医生激励机制是医院改革的核心

医生是整个医疗体系的核心,构建合理的医生激励机制,调动医生的工作积极性是医院改革成败的关键。目前我国医生与病人的关系基本上是随机配对、一次合作的关系,而且医生专业服务的价值被人为低估,这样造成了严重扭曲的医生激励机制,导致一系列难以解决的问题。只有在医生     

从医生激励机制分析公立医院改革要点

从医疗服务的经济学属性角度分析了医生激励机制是公立医院改革的核心，并以取消药品加成为分界，对改革前后医生激励的成本收益进行分析，建立医生效用最大化模型。提出了基于医生激励机制的公立医院改革要点，以实现公立医院的可持续发展。     

医生激励机制改革的路径依赖及重建

医生作为公立医院改革的直接体验者和推动者,其积极性的发挥直接影响医改的效果。而要在公立医院改革中实现维护公益性和调动医生积极性的平衡,必须重建医生激励机制。根据制度经济学理论,在改革和重建医生激励机制过程中,必须破解路径依赖,确定重建医生激励机制的路径。在当前背景下,应先对医疗服务价格进行合理定价,然后根据医生的职业性质建立合理的医生补偿机制,同时通过实施支付方式改革等,建立针对医生行为的约束机制,辅以教育和管理培育医生的责任心。     

基于多任务委托代理模型的公立医院医生薪酬激励机制研究*

目的：研究公立医院医生两种行为下最优努力水平和最优激励程度的影响因素,为进一步完善改进公立医院激励机制提出有效性建议。方法：运用委托代理数学模型进行研究。结果：医生的努力水平与医生努力成本呈负相关,与医生的激励系数呈正相关,医生会更倾向把努力放在激励系数较高的任务上;医生的最优激励系数与医生给政府带来的收益、医生的努力成本呈正相关,与行为的可监督性呈正相关,与医生的风险规避度呈负相关。结论：政府要加强对公立医院的监管,要完善公立医院的激励机制,加大对医生社会性行为的重视程度。     

基于利益相关者理论的医生激励机制构建

利益相关者分析作为一种新的理论,已经广泛应用于西方国家的企业管理与卫生政策改革研究与实践中,并取得了初步成效。在介绍该理论的基础上,针对我国现行医生激励机制的局限性,从利益相关者分析这一新的视角,探讨医生激励机制构建的新思路。     

乡村医生激励机制路径分析

目的:识别对乡村医生产生激励作用的影响因素,并对其可能的路径机制进行分析,为提高乡村医生工作积极性提供参考。方法:以马斯洛需求层次理论为依据,通过路径分析法,梳理出对乡村医生产生激励作用的生存、安全、社交、尊重和自我实现五大因素。结果:对乡村医生激励机制产生作用的因素主要是生存因素、尊重因素和自我实现因素,影响系数分别为0.495、0.183、0.095,安全因素、社交因素不直接影响乡村医生的受激励程度,但通过生存因素、尊重因素和自我实现因素对其产生间接影响。结论:通过提高乡村医生待遇,提升基本药物补助等,健全乡村医生养老保障机制,降低其工作环境的医疗风险等措施,完善乡村医生的激励机制,提高乡村医生工作积极性。     

政府管制与医生兼差的激励机制：多任务委托代理模型的视角

本研究利用激励理论中多任务委托代理模型,来探讨医生兼差(即医生"走穴")现象的微观激励机制,进而分析政府管制制度或行政管理措施对兼差者效用的影响。主要研究发现表明:(1)在医疗行业,政府对兼差行为的管制具有内生性,即受到薪酬制度中激励机制的影响;(2)简单的兼差禁制令,由于忽略并扭曲既有的激励机制,会经常失效;(3)在适当激励机制下,医院管理行为远比政府管制对兼差负面影响的约束力更大。     

某专科医院药品零差价下医生激励机制研究

目的探讨新医改背景下药品零差价政策对天津市某传染专科医院医生临床工作影响及对应激励机制研究。方法对实施药品零差价政策后工作量指标、收入指标与往年同期进行对比;采用问卷调查方式收集分析临床医生对于药品零差价实施后工作开展及收入主观感受,并制定了相关激励对策。结果药品零差价政策实施后,医院患者人数、总收入较往年同期有所增加,药品收入下降,临床医生对药品零差价实施后薪酬福利存在一定担忧情绪,相关激励政策制定和实施确实有效。结论实施药品零差价政策,对专科医院运营是积极促进的,有利于专科医院长远发展,政策实行前期针对临床医生激励机制探索也是必要的。     

乡镇卫生院预防保健科医生对结核病防治激励机制的评价研究

为探讨乡镇卫生院预防保健科(防保科)医生对结核病防治激励机制的评价情况,笔者对山东省部分乡镇卫生院防保科医生进行了调查,现报道如下.     

