脑梗死住院患者诊疗中的过度医疗行为分析

目的分析脑梗死住院患者不必要诊疗服务及住院费用的构成,为规范医师行为、控制住院费用不合理增长、完善医疗卫生政策等提供参考。方法随机抽取唐山市某医院137例脑梗死患者作为研究对象,结合临床路径和模糊标准法对脑梗死病例进行回顾性评判,测算和分析脑梗死患者诊疗中的过度医疗行为及产生的费用。结果脑梗死患者中过度医疗行为主要表现为不必要的药物、检查和化验项目,不必要的会诊和转诊,提高护理级别,夸大病情和增设知情同意书等。其中,药品、检查和化验项目的费用之和平均为944元,占三项实际费用的11.93%。结论过度医疗行为在脑梗死住院患者中普遍存在;导致医生过度医疗行为产生的原因包括追求经济利益和避免自身陷入不必要的医疗纠纷和诉讼两个方面;控制过度医疗行为的策略和措施包括实行预付制、推行临床路径,改革医院不合理的补偿机制,采取必要措施抑制医生的防御性医疗行为等。

Analysis of Excessive Medical Care in Inpatients with Cerebral Infarction

Objective To analyze the unnecessary medical services and the proportion of ensuing expenses in inpatients with cerebral infarction so as to provide the decision-making basis to regulate doctor′s behaviors,control irrational rise of hospitalization expenses and to improve health policy.Methods Altogether 137 inpatients with cerebral infarction in a hospital of Tangshan City were selected by random sampling.Retrospective evaluation based on clinical pathways and fuzzy criteria was conducted to estimate and analyze the excessive medical services and expenses in inpatients with cerebral infarction.Results Excessive medical services in patients with cerebral infarction mainly included unnecessary medications,inspections,tests,consultations,referrals,upgrading nursing standards,exaggerating the seriousness of the disease and additional informed consent.The average expense of unnecessary medications,inspections and tests was 944 yuan,accounting for approximately 11.93% of total expenses of the three categories.Conclusion Excessive medical services are common in inpatients with cerebral infarction.To pursue economic benefit and evade unnecessary medical disputes and suits are the key reasons for excessive medical services.Some measures to control excessive medical services include implementation of prepayment mechanism,promotion of clinical pathways,reform of irrational compensation mechanism,and control of defensive medical behaviors.