医疗检查合理性及其相关问题研究
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摘要
一、研究目的
医疗检查是现代医疗服务不可或缺的重要组成部分。本文对医疗检查合理性及其相关问题的研究,有助于人们更深入、系统地了解医疗检查实施行为的基本特征和内在机理,有利于针对性地指导和规范医疗检查的实务工作,从而提高医疗服务质量、降低医疗服务费用和建立和谐医患关系,也可为医疗卫生主管部门科学性地制定医疗检查监督管理规范提供参考依据。
二、研究方法
本论文运用了理论分析和实证分析相结合的研究方法。理论分析部分主要结合文献资料、医疗服务宗旨和医疗检查的职业特点,通过总论和专题相结合的理论分析方式,对医疗检查合理性的内涵与评价等问题进行了理论阐述和论证。实证分析部分主要运用现场调查法,一是运用深入访谈法调查了浙江、安徽6家医院的329例患者和58例医务人员,研究了医患双方对医疗检查合理性及其相关问题的主观认知情况；二是通过医疗机构病案管理系统收集浙江地区某综合性医院2008-2009年期间1496例患者的住院医疗信息资料,分析其医疗检查的费用和有效使用情况。
三、研究内容
本文围绕医疗检查合理性问题,共分三个层面展开研究：第一层面阐述了合理性的基本内涵及理性定位,探讨了医疗检查合理实施的主要影响因素和评价标准。第二层面专题剖析了医疗检查的侵权行为及责任承担、医疗检查技术对医患关系和患者知情同意权的影响、以及临床路径实施新形势下医疗检查的观念营销和亚文化建设。第三层面实证分析了医患双方对医疗检查合理性的认知、患者对医技科室满意度、住院患者医疗检查的费用和有效使用等状况。
四、研究结果
1医疗检查合理性的理论研究结果
研究发现,医疗检查合理性的内涵相当宽泛,不同的行为主体,从不同的视角出发,会产生不同的评价结果。因此,人们应具体、历史地审视医疗检查的合理性问题。医疗检查合理性之理性应该是工具理性和价值理性的统一、形式理性和实质理性的统一、程序理性和结果理性的统一,应摒弃医疗检查技术主义和纯经济观念,客观地看待和处理医疗检查实施中的无限理性和有限理性的矛盾。同时,研究还发现,影响医疗检查合理实施的主要因素有医疗检查的供求状况、市场调节和政府监管、社会经济发展水平以及医疗机构内部的监督管理等,医疗检查合理性评价的基本标准主要包括医疗检查的技术合理性评价、卫生经济评价、合法性评价、伦理性评价和安全性评价等。
2医疗检查合理性的相关问题研究结果
第一,医疗检查不合理实施会侵犯到患者的生命健康权、人格权和财产权等合法权益,从而依据过错责任、无过错责任等原则,可能承担道歉、赔偿等民事责任,以及行政和刑事法律责任。第二,医疗检查不合理的开发和使用造成了医患关系物化,因此,应该处理好医疗检查技术的创新性、适用性和可及性关系；同时,特殊医疗检查中还应尊重患者的知情同意权,妥善对待患者的医疗自主权和医务人员医疗权威的关系、患者健康利益和经济利益的关系。第三,在我国临床路径逐步试行和实施的新形势下,应该更新医疗检查传统职业思想,积极融入到临床路径实施的大环境中,主动实施医疗检查的观念营销,着力打造体现新时期医疗检查专业特色和医疗服务新理念的医疗检查亚文化。
3医疗检查合理性的实证研究结果
3.1医患双方对医疗检查合理性的认知差异,会导致对医疗检查评价的分歧
34.5%的医务人员认为诊疗需要的医疗检查即为合理,而患者持此观点只有19.4%。对于合理检查意义的认知,医务人员认为可以提高医疗质量和改善医患关系的分别占62.7%和84.5%,而患者分别为45.0%和91.8%。对于实施医疗检查的主要考虑因素,医务人员认为是诊疗需要、患者要求和医院分配机制的分别占97.3%、71.4%和72.4%,而患者分别为62.3%、26.4%和84.5%。对不合理医疗检查的主要原因,医务人员认为是技术问题和法律问题的分别占79.3%和89.7%,而患者分别为49.8%、65.7%。
3.2患者对医疗检查信息的认知不容乐观,直接影响对医疗检查的合理评价
对医疗检查目的、适应症、注意事项、危险性和检查结果,患者完全不了解的分别占17.9%、30.0%、52.0%、55.9%、和27.4%。32.5%的患者不是从医务人员处知晓医疗检查结果,从医务人员处知晓医疗检查价格的只有47.4%。对于所实施的医疗检查,只有49.8%的患者被征求过意见,32.5%的认为完全不必要。对于医疗检查费用,55%的患者认为太贵,68.4%的觉得不能承受。
3.3患者对医技科室工作的不满意率较高,将阻碍医疗检查的合理实施
患者对医技科室的服务态度、技术水平、服务环境和服务流程感到很满意的分别只有32.8%、32.8%、28.0%和22.2%,而感到不满意的分别有23.1%、12.6%、19.4%和24.6%。不满意主要集中表现在医技人员对患者知情权和隐私权保护的重视不够、标本采集的不熟练、候检区域狭窄和检查时间过长等方面。
3.4医疗检查费用整体较高,已构成患者住院总费用的重要部分
住院患者的医疗检查费用平均占住院总费用的10%左右,其中,儿科为17.6%；医疗检查费用和药费的相对比在20%左右,其中,外科和儿科分别为27.2%和40.9%。住院患者的临床检验费平均占检查总费用的50%左右,其中,内科和儿科分别为76.3%和69.4%；内科和儿科的放射费大约占检查总费用的20%,而外科、五官科和妇科分别为39.4%、50.2%和30.3%。
3.5医疗检查项目的使用效果整体不高,造成了医疗资源的浪费
住院患者对血常规、粪便常规、尿常规和生化系列等检验项目的使用率分别为1.85、1.49、1.57和1.14次/人,其阳性率分别为13.8%、8.2%、8.7%和11.7%。对X线、B超和心电图的使用率分别为1.34、0.96和1.21次/人,其阳性率分别为7.2%、9.3%和9.1%。
五、研究创新
第一,理论研究方面,本课题研究突破了医疗检查合理性评价的技术主义观念和纯经济思想,以理性理论为研究基点,首次阐述了医疗检查合理性的具体内涵。同时,综合运用多学科专业知识,创新性地多维度、多视角探讨了合理检查的评价标准,一定程度补充了医疗检查合理性的研究理论。