转型时期医生的道德风险

在我国转型时期,医生存在较严重的道德风险.从表面上看,医生道德风险是政府对公立医院投入不足,医院被迫实行内部经济激励机制所致.实际上医院混业经营、多层委托代理关系、对供方支付方式等,是更重要的制度因素.如何设计科学的综合机制,是遏制医生道德风险的关键,也是医改能否成功的试金石.     

Self-assessments of need, relevance and motivation to learn as indicators of participation in continuing medical education

This study examined the validity of using physicians' self-assessed needs, relevance and motivation to learn about clinical topics as a means for setting objectives and priorities for continuing medical education (CME) programmes. In an initial survey family doctors were asked to rate their need, relevance and motivation to learn about 120 different clinical topics. Eight months later, the same population was sent a second mail survey asking respondents to indicate if they had learned about a set of sixteen topics taken from the initial survey and, if so, in what kind of learning activities. Eight of the sixteen topics were highly rated and eight were low rated in the initial survey. In terms of actual participation of family doctors, self-assessed motivation to learn exhibited a strong positive relationship with actual participation. Both self-assessed need and relevance were negative to only moderately positive in their association with actual participation. This evidence contributed to the value of using self-assessed motivation as an indicator of future participation of family doctors in CME and questioned the value of using self-assessed need and relevance as indicators of future patterns of participation.     

Little communication between company doctors and private physicians with respect to hindrances to return to work after prolonged absence from work because of low back pain]

OBJECTIVE: To determine occurrence and reasons of contact between company doctors and treating physicians with respect to patients absent with low back pain for three months. DESIGN: Prospective cohort study. METHOD: A cohort of employees who were absent for 3 months with back pain were selected according to defined criteria. A questionnaire about medical status and communication with treating physicians was sent to their company doctors. RESULTS: The company doctors of 300 of 467 employees participated. In 19% of the employees the company doctor contacted the curative sector (56 contacts had taken place, 14 were planned). The contact consisted almost always of exchange of information and less frequently of co-operation towards a mutual policy. In almost 50% of the cases the company doctors regarded the clinical waiting period, length of treatment and opinion of the curative sector as disincentives to return to work. Psychosocial factors such as psychological problems, work-related motivation, private problems and a conflict between employer and employee all were mentioned less frequently. Although contacts were slightly more frequent when psychosocial factors, treatment or opinion of the curative sector inhibited return to work, only disincentives such as work-related motivation, motivation to return to work and the waiting period were significantly associated with the contact frequency. CONCLUSION: The communication rate between company doctors and the curative sector in employees long absent with back pain is low. Communication consists of exchange of information rather than co-operation towards a mutual policy. Although according to many company doctors the curative sector plays an inhibitive role in return to work, they do not communicate accordingly.     

Incentives and intrinsic motivation in healthcare

ObjectiveIt has been established in the literature that workers within public organisations are intrinsically motivated. This paper is an empirical study of the healthcare sector using methods of qualitative analysis research, which aims to answer the following hypotheses: 1) doctors are intrinsically motivated; 2) economic incentives and control policies may undermine doctors’ intrinsic motivation; and 3) well-designed incentives may encourage doctors’ intrinsic motivation.MethodWe conducted semi-structured interviews à-la-Bewley with 16 doctors from Navarre's Healthcare Service (Servicio Navarro de Salud-Osasunbidea), Spain. The questions were based on current theories of intrinsic motivation and incentives to test the hypotheses. Interviewees were allowed to respond openly without time constraints. Relevant information was selected, quantified and analysed by using the qualitative concepts of saturation and codification.ResultsThe results seem to confirm the hypotheses. Evidence supporting hypotheses 1 and 2 was gathered from all interviewees, as well as indications of the validity of hypothesis 3 based on interviewees’ proposals of incentives.ConclusionsThe conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated.     

Can we get doctors to use computers?

