基于ISM模型的向下转诊影响因素研究

Research on Influencing Factors of Downward Referral Based on ISM Model

摘要: 中国的卫生健康事业快速发展，医疗服务需求和医疗服务发展之间矛盾的日益突显，双向转诊制度的实施仍然存在“上转容易下转难”的问题，文章在理清双向转诊中下转行为行为显著性影响因素的基础上，运用解释结构模型(ISM)对各因素之间的关联性与作用机理进行探究分析。结果表明，病情严重程度、对基层医院的信任程度、医疗服务水平和对转诊制度的知晓度使双向转诊中下转行为的表层影响因素，监督激励机制、权力责任划分、医疗设备条件和经济水平是双向转诊中下转行为的中层影响因素，科学的转诊流程和医保制度的匹配度是智双向转诊中下转行为的深层影响因素。根据所得分析结果，文章提出：1) 提高基层医院的服务质量，加强双向转诊制度的宣传；2) 制定监督激励制度，明确上下级医院的权力责任划分；3) 制定科学合理的转诊流程及提高与医保制度的匹配度等可行性建议，以此来真正解决患者“看病难，看病贵”的问题，促进形成真正意义上的分级诊疗、双向转诊的就医格局。

Abstract: With the rapid development of China’s healthcare industry, the contradiction between the demand for medical services and the development of medical services is becoming increasingly prominent. The implementation of the two-way referral system still faces the problem of “easy upward referral and difficult downward referral”. On the basis of clarifying the significant influencing factors of downward referral behavior in two-way referral, the article uses the Interpretative Structural Mod-el (ISM) to explore and analyze the correlation and mechanism of action between various factors. The results showed that the severity of illness, the degree of trust in primary hospitals, the level of medical services and the degree of awareness of the referral system were the surface influencing factors, and the supervision incentive mechanism, the division of power and responsibility, the con-dition of medical equipment and the economic level were the middle influencing factors. The matching degree between scientific referral process and medical insurance system is the deep in-fluencing factor of downward referral behavior in two-way referral. According to the analysis results, the paper puts forward that: 1) improve the service quality of primary hospitals, strengthen the publicity of two-way referral system; 2) Formulate a supervision and incentive system to clarify the division of power and responsibility between superior and subordinate hospitals; 3) Develop a sci-entific and reasonable referral process and feasible suggestions to improve the compatibility with the medical insurance system, in order to truly solve the problem of "difficult and expensive medi-cal treatment" for patients, and promote the formation of a truly hierarchical diagnosis and treat-ment, two-way referral medical pattern.