Research On Status Of The Multiple-site Physician Practice Policy Under The Hierarchical Diagnosis System

ObjectivesHow to enhancing medical resource and solving the difficulty medical service and medical treatment is always the concern of the Chinese government about people's livelihood issues.The main trend of Chinese medical reform is to active the quality medical service and provide better medical treatment to people.In2009,the government of China introduced the policy of multiple-site physician practice,even though the policy continued to advance,it was still in “inactive” situation.In 2015,the hierarchical diagnosis system was in substantial promote stage,the number of hospital's physicians was increased while hospitals began to take meastures to medical partnership.This research treated the hospital's physicians as the sample of study.Investigating and compareing these physicians to their understanding,attitude,willingness and implementation status during 2015 to 2016(period of hierarchical diagnosis system),in order to provide a theoretical basis for Chinese government of multiple-site physician practice.MethodsThis research used convenience sampling as the research tool.Questionnaire survey of physicians at Henan,Sichuan,Beijing and Guangzhou province And 10 hospital physicians were invited to completing semi-structure interview.Then these resources were analysed and processed into categories;based on these resources,bunch of information was gotten and classified into a database and The Research On Status of Multiple-site Physician Practice under Hierarchical Diagnosis System was designed.The research questionnaire consisted of five sections,which is policy understanding,cognitive and attitude,implemented status and problem of hierarchical diagnosis system.Questionnaires were conducted on 2015(n=420)and2016(n=365)the physicians who meet qualification of multiple-site practice.then a database was established by the collected questionnaires.The data was input and analyzed by EXCEL2007 and processed by SPSS17.0.Couple of statistical methods were used in the research,such as statistical description,project analysis,reliability analysis,chi-square test,etc.ResultsIn part of policy understanding,the survey results indicated that there is significant difference between 2015 and 2016(p<0.01).In 2016,hospital's physicians understanding of the policy more clearly than 2015.In the part of “cognitive and attitude”,the two survey results indicated that hospital' physicians hold the high positive attitude to multiple-site physician practice and there was no significant difference in the two years(p>0.05).The willingness of application had an increase,in 2016,and the two surveys had statistical significance(p<0.05).The survey about the question of the direction of multiple-site physician practice policy is to increase income,the result indicated more than 90% hospitals' physicians did not treat the revenue increasing as their direction of application,and also two surveys did not have significant difference(P>0.05).The question of the implementation in multiple-site physician practice conflict with their own works,the result of the two surveys had statistical difference(p<0.05).In 2016,implementing multi-site practice have negative impact on their works and the survey had statistical significance(p<0.05).The questions of the policy influenced in order of medical service management,increase the difficulty in management and decrease the health care's quality,and comparing between the year of 2016 and 2015 shows,the policy increasing the difficulty of management and decreasing health care's quality,in 2016.The question of policy increasing risk for adverse events,two surveys had statistical significance(p<0.05),and in2016,the result indicated which had a relatively reduction comparing with 2015.The question of hospital adminstrators' attitude impact on the implementation of policy had statistical significance(p<0.05),in 2016,the atitude of opposition have reduced.The question of personnel system of China have influence on multiple-site physician practice,indicated in two results(2015 and 2016)had no difference,there was no statistical difference(P>0.05).In 2016,the number of participation in multiple-site physician practice increased after the year of 2015,and the result had statistical significance(p<0.05).In 2016,the number of people sponsored by hospital to take part in the multiple-site physician practice increased comparing with the year of 2015,and the result had statistical significance(p<0.05).The circumstance of second working site,in the year of 2016 was better than2015,the result had statistical significance(p<0.05).In 2016 compared with 2015,the proportion of multiple-site physician practice places increased among the county-level hospitals and the township health centers decreased.The question of hospital's physicians hold office at second working site,in 2016,the number of people decreased in the comparison with 2015,the result had statistical significance(p<0.05).The question of the formation of multiple-site physician practice,the form of elastic visits and resident visits had difference between two years,the result had statistical difference(p<0.05).Research conclusionsThe implementation of hierarchical diagnosis system has a promoting effect on the implementation of Physician multiple-site physician practice.Especially,the hierarchical diagnosis system into the substantive promotion phase,hospital physicians of the multiple-site physician practice began to increasing.However,under the current medical circumstance,as the lack related policies and measures,the physician's are burdened the great work pressure,personnel management immobilized,worried about the limitation of their career,concerned about medical safety,self-application multiple-site physician practice is still notoptimistic,therefore,the Chinese government should main to promoting the hospital's physician multiple-site practice.Countermeasures and recommendations1.Increase the publicity of multiple-site physician practice,needs a long-term planning and progressive developing.2.The implementation and promotion of multiple-site physician practice,need the related policies and measures.3.In considering the profits of multiple-site physician practice,should also take consideration of the profits of the first practice site at the same time.4.Under the current work pressures of physicians,the self-application multiple-site physician practice is powerless,5.To solve the problem of grassroots talent,should based on long-term and multiple-level personnel training.