Research On The Rationality And Others Of Medical Examination

ObjeetivesMedical Examination is the necessary comPonent of modern medical health service. The study on the rationality and its relevant issues in this PaPer was helPful for PeoPle to systematically understand the basic characteristics and internal mechanism of medical examination Practice and internal mechanism in dePth; it was beneficial to guide and regulate the Practical work of medical examination, to Promote the quality of medical service, to reduce the cost of medical treatment, and to build a harmonious doctor-Patient relationship; and it can also Provide a reference for the medical administration departments to scientifically make uP the regulations for medical examination supervision and management.MethodsThe combination of the theoretical analysis and emPirical analysis methods was used in this dissertation. In Part of the theoretical analysis, a series of theories and views on medical examination rationality were demonstrated through the Pandect and sPecial toPics based on literature review and the Professional characteristics of medical examination. In the emPirical analysis, the field investigation was done, including dePth interview which investigated the knowledge and satisfaction of 329 Patients and 58 health Personnel to the work of medical technical departments of the hosPitals in Zhejiang Province and Anhui Province, and the analysis was done to the medical examination cost and the effective utilization of medical examination items of the inPatient medical information of 1496 Patients in a general hosPital of Zhejiang Province during 2008-2009.ContentsThe study was conducted on three layers:on the first layer, the basic connotation and orientation of rationality was analyzed, and the main influencing factors of medical examination rationality implementation and the evaluation standards of rationality were exPlored; on the second layer, the analysis was done to the infringement act and the undertaken duty of medical examination, the influence of medical technology to the doctor-Patient relationship and informed consent rights of Patients, sale of medical examination concePt and subculture construction; on the third layer, the emPirical analysis was done to the cognition of rationality of medical examination from the asPects of both doctor and Patients, the Patients'satisfaction to medical technical dePartment, and the medical examination cost and the effective utilization of medical examination items of the inPatients.Results1 The results of theoretical research of medical examination rationalityThe results showed that the connotation of medical examination rationality has a very wide scoPe, and there would generate the different evaluation results by the different actors from different angles, thus, PeoPle should review the medical examination rationality concretely from the history Point of view. The rationality of medical examination was the unification of instrument rationality and value rationality, the formative rationality and substantive rationality, Process rationality and outcome rationality, thus, the concePts of medical examination technicalization and Pure economics should be deserted, and objectively treat the contradiction of infinitive rationality and finitude rationality in the Practice of medical examination. The study also found that the main influence factors for the Practice of medical examination rationality included:the need-suPPly relationshiP, market regulation and the suPervision of the government, the level of the social economical develoPment and the internal suPervision and management of medical health institutions, etc.. The basic standards of evaluation mainly included:the technical rationality evaluation of medical examination, health economics evaluation, legal evolution, ethical evolution, and safety evolution, etc.2 The results for the sPecial toPics of medical examination rationalityFirst, the irrational Practice of medical examination will infringe the lawful rights of health, human dignity and ProPerty, etc.., as a result, medical institutions will undertake the civil, administrative, and criminal liabilities, such as aPology, and comPensation, etc. according to the rules of fault liability and no-fault liability.Second, the irrational develoPment and use of medical examination creates materialization of the doctor-Patient relationshiP, thus, it should balance well the relationshiPs among the innovation, suitability, and accessibility of medical examination technology; meanwhile, the informed consent rights of Patients should be resPected in the sPecial medical examination, and wisely deal with the relationshiP among the medical autonomy of Patients and the authoritative right of doctor, health benefit and economical interest of Patients.Third, in the new trend of Pilot of clinical Pathway and its imPlementation, the traditional Professional concepts of medical examination should be uPdated, and the medical institutions should actively merge into the context of clinical Pathway implementation, and imPlement the sale of medical examination concePt and creates