摘要
目的:随着我国疾病诊断相关分组(DRG)支付改革的持续推进,改革过程中暴露出部分医务人员为维护组织利益而产生亲组织非伦理行为的现象。本文旨在分析DRG支付改革背景下医生亲组织非伦理行为的成因及其影响,并提出相应治理建议。方法:采用文献分析与政策梳理方法,基于社会认知理论多维度探讨导致医生亲组织非伦理行为的关键因素。结果:DRG改革在控制医疗费用、提高效率方面取得成效,但制度不完善、考核机制不合理、监管不足等问题易诱发医生“低码高编”、分解住院、推诿重症、限制服务等亲组织非伦理行为,损害患者权益并导致资源配置失衡。结论:应完善支付与考核制度,优化激励约束机制,加强信息共享与监管体系建设,强化职业道德培训,以抑制非伦理行为,促进医疗服务体系高质量发展。
Objective With the continuous advancement of Diagnosis-Related Groups(DRG)payment reform in China,a problem of unethical pro-organizational behavior(UPB)has emerged in some medical staff to protect organizational interests.This study aims to analyze the causes and impacts of physicians'UPB under the DRG reform framework and propose corresponding governance strategies.Methods Using literature analysis and policy review methods,the key factors leading to physicians'UPB were explored from multiple dimensions based on social cognitive theory.Results Although the DRG reform has effectively controlled medical costs and improved efficiency,issues such as imperfect institutional design,unreasonable performance appraisal,and inadequate supervision tend to induce physicians'UPB behaviors such as"upcoding",case splitting,avoidance of critically ill patients,and restriction of services,which will undermine patients'rights and lead to an imbalance in medical resource allocation.Conclusion To curb unethical pro-organizational behaviors,it is necessary to improve the payment and appraisal systems,optimize incentive and restraint mechanisms,enhance information sharing and supervision systems,and strengthen professional ethics training,thereby promoting the high-quality development of the healthcare system.
作者
沈一纯
曾智
杨忆
杨添皓
Shen Yichun(Nanjing University of Chinese Medicine,Nanjing,P.R.China)
出处
《中国卫生事业管理》
北大核心
2026年第1期6-9,61,共5页
Chinese Health Service Management
基金
国家社会科学基金资助项目“双系统理论视角下慢阻肺高危人群筛查行动驱动机制及社区助推策略研究”(72504148)。