第二,实证研究方面,本课题首次调查了不同特征的医疗检查供求双方主体对医疗检查合理性及其相关问题的认知情况,以此剖析了医疗检查合理性评价的主观影响因素；同时,首次专题分析了医疗检查的费用水平和结构,以及人均使用率和阳性率等指标,以此解读了医疗检查合理性评价的客观影响因素。
Objeetives
Medical Examination is the necessary comPonent of modern medical health service. The study on the rationality and its relevant issues in this PaPer was helPful for PeoPle to systematically understand the basic characteristics and internal mechanism of medical examination Practice and internal mechanism in dePth; it was beneficial to guide and regulate the Practical work of medical examination, to Promote the quality of medical service, to reduce the cost of medical treatment, and to build a harmonious doctor-Patient relationship; and it can also Provide a reference for the medical administration departments to scientifically make uP the regulations for medical examination supervision and management.
Methods
The combination of the theoretical analysis and emPirical analysis methods was used in this dissertation. In Part of the theoretical analysis, a series of theories and views on medical examination rationality were demonstrated through the Pandect and sPecial toPics based on literature review and the Professional characteristics of medical examination. In the emPirical analysis, the field investigation was done, including dePth interview which investigated the knowledge and satisfaction of 329 Patients and 58 health Personnel to the work of medical technical departments of the hosPitals in Zhejiang Province and Anhui Province, and the analysis was done to the medical examination cost and the effective utilization of medical examination items of the inPatient medical information of 1496 Patients in a general hosPital of Zhejiang Province during 2008-2009.
Contents
The study was conducted on three layers:on the first layer, the basic connotation and orientation of rationality was analyzed, and the main influencing factors of medical examination rationality implementation and the evaluation standards of rationality were exPlored; on the second layer, the analysis was done to the infringement act and the undertaken duty of medical examination, the influence of medical technology to the doctor-Patient relationship and informed consent rights of Patients, sale of medical examination concePt and subculture construction; on the third layer, the emPirical analysis was done to the cognition of rationality of medical examination from the asPects of both doctor and Patients, the Patients'satisfaction to medical technical dePartment, and the medical examination cost and the effective utilization of medical examination items of the inPatients.
