CAJ | 학술논문

目的：了解医事服务费试点后医生在薪酬和工作方面发生的变化。方法选择北京市某三级甲等综合医院作为研究现场，该院自2012年9月启动“医药分开”试点。依据滚雪球法确定样本，按照信息饱和原则决定访谈样本量，采用个人深入访谈法，对1名医院中层管理者和14名医护人员进行访谈。访谈核心内容包括医事服务费试点前后院科薪酬分配方式、个人薪酬构成、试点后薪酬增长量；试点前后被访者日常工作内容、工作量方面发生的改变以及对当前薪酬与工作量的匹配程度、对医生劳动价值的体现程度等个人看法。采用MAXQDA10对访谈资料进行编码分析。结果试点后，医生薪酬构成中增加医事服务费一项，其每月薪酬总数增加，门诊量大、职称高的医生薪酬增加幅度较大。以药物治疗为主的内科诊室门诊量增长明显，以技术治疗为主的外科和口腔科，门诊量变化不大。在其他政策并行推进后，大处方、不合理处方现象得到改善。结论医事服务费的设立使医生薪酬数量增加，体现医生劳动价值；规范医生诊疗行为的同时，也使不同科室医生的工作量发生改变。
목적：료해의사복무비시점후의생재신수화공작방면발생적변화。방법선택북경시모삼급갑등종합의원작위연구현장，해원자2012년9월계동“의약분개”시점。의거곤설구법학정양본，안조신식포화원칙결정방담양본량，채용개인심입방담법，대1명의원중층관리자화14명의호인원진행방담。방담핵심내용포괄의사복무비시점전후원과신수분배방식、개인신수구성、시점후신수증장량；시점전후피방자일상공작내용、공작량방면발생적개변이급대당전신수여공작량적필배정도、대의생노동개치적체현정도등개인간법。채용MAXQDA10대방담자료진행편마분석。결과시점후，의생신수구성중증가의사복무비일항，기매월신수총수증가，문진량대、직칭고적의생신수증가폭도교대。이약물치료위주적내과진실문진량증장명현，이기술치료위주적외과화구강과，문진량변화불대。재기타정책병행추진후，대처방、불합리처방현상득도개선。결론의사복무비적설립사의생신수수량증가，체현의생노동개치；규범의생진료행위적동시，야사불동과실의생적공작량발생개변。
Objective To investigate the changes in doctors' remuneration and work after the setting of medical service charge. Methods We chose a third - grade class A general hospital in Beijing as the researching spot. The hospital was designated as a pilot of " service and medication separation" . We determined the samples by the snowball method, and determined the sample volume for interviews according to the information saturation principle. By in-depth individual interview method,we conducted interviews with a middle manager and 14 health workers. The interview content included the changes of remuneration distribution pattern and individual remuneration makeup after pilot program began,remuneration increment after pilot program began,changes of daily work content and work volume after pilot program began,the matching degree between remuneration and work volume and the realization degree of doctors' value. The data from interviews were coded and analyzed by MAXQDA10. Results After the pilot program began,the remuneration items of doctor were added with medical service charge, monthly remuneration of doctor increased,outpatient service volume increased,and the doctors with highest professional titles had the largest increasing range in remuneration. Internal medicine departments with drug therapy as the main service content had the largest increase in outpatient service volume,and the departments of surgery and stomatology with technical therapy as the main service content had little change in outpatient service volume. With the concurrent implementation of other policies, extraordinary prescription and unreasonable prescription were curbed to some extent. Conclusion The setting of medical service charge can increase the remuneration of doctors,realize the value of doctors,standardize the diagnosis and treatment behaviors of doctors and bring changes to the work volume of doctors in different departments.