Research On The Contributions Of The Inappropriate Admission Behavior In County-level Hospitals

[Purpose]The purpose of this study is to rely on “un-diagnostic standards” through field research method.Firstly,we study the characteristics of inappropriate admission in the county hospitals after judging the rationality of in-patients' medical records which is extracted and inputting information from 2012 to 2016.Then,we should comprehensively analysis the decision-making behavior from both the supply and demand through the medical service process observation,while the follow-up investigation and in-depth interviews with the inpatients,combined with the theoretical analysis,we can analysis the causes of inappropriate admission to the county hospitals,and the causes' contribution mechanism and contribution effect.[Methods]1.Literature research method: Review,summary and analysis of domestic and foreign literature with the behavior research of medical service supply and demand,medical service unreasonable service,the influence factors of the medical treatment behaviors and health seeking behaviors,which lay the foundation for the research of this paper.2.Site investigation method: Selecting one county people's hospital in Gansu Province and Sichuan Province as the research lactation;Analyzing the decision-making behavior from both the supply and demand and the causes of inappropriate admission to the county hospitals through the field research,questionnaire survey,key insider interviews and other methods.3.Statistical methods: Using Epidata3.2 to build the database and recording the medical records information and the questionnaire survey data,then using SPSS12.0 to carry on descriptive statistical analysis,chi square test,regression analysis,factor analysis,and so on.[Results]1.The characteristics of inappropriate admission in the county hospitals: The irrational admission rate of county hospitals in the sample arears is 26.31%,while the irrational admission rate of X County and Y County was 28.91% and 23.63% respectively.There is a significant difference in X area and Y area.After logistic regression analysis,it was found that age,admission,hospital days,system diseases,normal health status,and whether chronic diseases or not were included in the model.2.The admission decision behavior of county hospitals: Under the field investigation of X hospital and Y hospital,the outpatients we observed were 497 cases and 418 cases respectively,in which the inpatients were 219 cases and 211 cases respectively.We found that the different hospital decision-making body plays distinct roles in the four stages of the emergence of inappropriate admission.Survey analysis shows that in county hospitals decision-maker is mainly for doctors(88.30%),while the percentages of the demand is 11.70%(penitent=18.57%,family=5.72%).3.Tracking survey shows that the factors influencing the inappropriate admission of the county hospitals has the following characteristics: Firstly,the Vulnerable population' characteristics of the treatment influence the inappropriate admission,mainly children and the elderly;Secondly,the psychology of avoiding the health risks,especially in patients with chronic diseases or focused on their own health patients,induce the inappropriate admission;Thirdly,the impact of the convenience of treatment in inappropriate admission is relatively small;Fourthly,the doctors' recommend have an important effect on the inappropriate admission;Fifthly,the health insurance system to a certain extent affected on the inappropriate admission.4.Based on the supplier's questionnaires and in-depth interviews,the research shows the reasons for the supply of inappropriate admission,such as the increasing tension between doctors and patients leads to the defensive behavior of doctors,the economic interests induce doctors induced behavior,the existence of third-party payment mechanism of medical insurance system,the lack of hospital-related hospital admission standards,the lack of the hospital internal and external regulatory mechanism.[Conclusions]1.Doctors,patients and their families are the main subject of inappropriate admission decision-making.According to the decision-making body,there can be four types of decision-making model,the “Paternalistic” decision model,the “Informed” decision model,the “Alternative” decision model and the “Shared” decision-making of the supply and the demand.The role of the four types played in different parties under different decision-making models.2.The activity between the supply under the defensive medical behavior and the induced medical behavior of the supplier and the demand with the health risk avoidance behavior and the health investment behavior,with their mutual effects,influence the inappropriate admission.The medical insurance payment system is an important contributor to the inappropriate admission behavior of the supply and the demand.3.Suggestions: For the supplier,strengthening the medical insurance supervision system,improving the medical insurance supervision system;Improving the county and township medical service system,building a new pattern of diagnosis and treatment model;strengthening the doctor's optimal role in the construction of agents,enhancing the constraints and norms of doctors' morals.For the demand,multiple ways to improve the patient's admission awareness,establishing the concept of the appropriate health seeking behavior;changing the psychology of risk aversion in the behavior ofmedical treatment behavior,promoting the rational concept of hospitalization;strengthening the health management of children and guideing parents to make proper medical treatment.