摘要
目的基于医生视角分析黑龙江省县域患者跨省转诊转院的主要原因,为提升基层医疗服务能力、优化医保基金使用效率及推动分级诊疗制度落实提供理论支持。方法采用目的抽样对31名县域医院医生进行半结构式深度访谈,借助NVivo 12 Plus软件进行词频分析与三级编码,基于扎根理论构建县域患者跨省转诊转院原因理论模型。结果编码提炼出17个副范畴和7个主范畴,主范畴包括医疗资源水平、经济因素、社会关系与外部影响、个体特征、就医认知、服务体验、制度环境等,其中,县级医疗机构技术设备落后、诊疗能力不足是关键诱因。结论患者跨省转诊行为受多重因素影响,建议加强基层专科建设,提升县级医院服务能力,完善医保差异化报销机制,强化医患沟通,以促进合理就医,推动分级诊疗有效实施。
Objective To analyze the reasons for inter-provincial patient referral in Heilongjiang Province’s counties from a doctor’s perspective,and to provide theoretical support for enhancing primary healthcare capacity,improving medical insurance fund efficiency,and promoting the implementation of the hierarchical diagnosis and treatment system.Methods Using purposive sampling,a semi-structured in-depth interview was conducted with 31 doctors from county-level hospitals.Based on grounded theory used NVivo 12 Plus software for word frequency analysis and three-level coding to build a theoretical model of the reasons for inter-provincial patient referrals.Results Through coding analysis,17 subcategories and 7 overarching categories were identified,overarching categories includes medical resource levels,economic factors,social relationships,external influences,individual characteristics,medical cognition,service experience,and institutional environment.Central contributing factors included the obsolescence of medical equipment and the inadequate diagnostic and therapeutic capacities of county-level healthcare institutions.Conclusion The inter-provincial referral behavior of patients is influenced by multiple factors.It is recommended to strengthen the construction of grassroots specialties,enhance the service capacity of countylevel hospitals,improve the differentiated reimbursement mechanism of medical insurance,strengthen doctorpatient communication,promote rational medical treatment,and promote the effective implementation of hierarchical diagnosis and treatment.
作者
程菲儿
崔立娟
何靖冉
田国梅
高凯
刘佳
许金鹏
邓芳敏
陈方厅
姜心妍
左昕卉
康正
Cheng Fei’er;Cui Lijuan;He Jingran(School of Health Management,Harbin Medical University,Harbin,Heilongjiang,150081,China;不详)
出处
《中国医院管理》
北大核心
2026年第1期74-79,共6页
Chinese Hospital Management
基金
国家自然科学基金面上项目(72074064)。
关键词
跨省转诊转院
县域患者
医生
cross-provincial referral and transfer
county-level patients
doctor
