Department of Public Administration, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
Health Policy. 2012 Dec;108(2-3):158-66. doi: 10.1016/j.healthpol.2012.08.024. Epub 2012 Sep 17.
Effective health system reform requires support from health care professionals. However, many studies show an increasing discontent among health care professionals toward certain government policies. When professionals resist implementing policies, this may have serious consequences for policy effectiveness.
To develop and test a model for explaining resistance of health professionals to implement policies, based on three dimensions: societal benefits (such as improving efficiency), patient benefits (such as improving quality for individual patients) and personal benefits for professionals (for example increased income or fewer administrative burdens).
We conduct a survey among 1317 Dutch psychologists, psychotherapists and psychiatrists in 2010 who had to implement a new policy: Diagnosis Related Groups (DRGs). The dependent variable is professionals' resistance to implement these DRGs. As independent variables we develop scales to measure perceived societal benefits, patient benefits and personal benefits. Socio-demographic variables are also included.
The model worked adequately in that the three benefit dimensions, together with control variables, explained 43% of the variance in resistance to implement DRGs. Results indicate that health professionals were overall quite resistant towards the policy. The main reason was widespread belief that DRGs neither contribute to care quality nor help to control costs (low societal benefits). Resistance can also be explained by fears for one's personal status, income, and administrative burdens. Professionals furthermore doubt whether the policy is beneficial for patients, although this dimension is the least influential, which was unexpected. Perceived effects on patient choice, furthermore, do not contribute to willingness or resistance to work with DRGs. These insights can help in understanding why health care professionals embrace or resist the implementation of particular policies.
有效的卫生系统改革需要得到医疗保健专业人员的支持。然而，许多研究表明，医疗保健专业人员对某些政府政策的不满情绪日益增加。当专业人员抵制执行政策时，这可能会对政策的有效性产生严重后果。
基于社会收益（如提高效率）、患者收益（如提高个体患者的质量）和专业人员个人收益（如增加收入或减少行政负担）三个维度，开发并检验一个解释卫生专业人员抵制执行政策的模型。
我们于 2010 年对 1317 名荷兰心理学家、心理治疗师和精神科医生进行了一项调查，这些人必须执行一项新政策：疾病诊断相关分组（DRGs）。因变量是专业人员对实施这些 DRGs 的抵制程度。我们开发了衡量社会收益、患者收益和个人收益的量表作为自变量。还包括社会人口统计学变量。
该模型表现良好，三个收益维度与控制变量一起解释了对实施 DRGs 的抵制程度 43%的方差。结果表明，卫生专业人员总体上对该政策相当抵制。主要原因是普遍认为 DRGs 既无助于提高护理质量，也无助于控制成本（社会收益低）。对个人地位、收入和行政负担的担忧也可以解释抵制。此外，专业人员怀疑该政策是否对患者有益，尽管这一维度的影响力最小，这出人意料。对患者选择的影响也无助于对使用 DRGs 的意愿或抵制。这些见解有助于理解为什么医疗保健专业人员会接受或抵制特定政策的实施。
