目的了解青少年性健康服务现状，为提高高校生殖健康服务质量提供依据。方法分别于2003和2006年对云南省6所高校的大学生进行性健康问题择医意向及其影响因素的问卷调查。结果大学生遇到性健康问题择医时首选的医疗机构是大医院，2003年为77．3％，2006年为93．8％；选择校医院服务的2003年为11．7％，2006年为4．2％。影响大学生择医的首要原因是医疗技术，2003年为58．7％，2006年为55．3％；其次是隐私保护，2003年为27．9％．2006年为35．7％。结论高校医院在提高医疗技术的同时，应强调尊重大学生的隐私，满足青少年性健康服务需求。     

行为医学简介(五)——病人决策

求医行为与卫生服务的规划、提供、利用、管理,以及健康教育等均存在着十分重要的联系。行为医学通过对病人在求医过程中的行为规律的研究,来引导病人进行科学的择医,指导卫生部门合理制订卫生规划,告诉卫生工作者如何因势利导地开展卫生服务,使供求双方达到尽可能高水平的相互配合,以取得最佳的社会效益、经济效益和健康效果。     

深化改革是企业医院发展的必由之路

结合医院实际，介绍了医院改革的主要做法及效果。主要做法：（１）对人员机构进行改革；（２）对干部人事制度进行改革；（３）对医院的管理体制进行改革；（４）对经济管理及分配方式进行改革；（５）实行一院两制，联合办院。效果：（１）职工的思想观念有了很大的转变；（２）成功地实现了人员分流；（３）增收节支成效显著；（４）经济效益明显提高，社会效益日益显现。     

Judging goodness must come before judging quality--but what is the good of health care?

The paper argues first that until it is known what the good of health care is there cannot be a judgement about what is better, and second that until it is known what is better there cannot be a judgement about what is quality. It is further suggested that in judging good and better with respect to health care as a social institution, there is no-one better placed to do this than the community. Too little is currently known about what communities want from their health services. Some suggestions as to how this situation might be improved in both principle and practice are discussed and the notion of 'communitarian claims' linked to conjoint analysis posited as a useful way forward. Such an approach will allow the development of a set of community-based principles--what is called a 'communitarian constitution'--on which to base the direction and objectives of health care.     

Managed care and mental health: personal realities

A review of the literature revealed mixed reviews on the impact of managed care on mental health service delivery. Research supports that managed care contributes to a reduction in inpatient costs and an increase in outpatient service use. Other studies suggest that there are problems with access and quality of care. An additional issue is whether or not, and to what extent, mental health services are "carved out" from physical health for patients. This study discusses the findings of a qualitative analysis of Medicaid managed care recipients on the barriers and enabling factors to obtaining mental health services in a full carve-out managed care model. Results indicate that reduced access, quality of care problems, and a lack of integration of care exist. Additionally, recipients' interactions with managed care, service providers, and caseworkers affect their mental health care. The results also report on the tactics used by recipients to cope with service problems. Implications for social work practice and research are discussed and recommendations for service delivery and evidence-based education are delineated.     

Trust in medical decision-making concerning older people: the views of key professionals in the Dutch health care practice

This article deals with the issue of public trust in decisions made by individual physicians, concerning older people, as perceived by various key professionals. While trust is a basic element in our health care service, it is at the same time a difficult phenomenon to conceptualize. This article tries to contribute to a better understanding of what trust in medical practice entails and what are the necessary conditions for a society to put trust in the medical profession. The focus is on care for older people under the condition of scarcity in health care resources. Our study has a qualitative design consisting of semi-structured in-depth interviews with 24 key professionals focusing on decision-makers and those in line of professionally organizing or influencing the decision-making process. We found roughly three categories of trust: distrust; trust; and qualified trust. In each category we found different reasons to give or withhold trust and different views on how far the discretionary power of doctors should go. We recommend promoting trust by addressing the criteria or limits brought forward in the qualified trust category. The preconditions as identified in the qualified trust section provide the boundaries and marking points between which physicians have to move regarding the care for older people. The qualifications provide us insight in where and how to invest in trust under these and under different circumstances. An important conclusion is that trust is never finished: trust needs to be gained and negotiated in a continuous process of action and interaction.     

