Behavioral Intention Mechanism Of Public Hospital Managers And Physicians On Physician Dual Practice And The Regulatory Strategy

ObjectivesThis study takes public hospital managers and physicians as the research object,with Zhejiang as a sample province,constructs the behavioral intention model on physician dual practice(PDP),and analyzes the mechanism of PDP perception on their behavior intention accordingly,so as to identify the influencing factors with strategic value and priority to improve,then put forward relevant regulatory strategies and suggestions.MethodsThrough the literature research method,this study collected and organized the related research results of PDP.Based on various theoretical models and methods,this study constructed the analysis framework and model,summed up and extracted the required variables and evaluation indexes.Through focus group discussion,experts from the government,universities,hospitals in relevant fields were invited to improve the research framework and initial scale of this study.Through preliminary survey,this study selected 6 public general hospitals in Wenzhou,Zhejiang Province,distributing 256 questionnaires for managers and 295 questionnaires for physicians.In the formal investigation,data of public hospital managers were collected by the field questionnaire survey from meetings,conferences,and training sessions for public hospital presidents held nationwide or in given districts.While data of public hospital physicians were collected by field and online questionnaires from 19 public hospitals in 8 cities of Zhejiang Province.In total,350 questionnaires for managers and 1000 questionnaires for physicians were distributed.SPSS 24.0,AMOS 24.0 were used for data processing and statistical analysis.Reliability analysis and factor analysis were used to deconstruct and test variables;structural equation model(SEM)was applied to verify the correlation degree between perceived latent variables;regression analysis was used to determine the influencing factors between PDP perception and behavioral intention.Importance-performance analysis(IPA)was introduced to identify the “urgent,critical and difficult” aspects for policy adjustment.Results(1)This study developed evaluation scale for measuring PDP perceptions and behavioral intention.Indicators of public hospital manager's evaluation scale included manager's economic risk(MER),manager's management risk(MMR),manager's benefit perception(MBP),manager's difficulty perception(MDP),manager's physician-oriented restrictions(MPR),and manager's institution-oriented restrictions(MIR),with a total of 23 items.Indicators of public hospital physician's evaluation scale included physicians' platform risk(PPR),physician's reputation risk(PRR),physician's economic risk(PER),physician's benefit perception(PBP),physician's difficulty perception(PDP)and participative behavioral intention(PBI),with a total of 25 items.(2)This study found interrelationship among PDP perceptions and perception levels.Results of SEM showed that manager's risk perception was significantly negative-correlated with benefit perception(?=-0.779,P<0.001),manager's risk perception was significantly positive-correlated with difficulty perception(?=0.556,P<0.001),and manager's difficulty perception was significantly negative-correlated with benefit perception(?=-0.246,P=0.004).The risk perception of physician was negatively correlated with benefit perception(?=-0.090,P=0.021),risk perception was positively correlated with difficulty perception(?=0.469,P<0.001),and benefit perception was not correlated with difficulty perception(P > 0.001).Factor score coefficient matrix indicated that the manager's difficulty perception factor score was2.82±0.57,the manager's risk perception factor score was 1.93±0.63,and manager's benefit perception factor score was 0.88±0.48,with MER factor score of 2.44±0.71 and MMR factor score of 2.53±0.57.Factor score of physician's benefit perception factor was 3.31±0.64,physician's risk perception factor score was 2.82±0.57,physician's difficulty perception factor score was 2.69±0.58,with platform risk factor score score 3.20±0.70,reputation risk factor score 2.63±0.54,and economic risk factor score 3.15±0.63.(3)This study analyzed the path and influence of PDP perceptions on behavioral intention.The results of multiple linear regression analysis showed the higher the management risk perception,the greater regulatory behavioral intention for managers to apply both physician-oriented restrictions(?=0.372,P<0.05)and institution-oriented restrictions(?=0.371,P<0.05).Manager's economic risk perception,benefit perception,and difficulty perception had no significant effect on their regulatory behavioral intention(P>0.05).Binary Logistic analysis showed that physician's intention to participate in PDP increased 2.981 times(95% CI:2.238-3.971)for each additional unit of Physician's benefit perception,while the physician's intention to participate in PDP decreased 0.558 units(95% CI : 0.386-0.808)for for each additional unit of physician's difficulty perception.Physician's risk perception had no significant effect on their participative behavioral intention(P>0.05).