王淑红 孙泽生

[摘要] 目的 評估医生群体对卫生资源下沉改革的认知和反应。 方法 基于马斯洛需求层次理论设计调研问卷并从浙江36家参与改革医院收集671份有效问卷，使用描述性统计、方差分析和有序Logistic模型进行研究。 结果 卫生资源下沉改革提升了医生感知到的医患信任并促进了人力资本溢出，医生群体对改革效果评价、支持度和改革参与意愿较高，但对医生安全保护、医疗服务价格和基层工作激励政策评价较低，医生亲历和感知到所就职医院存在较高的医疗暴力发生率。受访医生群体从所受医学教育和医院体系中很难获得反医疗暴力知识和技能，高暴力发生率负面影响医生的工作积极性，增加了其识别高风险患者、采取防御性医疗行为的激励。 结论 卫生资源下沉改革效果与医疗环境改善密切相关，应加强卫生政策和职业安全教育和培训，以更完善的反暴力制度框架推动卫生资源下沉改革效果的提升。

[关键词] 卫生资源下沉改革;医生;医疗环境;医疗暴力;人力资本溢出

[中图分类号] R195          [文献标识码] C          [文章编号] 1673-9701（2021）10-0152-06

Doctors′ cognition and response to the health resources subsidence reform in Zhejiang Province

WANG Shuhong1， 2   SUN Zesheng3

1.Department of Stomatology，Zhejiang Provincial Tongde Hospital，Hangzhou   310012，China; 2.Department of Stomatology，Aksu District First People′s Hospital in Xinjiang Uygur Autonomous Region，Aksu  843000，China; 3. Business School，Shanghai Normal University，Shanghai  200234，China

[Abstract] Objective To evaluate the cognition and response of doctors to the reform of health resources subsidence. Methods Questionnaires were designed based on Maslow's needs hierarchy theory and 671 valid questionnaires were collected from 36 hospitals that participated reform in Zhejiang province. Descriptive statistics，analysis of variance and ordered Logistic model were used for the study. Results Health resources subsidence reform promoted the doctor perceived doctor-patient trust and promoted the human capital overflow.The effect evaluation，support degree and participation intention of the reform were higher among doctors. But the price of safety protection，medical services to the doctor and grass-roots work incentive policy evaluation was low. The doctor experienced and perceived there was a higher incidence of medical violence. It is difficult for the interviewed doctors to acquire anti-medical violence knowledge and skills from the medical education and hospital system. The high incidence of violence negatively affects the work enthusiasm of doctors and increases their incentive to identify high-risk patients and adopt defensive medical behaviors. Conclusion The effect of health resources subsidence reform is closely related to the improvement of medical environment. Health policies and occupational safety education and training should be strengthened to promote the effect of health resources subsidence reform with a more perfect anti-violence institutional framework.

[Key words] Health resources subsidence reform; Doctor; Medical environment; Medical violence; Human capital overflow

中国医疗市场长期存在严重的资源配置不均衡问题，其不仅导致以城市高等级医院拥堵和基层医院资源闲置为表征的结构性拥堵，而且引起了趋于恶化的医疗环境和医疗暴力问题。因2009年启动的新医改主要专注于医药价格和基础设施投资，未能充分影响基层医院的诊疗能力并吸引患者回归[1-2]。……