上海市闸北区执业医师多地点行医现状分析和对策探讨

根据《中华人民共和国执业医师法》,国家实行执业医师资格考试制度和医师执业注册制度。医学院毕业的学生必须取得执业医师资格或者执业助理医师资格,并经注册后,才能按照注册的执业地点、执业类别、执业范围,从事相应的医疗、预防、保健活动。但是在实际监督管理过程中发现,在本区许多医院为了业务的提升、疑难病症的合力解决,     

新医改政策下医师多地点执业的研究和探讨

随着新医疗改革的逐步深入,国家对注册医师多点注册提出了新的要求。使整个医疗资源的分配更为合理,也可以保障区域化医疗资源能够得到充分的利用。对于提升我国整体医疗水平具有十分重要的作用,在很大程度上方便了群众就诊看病,减轻了群众的医疗负担。本课题对国内外医师执业制度进行全面的分析,分析我国当前形势下＂医师多地点执业＂不能有序开展的问题所在,提出一些政策性建议,以待管理层决策时参考。     

关于医师执业注册的法律问题研究

就医师执业注册的法律时限、执业地点变更等法律问题进行分析和研讨,认为在医师执业注册法律规范中存在时限较长、手续烦琐等若干法律缺陷,因而完善卫生法律法规规定,规范医师执业注册极为重要,并从法律和可行性对策的角度提出了建议。     

一起执业医师非执业地点行医案的法律适用分析与思考

患者为图方便，医生为求利益，在职医生不顾法律与制度的约束，私自在外行医，甚至未经批准开办私人诊所。这种在利益驱使下出现的“医疗行为”，存在着严重的安全隐患，极大地损害了群众的健康权益。文章通过对一起执业医师非执业地点行医致人死亡案例的分析与思考，对其法律法规适用进行分析比较，并对相关法律法规提出一些建议，旨在依法行政，健全法律制度。     

医师执业地点变更注册中的问题和设想

1998年6月26日第九届全国人民代表大会常务委员会第三次会议通过了《中华人民共和国执业医师法》(简称执业医师法)。执业医师法的颁布保障了医师的合法权益．保护了人民的健康，促进了医疗人才的流动和医疗市场的开放。     

医师异地执业的法律探讨与对策思索

近年来，卫生部门加大了对医师依法执业的管理监督力度，目前医师擅自在注册地点以外执业等违规行为有明显减少，但仍然有少数医师私自或假借“会诊”、“兼职”等名义擅自在未经注册的地点执业，上述行为扰乱了医疗服务市场秩序，由医师擅自异地执业造成患者健康损害的情况也时有发生。完善法规规定，明确医师依法多地点执业要求，有堵有疏、合法合理地解决医师多地点执业行为是医师管理中要解决的重要问题。该文试从法律探讨和可行性对策方面提出一些见解。     

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。     

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.     

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。     

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.     

国内外医师职业精神的研究与构建

在回顾近10年国内外有关医师职业精神的研究与发展进程的基础上,对医师职业精神的内容、测评、面临的问题与挑战、影响因素等进行了分析,并结合我国医师职业精神的现状,提出完善和构建我国医师职业精神的设想.     

Scope and scale inefficiencies in physician practices

Using a national data set, this paper looks at the efficiency of physician practices, focusing on scopes of service by comparing single specialty groups and multispecialty groups. An analysis of efficiency using DEA indicates that there are scope inefficiencies from combining different types of providers into a single practice. Most of the inefficiency is due to technical rather than allocative reasons. In addition, we find that larger practices are able to capture efficiencies of scope, but incur inefficiencies of scale.     

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。     

上海市餐厅顾客吸烟与被动吸烟状况及对餐厅禁烟立法态度

目的了解上海市顾客在餐厅吸烟与被动吸烟情况,调查顾客对餐厅禁烟立法的态度,分析实施餐厅禁烟政策对顾客就餐行为的可能影响。方法采取分层随机抽样方法,对上海市黄浦区5类餐厅(大型中餐厅、中小型中餐厅、休闲西餐厅、快餐厅和咖啡厅/酒吧),每类餐厅随机抽取20家餐厅进行调查,共计100家餐厅的961名顾客参加问卷调查(包括30.5%的吸烟者)。结果 72.7%的吸烟者曾在餐厅吸烟;90.7%的非吸烟顾客在餐厅就餐时遭受过被动吸烟。在遭受被动吸烟时,41.0%的顾客选择默认接受;55.8%的非吸烟者会有意识选择无烟座位;仅有11.4%的顾客对《上海市公共场所控制吸烟条例(草案)》非常了解;66.0%的顾客赞同上海市所有餐厅禁止吸烟,39.4%的调查对象表示餐厅禁烟立法实施后会提高外出就餐意愿。结论上海市餐厅顾客的吸烟与被动吸烟情况比较严重,吸烟行为很少受到劝阻,大部分顾客对《上海市公共场所控制吸烟条例(草案)》了解不够,但普遍支持餐厅禁烟立法。立法后顾客外出就餐意愿总体上增加。     

