| Doctor multi-sited licensed has been always hot and difficult problem in our national medical reform. As a kind of adjustment method for unbalanced medical resource allocation, doctor multi-sited licensed system is considered by academic field to be the best method of solving medical personnel allocation imbalance problem in our country. It selects partial excellent medical resources with good medical skills and rich clinical experience by setting certain qualification conditions, make them simultaneously practice in three medical organizations at most, in order to realize the objective that excellent medical resources are transferred to areas which lack health resources. Theoretically speaking, doctor multi-sited licensed system is designed to solve our national unbalanced health and medical market development, and people’s problems of "difficulties and high expense in medical care". But this people-benefiting policy which benefits the country and the people has met various difficulties since its implementation in 2009. Though our national administrative departments have been adjusting this policy according to problems during policy implementation, doctor multi-sited licensed system has gotten some achievements up to now, generally speaking, its implementation effect is not ideal. Personnel management system in public hospitals restricts the implementation of doctor multi-sited licensed system, doctors do not have high enthusiasm; qualification application standard of doctor multi-sited licensed is too high, which causes doctors to lack practice energy though they meet qualification requirements; how to ensure medical quality safety and effectively solve doctors’medical responsibility upon accidents are still several big mountains, they firmly stand in the road to doctor multi-sited licensed system.For decades, relevant laws in our country request that one doctor can only be registered in one medical institution. Whether laws and policies of doctors’ management or systems of hospital management are specific to doctor one-sited licensed method. Under the new situation of the medical system reform, there is a contradiction between doctor multi-sited licensed and the current legal system of doctor management. Therefore, solving these problems is key to true implementation of doctor multi-sited licensed system. The topic is based on problems caused by doctor multi-sited licensed system in medical organizations, deeply analyzes qualification condition, registration management, personnel system and responsibility of medical accidents, comprehensively analyzes and researches internal logic and connection causing problems in medical organizations with the principle line of breaking doctors’existing constraints and mobilizing enthusiasm of doctor multi-sited licensed, in order to help implementation of doctor multi-sited licensed work. The topic is mainly composed of introduction and following four chapters:Chapter 1:"Introduction". The chapter is mainly divided into four parts, research background is to analyze and explain current condition and problems of doctor multi-sited licensed system from the angle of historical evolution, compare and refer to our national doctor multi-sited licensed system and partial foreign countries’doctor multi-sited licensed system based on comprehensive combing of relevant domestic documents. It deeply analyzes doctors’low enthusiasm of doctor multi-sited licensed system through document analysis method, shareholder analysis method and comparative research method, and puts forward specific countermeasures and suggestions.Chapter 2:"Comparison and analysis of doctor multi-sited licensed system and relevant system". Concept of doctor multi-sited licensed is theoretical basis and logical starting point of implementing research on existing defects of doctor multi-sited licensed system. The chapter firstly makes scientific definition of concept of doctor multi-sited licensed system, deeply explains concept and regulations of doctor multi-sited licensed system, in order to distinguish it from other medical behavior. In the meanwhile, it makes comparative research of doctor multi-sited licensed system and supporting system, laws and regulations, definitely points out contradictions between existing relevant policies and regulations and doctor multi-sited licensed system, and puts forward relevant suggested solutions for various problems.Chapter 3:"Qualification and registration management of doctor multi-sited licensed". Doctor multi-sited licensed may cause doctor management chaos and lacking supervision, so it is necessary to set higher qualification limitation and registration management for doctor multi-sited licensed system, but level of qualification limitation and registration management procedure is a puzzle. Existing doctor multi-sited licensed system is not well implemented in various medical organizations, it can be said that overhigh threshold of doctor multi-sited licensed system and complicated registration procedure belong to an important reason. The chapter deeply analyzes existing management system and doctors’practical worries based on this problem, thinks that our national qualification of doctor multi-sited licensed system should be more flexible, and relatively simplify its registration procedure.Chapter 4:"Personnel and legal system reform of doctor multi-sited licensed" Our country has been implementing business establishment management for public hospitals for a long time, with development of medical and health service, business establishment has become the main factor hindering free flow of medical resources. Nowadays, though doctor multi-sited licensed regulations stipulate that doctors and hospitals should sign labor contract, this is impractical at all, it is because doctors who are qualified to enter into doctor multi-sited licensed system have their own career establishment. Insurance provided by business establishment are relatively rich for doctors, but they do not whether doctor multi-sited licensed is good or bad. Regarding the problem of doctor multi-sited licensed personnel management, the chapter thinks that systematic management should be implemented for these doctors, if doctors with establishment apply for multi-sited licensed, their original establishment will be kept, but welfare insurance will be reduced accordingly, in the meanwhile, they can sign labor contract with other multi-sited licensed hospitals.Chapter 5:"Medical tort liability allocation in doctor multi-sited licensed system". Our national practicing physicians law and supporting laws and regulations do not have relevant amendment from 2009 when our country tried out doctor multi-sited licensed system, which directly causes doctor multi-sited licensed system to lack legal and system insurance. Medical organizations would face following conditions, medical accidents happen during doctor multi-sited licensed process; how to undertake medical tort liability responsibility is not explicit; if hospitals ask for compensation from doctors, how can they undertake this. Though current doctor multi-sited licensed management system stipulates that if medical accidents happen in doctor multi-sited licensed process, medical organizations should undertake medical responsibility, encourages doctors and medical organizations to buy medical liability insurance. This kind of regulation lacks supervision for rights and interests of multi-sited licensed doctors, the management system only stipulates that multi- sited licensed doctors can buy medical liability insurance, but not stipulates specific buying method and cost sharing, therefore, how to implement remains open to question. The chapter suggests health authorities stipulate that doctors should buy medical liability insurance in their own names, buying charges should be mutually undertaken by all registered hospitals, insurance covers all medical risks in these hospitals. |
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