我国公立医院医生的价值医疗服务动机探究——概念建构与量表测度

健康中国建设行动彰显了以患者为中心的价值医疗理念，对医生医疗服务行为的价值诉求也日益提高。本研究试图将一般公共组织中公共服务动机概念引入公立医院之中，提出“价值医疗服务动机”概念，作为公立医院医生的一种公共服务动机表达。本文通过质性分析和量化测度，建构出“公立医院医生价值医疗服务动机”的概念，包含责任承诺、专业坚守、声誉维护、规范遵从四个概念维度，据此形成价值医疗服务动机量表。研究发现我国公立医院医生具有多维价值特征的医疗服务动机，呈现不同动机表达或行为倾向，在实现以患者为中心的价值医疗目标实践中，不断处理与平衡其中的公共价值冲突。该量表能够为测度医生价值医疗服务动机提供有效工具，为进一步发现医生价值医疗服务动机的影响因素，提升公立医院医疗服务能力、改善医疗行为、促进医患信任等提供理论与实践支持。

Exploring doctors'' motivation of value-based health care delivery in public hospitals in China：Concept construction and measurement

The Healthy China construction initiative highlights the concept of patient-centered value-based health care, and the value appeal of doctor''s medical service is also increasing. This study attempts to introduce the concept of public service motivation in general public organizations into professional public healthcare organizations——public hospitals, and proposes the concept of “value-based medical service motivation” as an expression of public service motivation for doctors in public hospitals. Through qualitative analysis and quantitative measurement, this paper constructs the concept of “public hospital doctor''s value-based medical service motivation”, finds its conceptual structure, namely responsibility commitment, professional adherence, reputation maintenance, and norm compliance, and finally forms a value-based medical service motivation scale. This paper confirms that doctors in public hospitals in China have multi-dimensional value-based medical service motivation, present different motivational expressions or behavioral tendencies, and constantly deal with and balance the public value tensions in the practice of realizing the patient-centered value-based medical goal. This scale provides an effective tool for measuring doctors'' value-based service motivation, and provides theoretical and practical support for further investigating the influencing factors of doctors'' motivation for value-based medical services, improving the medical service capacity of public hospitals, adjusting medical behavior, and advancing doctor-patient trust.