Results
1 The results of theoretical research of medical examination rationality
The results showed that the connotation of medical examination rationality has a very wide scoPe, and there would generate the different evaluation results by the different actors from different angles, thus, PeoPle should review the medical examination rationality concretely from the history Point of view. The rationality of medical examination was the unification of instrument rationality and value rationality, the formative rationality and substantive rationality, Process rationality and outcome rationality, thus, the concePts of medical examination technicalization and Pure economics should be deserted, and objectively treat the contradiction of infinitive rationality and finitude rationality in the Practice of medical examination. The study also found that the main influence factors for the Practice of medical examination rationality included:the need-suPPly relationshiP, market regulation and the suPervision of the government, the level of the social economical develoPment and the internal suPervision and management of medical health institutions, etc.. The basic standards of evaluation mainly included:the technical rationality evaluation of medical examination, health economics evaluation, legal evolution, ethical evolution, and safety evolution, etc.
2 The results for the sPecial toPics of medical examination rationality
First, the irrational Practice of medical examination will infringe the lawful rights of health, human dignity and ProPerty, etc.., as a result, medical institutions will undertake the civil, administrative, and criminal liabilities, such as aPology, and comPensation, etc. according to the rules of fault liability and no-fault liability.
Second, the irrational develoPment and use of medical examination creates materialization of the doctor-Patient relationshiP, thus, it should balance well the relationshiPs among the innovation, suitability, and accessibility of medical examination technology; meanwhile, the informed consent rights of Patients should be resPected in the sPecial medical examination, and wisely deal with the relationshiP among the medical autonomy of Patients and the authoritative right of doctor, health benefit and economical interest of Patients.
Third, in the new trend of Pilot of clinical Pathway and its imPlementation, the traditional Professional concepts of medical examination should be uPdated, and the medical institutions should actively merge into the context of clinical Pathway implementation, and imPlement the sale of medical examination concePt and creates the sPecialty characteristics and subculture of medical examination with the new concePts in the new time.
3 The results of emPirical study of medical examination rationality
3.1 The cognition difference between doctor and Patient to medical examination led to the diversity views towards the evaluation of medical examination.
34.5% of doctors believed that medical examination was rational when it was needed in diagnose and treatment, but only 19.4% of Patients thought so. For the cognition of the significance of rational medical examination,62.7% of the doctors believed that it could enhance the quality of care and 84.5% of the doctors believed that it could imProve the doctor-Patient relationship, while there were 45% and 91.8% of Patients respectively believed so. The main factors in deciding the medical examination included diagnose need (97.3%), Patient's requirement (71.4%) and the allocation mechanism of the hosPital (84.5%) from doctor's Point of view, but 62.3%, 26.4% and 84.5% respectively for these factors from Patient's Point of view. The main causes of irrational medical examination were technical issue(79.3%) and legal issue(89.7) from the doctor's Point of view, but 49.8% and 65.7% respectively for the two causes from Patient's Point of view.
3.2 It's not oPtimistic for the Patient's cognition of medical examination information, which directly influenced its rational evaluation.
For the aim, indications, instructions, risk and result of the medical examination, the Percentages of the Patients who totally didn't know were 17.9%,30%,52%, 55.9% and 27.4% respectively.32.55 of Patients didn't get the information from the doctors, and only 47.4% of Patients got to know the Price of medical examination from the doctor. For the Practice of medical examination, only 49.8% of Patients were asked oPinion by the doctors,32.5% of Patients thought it was not necessary. For the cost of medical examination,55% of Patients thought that it was too exPensive, and 68.4% of Patients thought that it was unbearable.
3.3 The Patient's dissatisfaction rate was very high, which would imPede the rational implementation of medical examination.
The Patient's satisfaction rates to service attitude, technical level, service environment and service Procedure were 32.8%,32.8%,28.0%, and 22.2% respectively, while the dissatisfaction rates to them were 23.1%,12.6%,19.4%, and 24.6% respectively. The causes for the dissatisfaction were mainly that the Protection to Patients'informed consent, and Privacy was not enough, the collection of samPling was not familiar, the area in waiting for the examination was too narrow, and the time for examination was too long.
