| ObjectiveThis study proposed by finding out the current situation of China's doctor multi-sited licensed, including the present situation of medical personnel multi-sited licensed and doctors practising outside the hospital. To analyzes the feasibility of carrying out multipoint practising policy and the affecting factors of implementing the physician multi-point licensed policy. To classify the affecting factors and point out the influence degree of the various factors that impact on the policy implementation. According to the above analysises of feasibility and affecting factors, proposing the countermeasures and suggestions to slow or eliminate the resistance faced in the multi-point practising policy implementation, providing relevant theoretical basis and data support to implement doctor multi-sited licensed policy effectively for government.Research contents and Methods(1) Using the Literature search and information analysis method to collect domestic and abroad documents on doctor multi-sited register, find the present situation of our country's medical practice beside clinic hospitals and multi-sited pilots, also find out the problems existing in doctor multi-sited polices to provide a foundation for follow-up study.(2) Questionnaire survey: Take 5 hospitals'clinic doctors and patients as samples. The five hospitals are as follow: one tertiary hospital and one secondary hospital in Wuhan city, 2 tertiary hospitals and 1 secondary hospital in Xiangfang city. 250 questionnaires were issued among clinicians, 213 were regained, 150 questionnaires were issued among patients, and 115 were regained. Meanwhile, a series of interviews were conducted among managing staffs in 5 hospitals to understand the clinicians and patients'attitude to doctor multi-sited register in the sampling area.(3) Using quantitative description analysis, including chi-square test, Fisher's test, Logistic regression analysis to analyze the presentation performance of our country's doctor multi-sited register and the factors which influence the implementation of doctor multi-sited register policy.(4) Using stakeholder group analysis to conduct a feasibility analysis of our country's doctor multi-sited register.(5)Through SWOT analysis to analyze the influence factors of executing the doctor multi-sited register policy.(6) Through the case study on Shenzhen city's doctor multi-sited register pilots situation, it will further analyze the influence factors of executing the doctor multi-sited register policy.Research results(1) Compared to Single-point practice,46.5% of those polled doctors tend to Multi-point practice, but the rate tending to Single-point practice only accounts for 31.5%;78.4% of the investigated doctors believe that Multi-point practice will become the future development trends; 71.8% of the investigated doctors say that they will carry out Multi-point practice if policy allows. From the interviews we find the doctor's closed management mode of our country is also an important factor which prompts doctors to have high identities with multi-point practice.(2) Compared with other industries, 62.0% of the investigated clinical doctors do not satisfy with the current income level; compared to their own value and technical level, 76.5% of the investigated people do not satisfy with their own income state; and compared to the workers'income of other local health unit, the number holding on satisfaction attitude with their income level only accounts for 8.0% of the total investigation. 23.0% of those polled doctors think the performance appraisal system of their unit is useful, only 9.4% think it is very useful; only 20.6%of the investigated clinical doctors consider that incentive mechanism of their unit is reasonable or very reasonable.(3) Chinese government has begun to pay attention to the physicians practicing physicians outside the hospital since from 1989. Now that it has issued so many policy documents, we can conclude that it is willing to promote the multiple-site practice of certified practitioners. Since the policy of Doctor Multi-sited Licensed means health personnel system reform and huge risk, government is cautious on the promoting ways, advocating "incomplete" road of multi-point practice.(4) The attitudes of various types of medical institutions to multiple-site practice are very different. Public hospitals object physician multi-point practicing policy, but private-owned hospital and primary heath service institutions welcome it.(5) The public are insufficient in the knowledge of multiple-site practice. Only 20.0% patients surveyed said understanding physician multi-point practice policy.And only 42.6% of those polled patients said identity this policy.(6) The implantation of multiple-site practice policy is restricted by many factors, including physicians work situation, health personnel system, legal norms limitation and lack of corresponding supervision system. Discussion and ConclusionDiscussion (1) Practitioners are not satisfactory with their income levels, but they have the willingness of multiple-site practice. (2) Practitioners are more identity to multiple-site practice than to single-site practice. (3) Government is willing to promote the multiple-site practice of certified practitioners, but it is cautious on the promoting ways. (4) The attitudes of various types of medical institutions to multiple-site practice are very different. (5) multiple-site practice could meet patients'needs to medical services, but the public are insufficient in the knowledge of multiple-site practice. (6) The implantation of multiple-site practice policy is restricted by many factors. Conclusion (1) Improving the relative legal system to ensure the legality of doctor multi-sited licensed. (2) Deepening the reform of health personnel system to define the clear identity of doctors. (3) Strengthen the primary health care system and cultivate the public the medical philosophy: if you have serious illness, please go to the hospital, if you have minor illnesses, go to community. (4) Establish multi cited register management system to ensure it conducting in a healthy way. For that, we need to do as following: a) Establish scientific and reasonable doctor multi-sited register access system to ensure the quality of medical service. b) Eablishing classified management system, rationally guiding different doctors; c) Establish public health administrative department under the guidance of the doctor multi-sited licensed industry; d) Establish comprehensive performance appraisal system of doctor multi-sited licensed; e) Establish comprehensive and perfect risk sharing mechanism of doctor multi-sited licensed.Innovations and Limitation Innovations: This study uses a combination of stakeholder analysis, SWOT analysis and case study method to analyse various factors that affecting the implementation of doctor multi-sited register. And Suggestions were proposed.Limitation: As time and funding constraints, we just survey 5 hospitals in Hubei Wuhan and Hubei Xiangyang, the results of the study may be less representative; In the course of the survey, we didn't use the interview results fully so that the results couldn't reflect the factors fully; As the survey was conducted in the hospitals, some data might not reflect fully the true thoughts of the health professionals. |
PDF Full Text Request