金钱谈话:基于绩效的报销系统对瑞典医生的感知工作,健康和患者护理的影响
Emma Brulin1, Kerstin Ekberg2, Bodil J Landstad3,4
1Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
瑞典医疗保健中的基于绩效的报销 (PBR) 系统对医生的工作和患者护理产生了负面影响,增加了他们患压力诱导的疲劳障碍的风险. 政策制定者应该审查这些系统,以减轻危害.
科学领域:
- 医疗保健管理的管理
- 医生福利 医生福利
- 卫生经济学 卫生经济学
背景情况:
- 基于绩效的报销 (PBR) 系统在全球范围内越来越多地在医疗保健中实施.
- 在瑞典的背景下,PBR对医生的工作和患者护理的主观影响及其与医生倦怠的关联仍未得到充分研究.
研究的目的:
- 调查PBR对瑞典医生的工作和患者护理的主观影响.
- 检查医生中PBR和压力诱导的疲劳障碍之间的关联.
主要方法:
- 采用混合方法设计,收集来自瑞典医生的代表样本的数据.
- 对开放式问卷答复的专题分析确定了与PBR有关的关键主题.
- 后勤回归分析评估了PBR与自我评估的压力诱导疲劳障碍之间的关联,通过燃烧评估量表来衡量.
主要成果:
- 专题分析揭示了四个主要主题:推动决策的财务激励,对患者护理的负面影响,对医疗伦理的挑战以及非法任务的增加.
- 经历PBR的医生报告说,压力诱导疲劳障碍的风险增加了两倍.
结论:
- 瑞典医疗保健中的当前PBR系统对医生的工作,健康和患者护理产生负面影响.
- 政策制定者应该批判性地审查PBR系统,以尽量减少对医生的不良影响,并确保提供优质的医疗保健.
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