3.4 The overall cost of medical examination was very high, which had consisted of the imPortant Part of Patient's inPatient total cost.
The average cost of medical examination for the inPatients accounted for 10% of total cost, of which this rate was 17.6% in the Pediatrics. The ratio of cost of medical examination to drug cost was 20%, of which this ratio was 27.2% for surgery and 40.9% for Pediatrics. The average clinical medical examination cost of the inPatients was 50% of total medical examination cost, of which, this rate was 76.3% for the medical dePartment and 69.4% for the Pediatrics. The X-ray cost for the medical department and the Pediatrics was 20% of total examination cost, while this rate was 39.4%,50.2% and 30.3% for surgery, ENT and gynecology respectively.
3.5 The overall utilization effect of medical examination items was not high, which created the waste of medical resources.
The utilization rates of blood routine, stool routine, urine routine and biochemical test series for the inPatients were 1.85 times Per Patients,1.49 times Per Patients, 1.57 times Per Patients and 1.14 times Per Patients respectively, while the Positive rates for these examinations were 13.8%,8.25,8.7%, and 11.75% respectively. The utilization rates of X-ray, ultrasound and ECG were 1.34 times Per Patients,0.98 times Per Patients,1.21 times Per Patients, while the Positive rates for these examinations were 7.25,9.35, and 9.15 respectively.
Innovations
First, the concePts of medical examination technicalization and Pure economics were broken through in the theoretical analysis. For the first time, the connotation, the main influence factors, and the standards of evaluation of medical examination rationality were discussed from the multi-dimensions with the synthesis of multidisciPlinary exPertise based on rational theories so that the theoretical thought of medical examination rationality was enriched greatly.
Second, The subjective value nature of rationality evaluation was fully Paid attention in evidence analysis for the first time, and the recognition of medical examination rationality was analyzed from both sides of suPPly and need; meanwhile, the indicators, such as the level and structure of medical examination cost, the utilization rate Per Person, and the Positive rate of the utilization were first used to systematically analysis the objective factors which influenced the evaluation of medical examination rationality with inPatients as the study subject.
医疗检查是现代医疗服务不可或缺的重要组成部分。本文对医疗检查合理性及其相关问题的研究,有助于人们更深入、系统地了解医疗检查实施行为的基本特征和内在机理,有利于针对性地指导和规范医疗检查的实务工作,从而提高医疗服务质量、降低医疗服务费用和建立和谐医患关系,也可为医疗卫生主管部门科学性地制定医疗检查监督管理规范提供参考依据。
二、研究方法
本论文运用了理论分析和实证分析相结合的研究方法。理论分析部分主要结合文献资料、医疗服务宗旨和医疗检查的职业特点,通过总论和专题相结合的理论分析方式,对医疗检查合理性的内涵与评价等问题进行了理论阐述和论证。实证分析部分主要运用现场调查法,一是运用深入访谈法调查了浙江、安徽6家医院的329例患者和58例医务人员,研究了医患双方对医疗检查合理性及其相关问题的主观认知情况；二是通过医疗机构病案管理系统收集浙江地区某综合性医院2008-2009年期间1496例患者的住院医疗信息资料,分析其医疗检查的费用和有效使用情况。
三、研究内容
