医师多点执业利弊分析

随着2009年新医改政策的实施,探索医师多点执业成为医改的一大亮点,有关其利弊的争论众说纷纭。在现行的医疗环境下,实施医师多点执业势必会带来诸多积极影响,然而也存在不利因素。立足于我国执业医师现状,对医师多点执业利弊进行了综合分析,为政策的贯彻落实提供参考依据。     

公立医院医师多点执业制度探讨

回顾了我国医师多点执业的制度背景,从微观层面分析了制约我国公立医院医师多点执业行为选择的原因,并以此为基础,探索促进医师多点执业行为选择的措施,包括先行设计多点执业制度、健全多点执业的医疗质量及安全机制、完善医师多点执业激励机制、实行强制医疗责任险以分担医师多点执业风险,期望对推进我国医师多点执业提供帮助.

Abstract：

A review of the system background for the multi-institution physician practice in China,and an analysis for the specific constraints for physicians of public hospitals to embrace such a practice On this basis, the paper probed into the measures to encourage the physicians for doing so. The measures recommended include advanced design, improvement of the quality of care and safety mechanism,incentives mechanism, mandatory enforcement of medical liability insurance to minimize risk exposure of such a practice, aiming at advancement of this practice.     

关于医师多点执业的思考

医师多点执业是当前社会热门话题之一,对其利弊的讨论众说纷纭。从医师多点执业的积极意义和可能带来的问题这2个方面进行了分析。     

医师多点执业改革的利与弊

卫生部出台《卫生部关于医师多点执业有关问题的通知》近3年,由此多点执业改革的试行和管理工作积累了一定经验,本文即对执业医师管理工作中的“多点执业”改革的概念和试行背景进行了阐述,分析管理中遇到的利与弊,并提出相应建议.     

医师多点执业问题刍议

新医改方案提出了探索注册医师多点执业的要求,这对于更好地统筹调配医疗卫生资源,调动医务人员积极性,促进区域间、机构间人员和技术的交流,提高基层医院诊疗技术水平,方便人民群众特别是基层群众看病就医,减轻群众就医负担等方面都具有积极作用,但这其中也存在着一些问题.对此,我们有必要制定相应的政策和措施对其进行鼓励与规范.     

我国医师多点执业研究综述

  目的  了解陕西省医师多点执业现状及其障碍因素,为推动陕西省医师多点执业提供参考依据。  方法  于2015年7月 — 2016年5月采用分层整群随机抽样方法在陕西省关中、陕南和陕北地区6家三级甲等医院抽取366名医师进行问卷调查,并应用文献分析法提炼障碍因素。  结果  陕西省366名医师中,有12.6 %的医师非常了解多点执业政策,有80.6 %的医师赞成多点执业政策,在条件允许的情况下有78.4 %的医师愿意多点执业;有多点执业行为的医师152人,占41.5 %,不同性别、年龄、职称、工作年限医师多点执业行为比例均不同,差异均有统计学意义（均P < 0.05）;医师多点执业的障碍因素主要涉及法律法规（包括多点执业制度未立法、配套法律法规不完善、执业管理办法地域差异大）,第一执业机构（医院反对、人事管理制度限制、薪酬待遇有差异、未来发展受限）,第二和第三执业机构（病人少、科研弱、硬件差、团队协调弱）;医生个人（时间受限、身份受限、影响薪酬和晋升、担心医疗风险大）,医疗责任险（赔偿额度少、赔付范围窄、责任主体划分不明确、险种可选择性小）等5个方面。  结论  陕西省医师多点执业比例较低,加快医师多点执业制度的法律化、确立医师和执业机构的劳动（劳务）合同关系、完善医疗责任险,可更好的推进医师多点执业。     

医院视角下对医师多点执业制度的思考

当前我国面临着医疗资源特别是优质医疗人才资源分配失衡的现状,优质医疗人才资源的失衡造成了医疗市场中患者流向的失衡,大医院人满为患,即“看病难”,而社区医院却门可罗雀的现状.本文结合医师多点执业现状,对医师多点执业制度的落实等相关问题进行具体分析与阐述.     