(4)This study identified the influence of basic characteristics on PDP behavioral intention.The results of multiple linear regression analysis showed that in comparison with managers at county level and above,managers below county level had stronger regulatory behavioral intention of both physician-oriented restrictions(? =0.166,P<0.05)and institution-oriented restrictions(? =0.142,P<0.05).Binary Logistic analysis showed that female physician's intention to participate in PDP was 0.523times(95% CI:0.375-0.729)that of male physician;participative behavioral intention of physician's with master's degree was 1.469 times that of undergraduate physicians(95% CI:1.015-2.128);participative behavioral intention of non-unit-assigned PDP practitioner was 6.761 times(95% CI:2.805-16.300)that of full-time physicians,but participative behavioral intention of unit-assigned PDP practitioner was 1.585 times(95% CI:1.080-2.325)that of full-time physicians.(5)This study constructed importance-performance matrix for PDP management priority and strategy improvement.For managers,IPA analysis results demonstrated that items of the management risk perception in the “continuous strengthening area”included “the decline of working hours and service supply in public hospitals(3.97,0.171)”;items in the “urgent improvement area” included “the excessive time management cost of public hospitals(3.79,0.24)”;items in the “adjustment transfer area” included “it is difficult to adjust the salary of PDP practitionersto a fixed proportion(4.03,0.07)”,“increase the difficulty of staffing and task distribution(3.89,0.05)”;items in the “maintenance area” included “the teaching effect and quality of public hospitals would be negatively affected(3.65,0.09)”.For physicians,IPA analysis results demonstrated that items of the benefit perception in the “continuous strengthening area” included “increase social awareness(3.71,0.11)”,“better personal value(3.80,0.15)”,“social respect(3.68,0.16)”;items in the “urgent improvement area” included “enhance clinical autonomy(3.63,0.12)”,“improve the clinical ability(3.61,0.10)”;items in the “adjustment transfer area” included “meet economic needs(3.80,0.08)”;items in the “maintenance area” included “increase peer-to-peer exchanges(3.58,0.07)”,“obtain the peer recognition(3.58,0.07)” and “relieve the high pressure in public hospitals(3.53,0.04);items of physician's difficulty perception in the “continuous strengthening area” included “I find it very difficult for public hospital physicians to PDP(3.46,0.22)”;items in the “urgent improvement area” included “it is hard to realize expected revenue by PDP(3.14,0.26)”;items in the “maintenance area” included “I can't get involved in PDP(3.18,0.25)”.Conclusions(1)Managers first experience difficulty,then risk,and finally benefit in PDP,and each perception is interrelated.Physicians first feel the benefit,then the risk,and finally the difficulty in PDP.Physician's benefit perception is related to their risk perception,physician's risk perception is related to their difficulty perception,but physician's difficulty perception is not related to their benefit perception.(2)Manager's regulatory behavioral intention is influenced by their management risk perception,while manager's economic risk perception,benefit perception and difficulty perception show no effect on their regulatory behavioral intention.Physician's participative behavioral intention is affected by their benefit perception and difficulty perception,but physician's risk perception show no effect on their participative behavioral intention.Among them,the motivation of physician's benefit perception to their participative behavioral intention is far greater than that of physician's difficulty perception.(3)The professional title of managers has influence on their PDP regulatory behavioral intention.Physician's gender,education level and PDP experience have influence on their participative behavioral intention.Participative behavioral intention of female physicians,undergraduate physicians,and physicians without PDP experience is relatively lower.The motivation of non-unit assignment PDP experience is much greater than that of unit assignment PDP experience.(4)It is “urgent” for policymakers to reduce the time management cost on PDP for public hospitals,and to increase the effect of PDP on improving physician's clinical autonomy and clinicalability.It is “critical” for policymakers to properly solve the crisis caused by PDP on the supply of public hospital services,andhelp physicians to achieve their personal value,increase their social respect and expand their social awareness.It is “difficult” for policymakers to help physicians to achieve their expected benefits by PDP,and make a breakthrough in facilitating public hospitals as a PDP supply-side.