本文围绕医疗检查合理性问题,共分三个层面展开研究：第一层面阐述了合理性的基本内涵及理性定位,探讨了医疗检查合理实施的主要影响因素和评价标准。第二层面专题剖析了医疗检查的侵权行为及责任承担、医疗检查技术对医患关系和患者知情同意权的影响、以及临床路径实施新形势下医疗检查的观念营销和亚文化建设。第三层面实证分析了医患双方对医疗检查合理性的认知、患者对医技科室满意度、住院患者医疗检查的费用和有效使用等状况。
四、研究结果
1医疗检查合理性的理论研究结果
研究发现,医疗检查合理性的内涵相当宽泛,不同的行为主体,从不同的视角出发,会产生不同的评价结果。因此,人们应具体、历史地审视医疗检查的合理性问题。医疗检查合理性之理性应该是工具理性和价值理性的统一、形式理性和实质理性的统一、程序理性和结果理性的统一,应摒弃医疗检查技术主义和纯经济观念,客观地看待和处理医疗检查实施中的无限理性和有限理性的矛盾。同时,研究还发现,影响医疗检查合理实施的主要因素有医疗检查的供求状况、市场调节和政府监管、社会经济发展水平以及医疗机构内部的监督管理等,医疗检查合理性评价的基本标准主要包括医疗检查的技术合理性评价、卫生经济评价、合法性评价、伦理性评价和安全性评价等。
2医疗检查合理性的相关问题研究结果
第一,医疗检查不合理实施会侵犯到患者的生命健康权、人格权和财产权等合法权益,从而依据过错责任、无过错责任等原则,可能承担道歉、赔偿等民事责任,以及行政和刑事法律责任。第二,医疗检查不合理的开发和使用造成了医患关系物化,因此,应该处理好医疗检查技术的创新性、适用性和可及性关系；同时,特殊医疗检查中还应尊重患者的知情同意权,妥善对待患者的医疗自主权和医务人员医疗权威的关系、患者健康利益和经济利益的关系。第三,在我国临床路径逐步试行和实施的新形势下,应该更新医疗检查传统职业思想,积极融入到临床路径实施的大环境中,主动实施医疗检查的观念营销,着力打造体现新时期医疗检查专业特色和医疗服务新理念的医疗检查亚文化。
3医疗检查合理性的实证研究结果
3.1医患双方对医疗检查合理性的认知差异,会导致对医疗检查评价的分歧
34.5%的医务人员认为诊疗需要的医疗检查即为合理,而患者持此观点只有19.4%。对于合理检查意义的认知,医务人员认为可以提高医疗质量和改善医患关系的分别占62.7%和84.5%,而患者分别为45.0%和91.8%。对于实施医疗检查的主要考虑因素,医务人员认为是诊疗需要、患者要求和医院分配机制的分别占97.3%、71.4%和72.4%,而患者分别为62.3%、26.4%和84.5%。对不合理医疗检查的主要原因,医务人员认为是技术问题和法律问题的分别占79.3%和89.7%,而患者分别为49.8%、65.7%。
3.2患者对医疗检查信息的认知不容乐观,直接影响对医疗检查的合理评价
对医疗检查目的、适应症、注意事项、危险性和检查结果,患者完全不了解的分别占17.9%、30.0%、52.0%、55.9%、和27.4%。32.5%的患者不是从医务人员处知晓医疗检查结果,从医务人员处知晓医疗检查价格的只有47.4%。对于所实施的医疗检查,只有49.8%的患者被征求过意见,32.5%的认为完全不必要。对于医疗检查费用,55%的患者认为太贵,68.4%的觉得不能承受。
3.3患者对医技科室工作的不满意率较高,将阻碍医疗检查的合理实施
患者对医技科室的服务态度、技术水平、服务环境和服务流程感到很满意的分别只有32.8%、32.8%、28.0%和22.2%,而感到不满意的分别有23.1%、12.6%、19.4%和24.6%。不满意主要集中表现在医技人员对患者知情权和隐私权保护的重视不够、标本采集的不熟练、候检区域狭窄和检查时间过长等方面。
3.4医疗检查费用整体较高,已构成患者住院总费用的重要部分
住院患者的医疗检查费用平均占住院总费用的10%左右,其中,儿科为17.6%；医疗检查费用和药费的相对比在20%左右,其中,外科和儿科分别为27.2%和40.9%。住院患者的临床检验费平均占检查总费用的50%左右,其中,内科和儿科分别为76.3%和69.4%；内科和儿科的放射费大约占检查总费用的20%,而外科、五官科和妇科分别为39.4%、50.2%和30.3%。
3.5医疗检查项目的使用效果整体不高,造成了医疗资源的浪费
住院患者对血常规、粪便常规、尿常规和生化系列等检验项目的使用率分别为1.85、1.49、1.57和1.14次/人,其阳性率分别为13.8%、8.2%、8.7%和11.7%。对X线、B超和心电图的使用率分别为1.34、0.96和1.21次/人,其阳性率分别为7.2%、9.3%和9.1%。
五、研究创新
第一,理论研究方面,本课题研究突破了医疗检查合理性评价的技术主义观念和纯经济思想,以理性理论为研究基点,首次阐述了医疗检查合理性的具体内涵。同时,综合运用多学科专业知识,创新性地多维度、多视角探讨了合理检查的评价标准,一定程度补充了医疗检查合理性的研究理论。
第二,实证研究方面,本课题首次调查了不同特征的医疗检查供求双方主体对医疗检查合理性及其相关问题的认知情况,以此剖析了医疗检查合理性评价的主观影响因素；同时,首次专题分析了医疗检查的费用水平和结构,以及人均使用率和阳性率等指标,以此解读了医疗检查合理性评价的客观影响因素。
Objeetives
Medical Examination is the necessary comPonent of modern medical health service. The study on the rationality and its relevant issues in this PaPer was helPful for PeoPle to systematically understand the basic characteristics and internal mechanism of medical examination Practice and internal mechanism in dePth; it was beneficial to guide and regulate the Practical work of medical examination, to Promote the quality of medical service, to reduce the cost of medical treatment, and to build a harmonious doctor-Patient relationship; and it can also Provide a reference for the medical administration departments to scientifically make uP the regulations for medical examination supervision and management.
