The Influence Of Single Disease Payment System On Doctors' Diagnosis And Treatment Behavior

In the mid-1970 s,the sharp rise of medical cost has made the payment method become a research hotspot in the field of medical insurance in many countries.How to control the excessive growth of unreasonable medical and health expenses has become a difficult problem faced by all over the world.However,China's basic national conditions determine that mature DRGs technology cannot be directly introduced,so it can only conditionally promote the DRGs payment method in large-scale hospitals in provinces and cities with good development status and high technical level,and generally implement single-disease payment system that belongs to the primary stage of DRGs in other regions.The single disease has a wide range of implementation,and its original intention is to control medical expense and ensure medical quality,but as the main body of the medical process,doctors control the entire diagnosis and treatment process.Whether the implementation of single-disease payment system can control medical expenses and guarantee medical quality by changing doctors' diagnosis and treatment behavior is still questionable in the academic field.The change of doctors' roles and the standard of diagnosis and treatment behavior are the key to whether the single-disease payment system can play a role.Therefore,the leading role of doctors is particularly important in medical expenses and medical quality,which has great practical and theoretical significance for the change of doctors' diagnosis and treatment behavior under the single-disease payment system.This paper followed the logic of finding,raising,analyzing and solving problems.Based on the grounded theory,this paper applied professional qualitative analysis software Nvivo11.0 to conduct qualitative research on the data obtained from in-depth interviews with 12 doctors and 8 patients in the department of surgery,obstetrics and gynecology and ophthalmology of a hospital.Firstly,through three-level coding of the interview data,nine main categories are found,including system perception,individual characteristics,patients' rights and interests,diagnosis and treatment items,diagnosis and treatment process,diagnosis and treatment attitude,labor remuneration,system supervision and medical environment.Second,the analysis of the main categories for the diagnosis and treatmentprojects,diagnosis and treatment process and the diagnosis and treatment attitude attribute for the doctors behavior,perception,patients' rights and interests,the labor remuneration system,system regulation and five medical environment as a single disease payment system of mediation variables affect the doctors behavior,the individual character as regulating variable system of perception.Again,build a single disease payment system based on the above analysis the influence mechanism of doctors behavior model and explanation,get the following conclusion: the single disease payment system by adjusting the individual characteristic variables in the system,due to different doctors for single disease payment system of cognition so as to show the different clinical behavior;The implementation of the single-disease system will have an impact on patients' rights and interests,and safeguarding patients' due rights and interests is the starting point of doctors' treatment,thus affecting doctors' diagnosis and treatment behavior.The implementation of single-disease payment system makes doctors' original labor remuneration change,and the change of motivation can directly affect the behavior change.