医师多点执业的政策障碍与可行路径

本文讨论了医师多点执业的内涵、该政策实行受阻的原因及对策。目前,我国公立医院的医师是“单位人”,而不是“自由执业者”,医院与医师均缺乏多点执业的动力,需要从立法、制度和政策三个方面来保障医师多点执业。大力发展私立医院、改善医师自由执业的条件是促进医师多点执业的重要前提。该政策的实行需要政府多部门和广大医师的参与,需要通过试点和实践检验做出循证决策。     

医师多点执业国内外发展状况比较研究

因各国的国家性质、国家制度、经济水平、公共医疗卫生体系发展的差异,医师多点执业在各个国家的实践模式、监督机制、风险保障方式与实施影响等各有不同.本文通过对国内外医师多点执业的发展现状研究进行系统梳理,科学分析,对比总结我国医师多点执业研究的不足,在此基础上明晰未来研究发展趋势,对推进我国医师多点执业管理向科学化、规范化...     

从公立医院角度探讨注册医师多点执业

阐述公立医院在实施医师多点执业过程中应注意的3对基本矛盾,同时探讨医师多点执业可能给公立医院带来的影响．并提出合理化建议：理清利益相关集团,建立风险分担机制：建立全方位的绩效考核体系,创造人才成长氛围：探索医疗集团化的多点执业,实现多赢局面：完善双向转诊机制,确保医疗安全。     

上海市外国医师执业现状分析

目的初步掌握外国医师在上海市执业现状,为进一步做好全市外国医师执业监管工作提供依据。方法搜集、分析上海市外国医师执业数据和日常监管工作中外国医师对中国法津、法规的知晓程度。结果现有171位来自17个国家或地区的外国医师在中国执业;有80．70％的外国医师使用英语执业;服务对象多为外籍人士（70．18％）,其次是中国人（24．56％）和台湾人（5．26％）;他们对中国的《外国医师来华短期行医暂行管理办法》比较了解,而对其他相关法律、法规了解程度较差。结论外国医师在上海市执业人数不断增加,整体执业情况良好,但仍应完善外国医师来华行医的有关法律法规并根据现状进一步明确细化准入及执业的有关规定。     

军队医院处理群体性医患纠纷的思考

本文分析群体性医患纠纷事件的特点,提出军队医院应客观正确面对医患纠纷,争取患者和亲属的理解认同,加强与地方政府、公安的沟通协调,依法打击“医闹”等非法团伙,严密控制事态的升级,同时严密关注舆论动向,及时应对虚假信息的传播。     

住院医师规范化培训与医学人才培养的实践与思考

实行住院医师规范化培训制度是遵循人才成长规律,培养高素质临床医学人才的必然要求,是深化医改的重大举措。笔者介绍了国内及我院开展住培的历史沿革、背景、意义、存在的问题,并分析总结了我院在开展住院医师规范化培训工作的实践与思考。目的是通过探讨,能使同行有所启发,更了解所面临的任务,保证人才培养的质量。     

How Can We Attract More Doctors to the Country?

ABSTRACT: Drawing on findings from an extensive survey of rural general practitioners in Victoria, this article explores proposals for improving the recruitment, training and retention of rural doctors. The study which included metropolitan comparison groups achieved a 75 per cent response rate, providing information representative of most GPs in Victoria. Main barriers to entering rural practice identified by rural doctors were spouse problems; lack of skills; city background and training; ignorance of country practice; lack of self confidence; and inadequate remuneration. Negative attitudes towards the country and general practice plus 'learned helplessness' picked up in medical school were rated by rural doctors as being of significant importance. Of 14 suggestions for improving recruitment, training and retention of rural GPs the following were rated as top priority; substantial clinical experience in rural hospitals and practices; reciprocal links between the country and medical schools; extra financial reward for isolated rural practice; establishment of Rural Medical Education Centres; and a program to meet the needs of the rural practitioner's spouse.     