Methods
The combination of the theoretical analysis and emPirical analysis methods was used in this dissertation. In Part of the theoretical analysis, a series of theories and views on medical examination rationality were demonstrated through the Pandect and sPecial toPics based on literature review and the Professional characteristics of medical examination. In the emPirical analysis, the field investigation was done, including dePth interview which investigated the knowledge and satisfaction of 329 Patients and 58 health Personnel to the work of medical technical departments of the hosPitals in Zhejiang Province and Anhui Province, and the analysis was done to the medical examination cost and the effective utilization of medical examination items of the inPatient medical information of 1496 Patients in a general hosPital of Zhejiang Province during 2008-2009.
Contents
The study was conducted on three layers:on the first layer, the basic connotation and orientation of rationality was analyzed, and the main influencing factors of medical examination rationality implementation and the evaluation standards of rationality were exPlored; on the second layer, the analysis was done to the infringement act and the undertaken duty of medical examination, the influence of medical technology to the doctor-Patient relationship and informed consent rights of Patients, sale of medical examination concePt and subculture construction; on the third layer, the emPirical analysis was done to the cognition of rationality of medical examination from the asPects of both doctor and Patients, the Patients'satisfaction to medical technical dePartment, and the medical examination cost and the effective utilization of medical examination items of the inPatients.
Results
1 The results of theoretical research of medical examination rationality
The results showed that the connotation of medical examination rationality has a very wide scoPe, and there would generate the different evaluation results by the different actors from different angles, thus, PeoPle should review the medical examination rationality concretely from the history Point of view. The rationality of medical examination was the unification of instrument rationality and value rationality, the formative rationality and substantive rationality, Process rationality and outcome rationality, thus, the concePts of medical examination technicalization and Pure economics should be deserted, and objectively treat the contradiction of infinitive rationality and finitude rationality in the Practice of medical examination. The study also found that the main influence factors for the Practice of medical examination rationality included:the need-suPPly relationshiP, market regulation and the suPervision of the government, the level of the social economical develoPment and the internal suPervision and management of medical health institutions, etc.. The basic standards of evaluation mainly included:the technical rationality evaluation of medical examination, health economics evaluation, legal evolution, ethical evolution, and safety evolution, etc.
2 The results for the sPecial toPics of medical examination rationality
First, the irrational Practice of medical examination will infringe the lawful rights of health, human dignity and ProPerty, etc.., as a result, medical institutions will undertake the civil, administrative, and criminal liabilities, such as aPology, and comPensation, etc. according to the rules of fault liability and no-fault liability.
Second, the irrational develoPment and use of medical examination creates materialization of the doctor-Patient relationshiP, thus, it should balance well the relationshiPs among the innovation, suitability, and accessibility of medical examination technology; meanwhile, the informed consent rights of Patients should be resPected in the sPecial medical examination, and wisely deal with the relationshiP among the medical autonomy of Patients and the authoritative right of doctor, health benefit and economical interest of Patients.
Third, in the new trend of Pilot of clinical Pathway and its imPlementation, the traditional Professional concepts of medical examination should be uPdated, and the medical institutions should actively merge into the context of clinical Pathway implementation, and imPlement the sale of medical examination concePt and creates the sPecialty characteristics and subculture of medical examination with the new concePts in the new time.
