Analysis Of The Effect Of Eliminating Economic Stimulus On The Quality Of Medical Service

ObjectiveThe objective of this study was to investigate the effect of eliminating economic stimulus on the quality of medical service, including the effects of the doctor-patient communication, the doctor's prescribing behavior and perception in patients with medical service quality. To provide empirical evidence for further standardizing the doctors' prescription behavior and improving medical service quality, and providing corresponding measures and suggestions for improving the quality of medical service.MethodsOn the basis of literature research, this study using the design method of field experiment, two trained investigators were divided into a group, going to the same doctor of same medical institutions as a simulating the common cold patient. The control group did not take any intervention, while the experimental group took the field intervention measures of eliminating the economic stimulus. The physicians and general practitioners in outpatient department of different level medical institutions in Wuhan were chosen as the study objects to investigate the effect of eliminating economic stimulation on the quality of medical service. A total of 126 doctors were investigated, and 252 questionnaires were obtained. Among them, 126 questionnaires were recorded from the control group and the experimental group. Using Epidata3.0 data entry software to double entry of the questionnaire and SAS9.2 software for statistical data analysis. Descriptive analysis, logistic regression model and generalized linear model were used to analysis the influence of eliminating economic stimulation on the quality of medical service.Results1. Impact of eliminating economic stimulation on the quality of communication between doctors and patientsThe proportion of inform attention matters and response politely after being thanked in control group was 69.84% and 81.00%, respectively, the proportion of inform attention matters and response politely after being thanked in experimental group was 44.44% and 54.76%. The proportion of instruct drugs usage in control group was 34.48% under the premise of prescription, the proportion of instruct drugs usage in experimental group was 20.00%. After adjusting the influence of hospitals, physician gender, age and title, there were statistically significant difference of the proportion of inform attention matters, response politely after being thanked and instruct drugs usage between the control group and the experimental group(P<0.05). The control group has a higher proportion of informing attention matters, responding politely after being thanked and instructing drugs usage than the experimental group.2. Impact of eliminating economic stimulation on doctors' prescription behaviorThe prescription rate of control group was 92.16%, the antibiotic use rate was 59.52%, the total drug expense per capita of control group was 64.70 Yuan and antibacterial drug costs per capita were 27.00 Yuan. The average number of drugs type contained in prescription of control group was 2.10; the use rate of second level antibiotic was 25.86% under the premise of prescription. In the experimental group, the prescription rate was 83.33%, the antibiotics use rate was 45.24%, the total drug expenses per capita of experimental group was 48.10 Yuan and antibacterial drug costs per capita was 18.92 Yuan. The average number of drugs type contained in prescription of experimental group was 1.86; the use rate of second level antibiotic was 15.24% under the premise of prescription. After adjusting the influence of hospitals, physician gender, age and title, there were statistically significant difference of prescription rate, the antibiotics use rate, drug expenditure and antibacterial drug expenditure between the control group and the experimental group(P<0.05). There were statistically significant difference of the average number of drugs type contained in prescription and the use rate of second level antibiotic between the control group and the experimental group under the premise of prescription(P<0.05). The control group has a higher proportion of prescription rate, the antibiotics use rate, drug expenditure, antibacterial drug expenditure, the average number of drugs type contained in prescription and the use rate of second level antibiotic than the experimental group.3. Impact of eliminating economic stimulation on the perceived service quality of patientsThe highest satisfaction of patients in control group was the degree of being respected, the average score was 3.92±0.65, followed by the overall treatment experience, the communication situation with doctor, degree of privacy protection, the doctor's ability of diagnosis and treatment, and the full extent of doctor introduce treatment program, the lowest satisfaction of patients in control group was the full extent of the doctor's explanation of the illness, the average score was 3.34 ± 0.81. The highest satisfaction of patients in experimental group was the degree of being respected, the average score was 3.84±0.89, followed by the communication situation with doctor, the overall treatment experience, degree of privacy protection, the doctor's ability of diagnosis and treatment, and the full extent of the doctor's explanation of the illness, the lowest satisfaction of patients in control group was the full extent of doctor introduce treatment program, the average score was 3.22±0.81. After adjusting the influence of hospitals, physician gender, age and title, there were statistically significant difference of satisfaction degree of the full extent of doctor introduce treatment program and overall treatment experience between the control group and the experimental group(P<0.05). The control group has a higher satisfaction of the full extent of doctor introduce treatment program and overall treatment experience than the experimental group.Conclusions and suggestionsEliminating the economic stimulus affects the quality of medical service, including the doctor-patient communication quality, doctors prescribing behavior and patient perceived service quality respectively. Reducing the proportion of doctor inform attention matters, response politely after being thanked and instruct drugs usage. Reducing the cost of prescription and improving the level in the rational use of drugs of physicians. Eliminating the economic stimulus affects the perceived service quality of patients by impacting the service quality of physiciansIt is suggested that the government should strengthen the research of the effect of economic stimulus on the quality of medical service and pay attention to the negative impact of the effect of eliminating economic stimulus on the quality of medical service. Meanwhile, the government should improve the incentive mechanism of hospital to avoid the negative impact of the effect of eliminating economic stimulus on the quality of medical service. The administration of medical institutions should allocate the human resources rationally, increase the time of doctor-patient communication, and improve the doctor-patient communication system. Rational use of medication training should be carried out regularly in hospital to improve the doctors' understanding of the importance of rational use of drugs and the level of rational drug use. In addition, the hospital's medical service should treat patients as the center; hospital should carry out patients' satisfaction survey regularly to improve the quality of patient's perception of service.