| 摘要: |
| 目的 构建我国医师多点执业制度实施困境的多级递阶结构模型，阐释各阶层间的内在逻辑，旨在为完善医师多点执业制度提供建设性策略。方法 采用文献法辅助4位卫生政策与管理专家核检，总结并归纳当前我国医师多点执业制度实施进程中的制约因素。采用解释结构模型方法解构各影响因素间的层级关系及传导环路。结果 我国医师多点执业制度实施困境的12类制约因素存在一个“四阶梯结构”与“一条传导环路”。直接因素为“医生积极性不足”及“个人利益受损威胁”，深层要素是“宏观政策的调控力不足”，通过“政策—制度—组织—个体”逐级递阶掣肘我国医师多点执业制度实施进程。结论 我国医师多点执业制度必须根植于“政策与立法”的双向保障，依赖于“制度与组织”的全面建设，才能实现“组织与个体”的协同共赢。 |
| 关键词: 医师多点执业 实施困境 解释结构模型 治理策略 |
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| Construction of the Interpretative Structural Modeling of Obstacle Factors for Physician’s Multi-sited Practice System |
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| Abstract: |
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Objective
To build a multi-level hierarchical structure model of obstacle factors for physician’s multi-sited practice system, to identify the internal logic among all strata, and to provide governance strategies to develop physician’s multi-sited practice system. Methods Data collection mainly used literature method, complementing with the checklist method by experts in field of health policy and management to summarize and conclude the restrictive factors in the process of the implementation of the current practice of the physician’s multi-sited practice system in China. Interpretative Structural Modeling was performed to analyze the logic among factors. Results 12 classes of implementation dilemma of physician’s multi-sited practice system exists the phenomenon of “four staircase structure” and “a transmission loop”. The directly obstacle factors of the physician’s multi-sited practice system are “insufficient motivation of physician” and “risk of personal benefit lost”, and the internal core drivers factors are “macro policy regulation failure”, which together hindered the implementation of physician’s multi-sited practice system mainly through the pathway of Policy-System-Organization-Individual. Conclusion The implementation of physician’s multi-sited practice system must be rooted in the two-way security by “policy and legislation”, and rely on the comprehensive construction by “system and organization”, to achieve the win-win together on the “organization and the individual”. |
| Key words: physician’s multi-sited practice system,dilemma,interpretative structural modeling,governance strategy |