3 The results of emPirical study of medical examination rationality
3.1 The cognition difference between doctor and Patient to medical examination led to the diversity views towards the evaluation of medical examination.
34.5% of doctors believed that medical examination was rational when it was needed in diagnose and treatment, but only 19.4% of Patients thought so. For the cognition of the significance of rational medical examination,62.7% of the doctors believed that it could enhance the quality of care and 84.5% of the doctors believed that it could imProve the doctor-Patient relationship, while there were 45% and 91.8% of Patients respectively believed so. The main factors in deciding the medical examination included diagnose need (97.3%), Patient's requirement (71.4%) and the allocation mechanism of the hosPital (84.5%) from doctor's Point of view, but 62.3%, 26.4% and 84.5% respectively for these factors from Patient's Point of view. The main causes of irrational medical examination were technical issue(79.3%) and legal issue(89.7) from the doctor's Point of view, but 49.8% and 65.7% respectively for the two causes from Patient's Point of view.
3.2 It's not oPtimistic for the Patient's cognition of medical examination information, which directly influenced its rational evaluation.
For the aim, indications, instructions, risk and result of the medical examination, the Percentages of the Patients who totally didn't know were 17.9%,30%,52%, 55.9% and 27.4% respectively.32.55 of Patients didn't get the information from the doctors, and only 47.4% of Patients got to know the Price of medical examination from the doctor. For the Practice of medical examination, only 49.8% of Patients were asked oPinion by the doctors,32.5% of Patients thought it was not necessary. For the cost of medical examination,55% of Patients thought that it was too exPensive, and 68.4% of Patients thought that it was unbearable.
3.3 The Patient's dissatisfaction rate was very high, which would imPede the rational implementation of medical examination.
The Patient's satisfaction rates to service attitude, technical level, service environment and service Procedure were 32.8%,32.8%,28.0%, and 22.2% respectively, while the dissatisfaction rates to them were 23.1%,12.6%,19.4%, and 24.6% respectively. The causes for the dissatisfaction were mainly that the Protection to Patients'informed consent, and Privacy was not enough, the collection of samPling was not familiar, the area in waiting for the examination was too narrow, and the time for examination was too long.
3.4 The overall cost of medical examination was very high, which had consisted of the imPortant Part of Patient's inPatient total cost.
The average cost of medical examination for the inPatients accounted for 10% of total cost, of which this rate was 17.6% in the Pediatrics. The ratio of cost of medical examination to drug cost was 20%, of which this ratio was 27.2% for surgery and 40.9% for Pediatrics. The average clinical medical examination cost of the inPatients was 50% of total medical examination cost, of which, this rate was 76.3% for the medical dePartment and 69.4% for the Pediatrics. The X-ray cost for the medical department and the Pediatrics was 20% of total examination cost, while this rate was 39.4%,50.2% and 30.3% for surgery, ENT and gynecology respectively.
3.5 The overall utilization effect of medical examination items was not high, which created the waste of medical resources.
The utilization rates of blood routine, stool routine, urine routine and biochemical test series for the inPatients were 1.85 times Per Patients,1.49 times Per Patients, 1.57 times Per Patients and 1.14 times Per Patients respectively, while the Positive rates for these examinations were 13.8%,8.25,8.7%, and 11.75% respectively. The utilization rates of X-ray, ultrasound and ECG were 1.34 times Per Patients,0.98 times Per Patients,1.21 times Per Patients, while the Positive rates for these examinations were 7.25,9.35, and 9.15 respectively.
Innovations
First, the concePts of medical examination technicalization and Pure economics were broken through in the theoretical analysis. For the first time, the connotation, the main influence factors, and the standards of evaluation of medical examination rationality were discussed from the multi-dimensions with the synthesis of multidisciPlinary exPertise based on rational theories so that the theoretical thought of medical examination rationality was enriched greatly.
Second, The subjective value nature of rationality evaluation was fully Paid attention in evidence analysis for the first time, and the recognition of medical examination rationality was analyzed from both sides of suPPly and need; meanwhile, the indicators, such as the level and structure of medical examination cost, the utilization rate Per Person, and the Positive rate of the utilization were first used to systematically analysis the objective factors which influenced the evaluation of medical examination rationality with inPatients as the study subject.
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