the sPecialty characteristics and subculture of medical examination with the new concePts in the new time.3 The results of emPirical study of medical examination rationality3.1 The cognition difference between doctor and Patient to medical examination led to the diversity views towards the evaluation of medical examination.34.5% of doctors believed that medical examination was rational when it was needed in diagnose and treatment, but only 19.4% of Patients thought so. For the cognition of the significance of rational medical examination,62.7% of the doctors believed that it could enhance the quality of care and 84.5% of the doctors believed that it could imProve the doctor-Patient relationship, while there were 45% and 91.8% of Patients respectively believed so. The main factors in deciding the medical examination included diagnose need (97.3%), Patient's requirement (71.4%) and the allocation mechanism of the hosPital (84.5%) from doctor's Point of view, but 62.3%, 26.4% and 84.5% respectively for these factors from Patient's Point of view. The main causes of irrational medical examination were technical issue(79.3%) and legal issue(89.7) from the doctor's Point of view, but 49.8% and 65.7% respectively for the two causes from Patient's Point of view.3.2 It's not oPtimistic for the Patient's cognition of medical examination information, which directly influenced its rational evaluation.For the aim, indications, instructions, risk and result of the medical examination, the Percentages of the Patients who totally didn't know were 17.9%,30%,52%, 55.9% and 27.4% respectively.32.55 of Patients didn't get the information from the doctors, and only 47.4% of Patients got to know the Price of medical examination from the doctor. For the Practice of medical examination, only 49.8% of Patients were asked oPinion by the doctors,32.5% of Patients thought it was not necessary. For the cost of medical examination,55% of Patients thought that it was too exPensive, and 68.4% of Patients thought that it was unbearable.3.3 The Patient's dissatisfaction rate was very high, which would imPede the rational implementation of medical examination.The Patient's satisfaction rates to service attitude, technical level, service environment and service Procedure were 32.8%,32.8%,28.0%, and 22.2% respectively, while the dissatisfaction rates to them were 23.1%,12.6%,19.4%, and 24.6% respectively. The causes for the dissatisfaction were mainly that the Protection to Patients'informed consent, and Privacy was not enough, the collection of samPling was not familiar, the area in waiting for the examination was too narrow, and the time for examination was too long.3.4 The overall cost of medical examination was very high, which had consisted of the imPortant Part of Patient's inPatient total cost.The average cost of medical examination for the inPatients accounted for 10% of total cost, of which this rate was 17.6% in the Pediatrics. The ratio of cost of medical examination to drug cost was 20%, of which this ratio was 27.2% for surgery and 40.9% for Pediatrics. The average clinical medical examination cost of the inPatients was 50% of total medical examination cost, of which, this rate was 76.3% for the medical dePartment and 69.4% for the Pediatrics. The X-ray cost for the medical department and the Pediatrics was 20% of total examination cost, while this rate was 39.4%,50.2% and 30.3% for surgery, ENT and gynecology respectively.3.5 The overall utilization effect of medical examination items was not high, which created the waste of medical resources.The utilization rates of blood routine, stool routine, urine routine and biochemical test series for the inPatients were 1.85 times Per Patients,1.49 times Per Patients, 1.57 times Per Patients and 1.14 times Per Patients respectively, while the Positive rates for these examinations were 13.8%,8.25,8.7%, and 11.75% respectively. The utilization rates of X-ray, ultrasound and ECG were 1.34 times Per Patients,0.98 times Per Patients,1.21 times Per Patients, while the Positive rates for these examinations were 7.25,9.35, and 9.15 respectively.InnovationsFirst, the concePts of medical examination technicalization and Pure economics were broken through in the theoretical analysis. For the first time, the connotation, the main influence factors, and the standards of evaluation of medical examination rationality were discussed from the multi-dimensions with the synthesis of multidisciPlinary exPertise based on rational theories so that the theoretical thought of medical examination rationality was enriched greatly.Second, The subjective value nature of rationality evaluation was fully Paid attention in evidence analysis for the first time, and the recognition of medical examination rationality was analyzed from both sides of suPPly and need; meanwhile, the indicators, such as the level and structure of medical examination cost, the utilization rate Per Person, and the Positive rate of the utilization were first used to systematically analysis the objective factors which influenced the evaluation of medical examination rationality with inPatients as the study subject.