Vitamin D Knowledge,Attitudes and Practices of Polish Medical Doctors

Background Vitamin D deficiency occurs in as much as 90–95% of the Polish population, although this condition is known to cause negative long-term health implications. The role of medical doctors in advising proper supplementation, monitoring and correcting the levels of 25-hydroxyvitamin D in individuals is of great importance and should be used to help mitigate its common deficits. The aim of this study was to evaluate knowledge, attitudes and practices of Polish physicians regarding vitamin D supplementation in order to identify areas for improvement and determinants for the knowledge gaps. Methods The study group comprised 701 medical doctors aged 32.1 ± 5.3 years on average, mostly women (71.61%). An original survey questionnaire was developed for the purpose of the study. Results The mean vitamin D knowledge score was 6.8 ± 2.3 (in a scale 0–13) and was related to gender (p < 0.001), type of specialization (p = 0.032), D3 supplements use (p < 0.001), recommending supplementation to patients (p = 0.005), to relatives and friends (p < 0.001) and to healthy adults (p < 0.001). In terms of self-administration, 14% of respondents take vitamin D all-year-round while 24% only in autumn and winter. 25% of respondents monitor their vitamin D (25-hydroxyvitamin D) serum concentration. Most participants (61%) did not recommend supplementing vitamin D to their patients on a regular basis. Conclusions The study indicates that medical doctors in Poland need to have more training and education on vitamin D supplementation in order to better address the problem of its deficits in the population.     

维和医疗分队集训实践与思考

本文提出维和医疗分队国外执行任务前要针对任务区的特点和现状，有目的、有针对性地强化训练，强调培训应突出医疗中心工作和实施有效管理两个重点。     

社区卫生服务机构实行药品“零差率”的实践与思考

自2006年初<国务院关于发展城市社区卫生服务的指导意见>发布之后,国内北京、上海、南京等城市逐渐开始了社区卫生服务机构药品"零差率"销售的试点活动,并在取得一定成绩后在全市推广.药品"零差率"销售能够在一定程度上缓解患者看病贵的问题,药品集中采购、统一配送,切断医疗机构在药品销售上的利益驱动,减少贵处方、大处方等弊端.     

Healthcare Marketing on the Web: Moving Forward Toward More Interactive Practices

It is hard to deny the notion that the Internet has been very efficient in distributing health information to millions of individuals and has become one of the best marketing tools in healthcare. We have been witnessing so many very creative and interactive practices in this field that we can safely assume that it is now the time for e-commerce in healthcare industry. While this is true for many participants, there are also some who are concerned about using some of these new online options in the field of healthcare. Most of these concerns are derived from the questionable accuracy of the “health” information on the net. Considering the fact that the subject matter of the field is “health,” we can realize that these concerns are serious and deserve an in-depth look. This paper reviews some of the most current practices in the field and provides some examples of these online options. It is hoped that the review of these examples will result in similar inquiries in the future and as those questionable options are exposed more and more, they will eventually be eliminated and replaced with the better ones.     

区域医院（疗养院）系统综合整治的实践与思考

作者介绍了所在军区开展医院综合整治的做法,总结了综合整治的效果,提出了在把握方向中正风气、在解决敏感问题中正风气、在完善管理体系中正风气的管理思路,对于医院完善管理机制具有指导意义。     

Evaluating the impact of physicians' provision on primary healthcare: Evidence from Brazil's More Doctors Program

This study aims to evaluate the More Doctors Program (Programa Mais Médicos) in terms of the provision of physicians, presenting estimates of its impact on hospitalization for ambulatory care sensitive conditions. The differences‐in‐differences method was used with propensity score matching (double difference matching), using 3 specifications, a falsification test, and also a dynamic endogeneity test to confirm the robustness of the results. For the application of this methodology, a panel of municipal data was constructed covering several variables related to socioeconomic, demographic, and public health infrastructure characteristics in the cities for the period from 2010 to 2016. The results show a significant reduction in hospital admissions in treated municipalities with an increasing and perceptible effect in the second year of the program.