Algorithmic assemblages of care: imaginaries,epistemologies and repair work

In the past decade, the figure of the algorithm has emerged as a matter of concern in discussions about the current state of the healthcare sector and what it may become. While analytical focus has mainly centred on ‘algorithmic entities’, the paper argues that we have to move our analytical focus towards ‘algorithmic assemblages’, if we are to understand how advanced algorithms will affect health care. Departing from this figure, the paper explores how an algorithmic system, designed to ‘take on’ the role of a physiotherapist in physical rehabilitation programmes in Denmark, was designed and made to work in practice. On the basis of ethnographic fieldwork, it is demonstrated that the algorithmic system is a fragile accomplishment and outcome of negotiations between the imaginaries embedded in its design and the ongoing adjustments of IT workers, patients and professionals. Drawing on recent work on the fragility and incompleteness of algorithms, it is suggested that the algorithmic system needs to be creatively ‘repaired’ to build and maintain enabling connections between bodies in‐motion and professionals in arrangements of care. The paper concludes by addressing accountability for the workings of algorithmic systems in medical practice, suggesting that such questions must also be discussed in relation to encounters between algorithmic imaginaries, health professionals and patients, and the various forms of ‘repair work’ needed to enable algorithmic systems to work in practice. Such acts of accountability cannot be understood within an ethics of transparency, but are better thought of as an ethics of ‘response‐ability’, given the need to intervene and engage with the open‐ended outcomes of algorithmic systems.     

Physician response to the United Mine Workers' cost-sharing program: the other side of the coin.

The effect of cost sharing on health services utilization is analyzed from a new perspective, that is, its effects on physician response to cost sharing. A primary data set was constructed using medical records and billing files from a large multispecialty group practice during the three-year period surrounding the introduction of cost sharing to the United Mine Workers Health and Retirement Fund. This same group practice also served an equally large number of patients covered by United Steelworkers'' health benefit plans, for which similar utilization data were available. The questions addressed in this interinsurer study are: (1) to what extent does a physician''s treatment of medically similar cases vary, following a drop in patient visits as a result of cost sharing? and (2) what is the impact, if any, on costs of care for other patients in the practice (e.g., "spillover effects" such as cost shifting)? Answers to these kinds of questions are necessary to predict the effects of cost sharing on overall health care costs. A fixed-effects model of physician service use was applied to data on episodes of treatment for all patients in a private group practice. This shows that the introduction of cost sharing to some patients in a practice does, in fact, increase the treatment costs to other patients in the same practice who remain under stable insurance plans. The analysis demonstrates that when the economic effects of cost sharing on physician service use are analyzed for all patients within a physician practice, the findings are remarkably different from those of an analysis limited to those patients directly affected by cost sharing.     

Perceptions of ethnic and cultural factors in the delivery of services in the treatment of sickle cell disease

Twenty-two parents or guardians of children with sickle cell disease seen at a university medical center were administered the Service Perception Test (SPT), a pilot designed for this study to assess how ethnocultural factors of age, race, and gender were perceived as influencing quality of health care received by patients. The medical staff at the sickle cell treatment clinic were also administered the SPT. Data were analyzed for family respondents, medical staff, and a comparison of the two groups. Results consistently show that whites were perceived as getting better service than blacks; young children as receiving better service than the elderly; and the elderly as getting better service than middle age adults. Females were perceived as receiving better service than males with an interaction of race and age. Conclusions and implications for delivering health care services to ethnically and culturally diverse patients with sickle cell disease are offered.     

Assessing Medicaid patients' perceptions of the OB/GYN-patient relationship

OBJECTIVES: The objective of this study was to understand how the dynamics of the health care provider-patient relationship differ between Medicaid patients and private pay patients in the context of obstetric care. Various aspects of the patient-physician relationship were examined including trust, commitment, dependence, social content, service quality, and behavioral outcomes such as satisfaction, referral behavior, ease of voice, and retention. METHODS: Questionnaires were mailed to a sample of mothers who had recently given birth. MANOVA was used to compare the means of Medicaid patients with private pay patients for the variables of interest in the study. RESULTS: Medicaid patients had lower commitment to their primary physician. They trusted the practice, the primary physician, and the other physicians in the practice less. They perceived themselves as less similar to both the overall practice and their primary physician and also rated their health care service experience lower. They were less satisfied and less likely to use the same practice for future pregnancies or make referrals. They also felt less comfortable voicing complaints. CONCLUSIONS: The evidence clearly indicates that Medicaid obstetric patients perceived their service experience more negatively than private pay patients. Health care providers know they must provide clinical quality for their patients, however, in treating Medicaid patients they need to focus on patient driven-quality as well. The results indicate that health care providers, particularly OB/GYNs, need to do a better job of determining and delivering the key performance criteria that Medicaid patients use to make trust judgements.     

医学思想卫生服务临床教育

医学模式的转变，使医学思想也发生了相应的变化，为实现２０００年人人享有卫生保健的战略目标，卫生服务的目的、范畴、模式、观念、内容、体系和需求都将发生一系列变化；而医学思想和卫生服务的转变，要求临床教育从教育观念、教育目标、课程改革和教学方法等方面加以改革，以适应知识经济时代的需要。