Research On The Relationship Between Doctor-patient Communication Skills And Medical Service Quality Of Rural Grassroots Doctors

Health human capital is the source of enhancing residents’ physical fitness,improving labor productivity,and promoting economic growth.The Chinese economy has entered a "new normal".In this important process of economic restructuring and transformation,the role of health human capital is indispensable.Residents’ health is mainly derived from medical services.Rural primary health institutions are the first points of contact for rural residents,which accounted for 41.5%of China’s population.However,research on rural primary doctors in China shows that the quality of their service remains poor,which is far enough to protect residents’ health.Improving the medical qulaity of rural primary doctors is of great significance to improve the health human capital of rural residents and then promote economic development.At present,most of the researches improve the quality of medical services from the perspectives of training medical knowledge and improving the assessment mechanism,and they pay insufficient attention to the capabilities beyond the professional knowledge of doctors,such as physician-patient communication skills.The study found that good doctor-patient communication can significantly improve the accuracy and efficiency of diagnosis and treatment,enhance patient understanding and compliance,improve patient satisfaction and return visits,and ultimately bring patient health.Now that doctor-patient communication is so important,is improving rural doctors’ physician-patient communication skills an effective starting point for improving the medical quality?There are still many questions to answer in order to answer this question.Is there a shortage of physicianpatient communication skills for rural primary doctors in China?If so,what are the specific aspects?Is there a correlation between their physician-patient communication skills and medical quality?What is the path of action?If designing a system to improve the medical quality,only focusing on training and assessment and neglecting physician-patient communication skills?What are the consequences?Compared to other methods to improve the medical quality,how cost-effective is it to improve physician-patient communication skills?Therefore,this thesis aims to answer the above questions on the basis of clarifying the physician-patient communication skills and medical quality of rural primary doctors in China.And to provide empirical evidences for policy making.This thesis grounded in a standardized patient project conducted in China’s three provinces and 21 counties in 2015 by the Center for Experimental Economics of Education of Shaanxi Normal University.The standardized patient method was used to measure the medical quality of 413 sample doctors in 504 consultations,including the quality of diagnosis and treatment and patient satisfaction.The SEGUE Framework was used to evaluate sample doctors’ physician-patient communication skills.Vignettes were used to measure the medical knowledge of doctors.Based on the above data,this thesis first describes the physician-patient communication skills and medical service quality of rural primary doctors.Then analyzes the relationship and mechanism of physician-patient communication skills and medical service quality,conducts endogenous discussions and robustness tests,and analyzes heterogeneity of train and assessment on medical quality.Finally estimate the costeffectiveness of training physician-patient communication skills and compare it with training medical knowledge.Major conclusions of this thesis are as follows:(1)There is a significant shortage of physician-patient communication skills among rural primary doctors.The total scoring rate of physician-patient communication skills is only 51%,which is inferior to domestic community doctors or medical students at home and abroad.From different characteristics,female doctors performed better than male doctors.There is no significant difference in the total score of physician-patient communication skills among doctors of different age,institution level and provinces.(2)The quality of medical treatment provided by rural primary care physicians is low.The proportion of correct diagnosis is 42%,the proportion of correct treatment is 40%,and the patient satisfaction rate is 59%.(3)There is a significant positive correlation between physician-patient communication skills and medical quality.Specifically,communication process skills are more effective for diagnosis,communication content skills are more effective for correct treatment,Give Information has a significant impact on the quality of diagnosis and treatment."Elicit Information","Give Information" and "End the Encounter" affect patient satisfaction.Physician-patient communication skills affect the quality of medical services by affecting the quality of the admission process.(4)Strengthened training and assessment amplifies the adverse effects of poor physician-patient communication skills.When receiving more training and more frequent assessments,the gap in physician-patient communication skills will be enlarged and reflected in the quality of medical services.(5)In order to increase the probability of correct diagnosis by 1 percentage point,the direct per capita cost required to train physicianpatient communication skills is between 231.14 yuan and 1166.36 yuan.Compared with 1155.85 yuan for training medical knowledge,the benefits are considerable.So training physician-patient communication skills is also a worthwhile investment.Based on the above conclusions,this thesis proposes the following three policy suggestions:(1)Government should pay more attention to improving the quality of rural primary care services as the main source of healthcare for rural residents.(2)Emphasize the improvement of rural primary care physicians’ physician-patient communication skills.Focus on communication content,"Elicit Information”,"Give Information" and "End the Encounter".(3)When designing a system plan,the health department should consider training and assessment in conjunction with physicianpatient communication skills,that is,while increasing training and designing a more comprehensive assessment mechanism,pay attention to the improvement of physician-patient communication skills.