我国现有医师培养制度存在的问题及对策

通过分析我国现有医学院校教育、毕业后医学教育和继续医学教育等医师培养三阶段的现状,结合我国卫生事业目前发展水平,对其中存在的问题进行较深入地探讨与分析,就实施医师培养相关阶段中存在的问题提出了解决对策。     

Application of a propensity score approach for risk adjustment in profiling multiple physician groups on asthma care

OBJECTIVES: To develop a propensity score-based risk adjustment method to estimate the performance of 20 physician groups and to compare performance rankings using our method to a standard hierarchical regression-based risk adjustment method. DATA SOURCES/STUDY SETTING: Mailed survey of patients from 20 California physician groups between July 1998 and February 1999. STUDY DESIGN: A cross-sectional analysis of physician group performance using patient satisfaction with asthma care. We compared the performance of the 20 physician groups using a novel propensity score-based risk adjustment method. More specifically, by using a multinomial logistic regression model we estimated for each patient the propensity scores, or probabilities, of having been treated by each of the 20 physician groups. To adjust for different distributions of characteristics across groups, patients cared for by a given group were first stratified into five strata based on their propensity of being in that group. Then, strata-specific performance was combined across the five strata. We compared our propensity score method to hierarchical model-based risk adjustment without using propensity scores. The impact of different risk-adjustment methods on performance was measured in terms of percentage changes in absolute and quintile ranking (AR, QR), and weighted kappa of agreement on QR. RESULTS: The propensity score-based risk adjustment method balanced the distributions of all covariates among the 20 physician groups, providing evidence for validity. The propensity score-based method and the hierarchical model-based method without propensity scores provided substantially different rankings (75 percent of groups differed in AR, 50 percent differed in QR, weighted kappa=0.69). CONCLUSIONS: We developed and tested a propensity score method for profiling multiple physician groups. We found that our method could balance the distributions of covariates across groups and yielded substantially different profiles compared with conventional methods. Propensity score-based risk adjustment should be considered in studies examining quality comparisons.     

国内外医生工作满意度与稳定性研究现状与展望

通过对国内外医生工作满意度与稳定性研究现状的综合描述与分析,指出国内外医生工作满意度与稳定性研究方面存在的薄弱环节与主要问题:研究执业环境、工作倦怠对医生工作满意度的影响较少,亟需加强对医生工作满意度的系统评价;我国对医生工作满意度研究中未涉及工作满意度量表的研制、模型的建立,主要影响因素的识别及成因的探讨等。从各级医院面临的竞争、双重管理目标、人性化管理等方面阐明在我国进行医生工作满意度与稳定性系统研究的迫切性与现实意义,并在此基础上,从研究目的、研究内容、研究方法等方面进行了展望。     

美国医生集团发展以及对我国的启示

在美国,医生集团和医生团体执业已发展成较为普遍的执业模式,并具备相对完善的法律法规体系监管其执业行为。政策方面,由联邦政府颁布《斯塔克法》(Stark Law),对医生集团(团体执业)的定义、性质、运营、服务内容进行详细规定。市场方面,建立与医生集团以及医生执业行为相关医疗保险规范,保障医生集团的执业行为。在我国,医生集团作为新生事物已得到了社会各界的普遍关注。但由于发展时间短,发展路径还在继续探索中,医生集团相关法律法规尚不健全。本文旨在总结美国医生集团的发展及监管情况,为我国医生集团的规范发展提出政策建议:完善相应法律法规;推动建立相应保障政策;加快研究和制定医生责任险;持续跟踪、正确对待、及时总结。     

Integration and retention of American physician assistants/associates working in English hospitals: A qualitative study

BackgroundHealth workforce planners in many high-income countries are considering policy strategies to retain home and overseas-trained health professionals. There is a lack of evidence on how hospitals can successfully integrate and retain skilled overseas professionals in relevant work roles. This study aimed to explore the integration and retention experiences of skilled American physician assistants/associates working in English hospitals.MethodsA qualitative study using semi-structured telephone interviews was undertaken in spring 2017 and spring 2018. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of role development.ResultsNineteen physician assistants/associates participated in interviews at timepoint one, and seventeen at timepoint two, across seven English hospitals. Four themes were identified in the integration and retention processes experienced by participants: motivations and expectations, seeking role identity, acceptance and integration, and establishing a niche role. Supervising doctors appeared instrumental in creating opportunities through training and system adjustment that enabled development of niche roles; offering an effective match between participant skills and interests, and medical/surgical team or organisational needs. Whether or not they had a niche role influenced the decision of participants to remain or leave.ConclusionIntegration approaches that maximise the value of the skilled health professional to the medical/surgical team and support retention, including development of optimum roles, require time and resources.