David Young argues that although doctors are interested and willing to use computers, in general they do not use them in health care. It is a complex matter, but an important reason is that the system designers have ignored the clinical environment and the motivation of doctors. In particular the conventional approach to data input is inappropriate, and he suggests a better way.     

综合性医院青年医师科研现状分析

目的 了解综合性医院青年医师的科研现状;方法 根据复旦大学中山医院掌握的数据和问卷调查,对综合性医院青年医师的基本情况、负责科研项目情况、发表论文情况、进行科研的主要原因和障碍等情况进行统计分析.结果 青年医师负责科研项目和发表SCI论文偏少,进行科研的主要原因和障碍分别为职称晋升和临床任务繁重.结论 中山医院青年医师整体科研基础和水平与我院发展的需要有一定差距.     

三甲医院医生创新能力影响因素分析

研究人格、动机、专业技能和组织环境因素对医生创新能力的影响,据此为医院选拔和聘用人才、培养和提高医生创新能力提供科学依据.采用问卷调查法,对599名广州市3所不同类型三甲医院具有执业医师资格的临床医生进行调查.显示人格、动机、专业技能和组织因素对创新能力都有不同程度的影响,而且影响作用体现在创新过程的不同阶段.为了提高医生创新能力,管理者需要重视医生知识积累,充分支持医生创新行为,而且要注重支持措施的形式、程度和针对性.     

乡村医生抗生素使用情况调查分析

滥用抗生素导致了越来越多耐药菌群的产生，因而成为目前全球关注的热门话题之一。多种原因可以导致抗生素的滥用，医生用药不当是原因之一。本文通过对乡村医生的抽样调查分析，从一个侧面反映了我国乡村医生抗生素的使用情况，认为目前我国乡村医生的抗生素使用除了存在着认识不足问题，在一定程度上还受经济激励机制的影响。     

肿瘤专科医院医师进修的过程管理

进修学习是医务人员提高临床实践能力和更新知识的有效途径,能够达到培养医师与医院提升自我的双重目的。通过严格准入制度、加强岗前培训、明确奖惩机制、建立交流平台、完善培训体系、实时调查反馈等方式的过程管理,探索进修医师管理中的经验并通过SWOT方法分析医院在进修医师招生及培训中的优势、劣势、机会和威胁。     

Practices and knowledge regarding prevention of tetanus among doctors in Delhi

A cross-sectional study was conducted in Delhi to study immunisation practices regarding prevention of tetanus among doctors and their knowledge regarding its prevention. Delhi was divided into five zones, and from each zone two hospitals and five dispensaries were selected, giving due representation agency-wise. All the doctors posted for casualty duty in the selected hospitals, all doctors posted in the selected dispensaries and two private practitioners selected randomly from the nearby area of the selected dispensaries were included in the study. Only 7% of doctors had received their last dose of tetanus toxoid to complete the immunisation schedule and majority had received it following injury. As much as 38.3% of doctors favoured TT after every injury. Out of the remaining who opposed it only 59.5% could provide the correct reason for this. Less than half of the doctors knew the indications of anti-tetanus serum. There is a need for the doctors to take TT immunisation more seriously and adopt recommended immunisation practices, because if they themselves are not following the guidelines, it is likely to be reflected in their advice and motivation to patients.     

南京市公立医院医务人员内外部工作动机对工作投入的影响研究

目的 分析公立医院医务人员的内外部工作动机对工作投入的影响机制及内外部动机之间的关系,为提高医务人员的工作投入提供借鉴。方法 利用工作动机量表和工作投入量表,采用分层抽样方法,选取南京市3家三级医院、4家二级医院和16家社区卫生服务中心的医务人员进行问卷调查。结果 结构方程模型显示,内部动机和外部动机对工作投入的各个维度的路径系数分别为0.42、0.35、0.33（P＜0.001）和0.21、0.23、0.29（P＜0.001）,内部动机和外部动机的交互项对工作投入的路径系数为- 0.13（P = 0.003）。说明医务人员内部动机、外部动机对工作投入各维度:工作活力、工作奉献和工作专注都有正向影响;外部动机与内部动机协同影响医务人员的工作投入。结论 医院应关注医生内部动机与外部动机间的差异以及工作动机对医生工作投入的影响的不同,有针对性地采用不同的激励手段,全面提升医务人员的职业素养。