Study On The Behavior Of Decision-making And Decision-making Mechanism Of Inappropriate Admission In Township Hospitals About The New Rural Cooperative Medical Patients

[Purpose]Under the guidance of the “un-diagnostic standard”, using field research method,we study the behavior of patients and medical staffs in the process of clinic diagnosis and treatment by in-depth observation, understand the subject of the admission decision and decision-making motive, and then keeping track of the hospitalized patients, further understand the cause of making the admission decision of the patients,psychological motivation and decision-making goal.On this basis, analyze the main decision-maker, behavior motive of irrational admission in township hospital from the perspective of the supply and demand and decision-making mechanism.[Methods]First of all, by searching the literature and information, knows the behavior research of medical service supply and demand, unreasonable provision and utilization of medical services, the influence factors of the medical treatment behaviors and health seeking behaviors, advances in research on the use and supply of unreasonable medical services and so on, which lay the foundation for the research of this paper. Then using the method of field survey, mainly by field research,questionnaire survey, key informant interviews and other methods, understand the decision maker, the rationality of the decision, and the behavior motive of the doctors and patients in the process of the actual medical treatment. Subsequently, the statistical analysis and chi square test are conducted to analyze the survey data through SPSS12.0, and analyze the hospital decision-making behavior from supply and demand sides through the typical case analysis.[Results]1. Fieldwork A, B to a total area of 153 cases of hospitalized patients, 56 patients hospitalized irrational, irrational hospitalization rate is 36.60%. Among them, 86 cases of hospitalized patients in A area, irrational admission rate is 34.88%; B area of 67 cases of hospitalized patients, irrational admission rate is 38.80%. There is nosignificant difference in A and B area.2. Survey analysis shows that in township hospital decision-maker is mainly for doctors, A and B in A total of 153 cases of hospitalized patients, of which 110(71.90%) cases are doctors for hospital decision-maker, 53 cases of the demander for the admission decision maker for makers( decision makers in 26 patients is hospitalized, 17 cases of families admission policy makers).Reasonable admission decisions doctors as decision-makers accounted for 77.31%, irrational admission decisions doctors as decision-makers accounted for 62.5%.3. The survey found that the decision to refuse admission subject mainly patients,36 cases of hospitalized patients, the doctor refused to reject two cases of admission,the patient refused 34 cases of hospitalization.4. From the admission decision rationality analysis, c2analysis showed that decision-makers have an impact on the rationality of admission, supply-side decision-making irrational admission constituent ratio(31.48%) lower than the demand side in the decision-making irrational admission constituent ratio(48.84%),demand side play an important role in irrational admission decisions.5. The patient questionnaire analysis shows that patients feel disease severity influence admission decision rationality, the difference has significant difference(P =0.004), irrational admission constituent ratio of patients hospitalized with moderate disease is maximum, 55.56%, however, irrational admission constituent ratio of patients hospitalized with seriously conscious of disease severity is only 15.15%;in addition, irrational admission constituent ratio(46.65%) of patients hospitalized not in the hospital at night is higher than that(22.95 %)of patients hospitalized living in the hospital at night,the difference is statistically significant.74.23% reasonable hospitalized patients conscious and serious illness heavier compared irrational admission(50.0%), disease severity in patients with irrational hospitalized is relatively lighter than reasonable patients admitted, and irrational hospitalized patients(75%) compared to reasonable hospitalized patients(51.51%) are more likely to choose living go home at night.6. The field investigation and study found that demand-side perspective, the patients’ age, family property, whether suffering from chronic diseases, treatment distance, economic conditions, hospitalization expenses and other factors have an effect on the admission decision-making behavior, patients with chronic diseases,good economic conditions, high reimbursement ratio of medical expenses of infirm,low-income residents, entitled groups are more likely to make admission decisions;supply-side perspective, the doctor for hospital treatment is effective and cost-effective post-hospital reimbursement induce patients to make irrational admission decisions.[Conclusions]1. Irrational admission decisions in township hospital contain the supplier’s defensive treatment, induced demand, patients requested hospital treatment. The New Rural Cooperative Medical Insurance reimbursement scheme is an important factor of irrational admission decisions from both supply and demand.2. Suggestions: Improve the supply and demand sides conduct oversight mechanisms to reduce irrational admission; promoting Hierarchical Diagnosis System and improve the ability of village health services, reduce health centers irrational admission; explore "integrated medicine and care the nursing system" model of primary health care institution, reducing the elderly unreasonable admission;reasonably regulating the behavior of the supplier of the diagnosis and treatment,reducing supply-side dominant unreasonable admission; reasonablly guide the demand side of health seeking behavior, reducing the demand side dominated unreasonable admission.