在公私混合医疗保健体系中，是什么促使医生提出私人服务？一项混合方法研究。
What motivates physicians to propose private services in a mixed private-public healthcare system? A mixed methods study.
机构信息
School of Public Health, Ben-Gurion University of the Negev, POB 653, 84105, Be'er-Sheva, Israel.
Department of Politics and Government, Ben-Gurion University of the Negev, Be'er- Sheva, Israel.
出版信息
BMC Health Serv Res. 2022 Jan 10;22(1):51. doi: 10.1186/s12913-022-07474-9.
BACKGROUND
Implementation of private elements, including private insurances, in public healthcare system is now common in many countries, and its impacts have been well studied. Little, however, is known about the motives leading physicians, major role players in the system, to promote the usage of private services. The aim of this study was to explore the various motives leading physicians within public systems to propose private services to their patients, while examining the possible associations to their specialty and level of commitment.
METHODS
A total of 197 physicians from specialisms loaded more to private/public sectors participated in a cross-sectional telephone survey regarding their attitudes on their practices, private insurances, access to healthcare, and job satisfaction. The association between the likert scale questions to their recommendation to purchase private insurance, and the commitment they felt towards patients were analyzed using Generalized Estimating Equations (GEE) as well as logistic regression models.
RESULTS
Our findings suggest physicians engaged in dual practice are less likely to promote private insurances among their patients if they are satisfied with their public job (OR = 0.92, 95%CI 0.89,0.94). Physicians perceived private insurances as beneficial for patients, were found likely to promote them (OR = 1.65, %95CI 1.16, 2.35). The commitment physicians felt toward patients who paid out-of-pocket money was associated to their sense of being trusted and valued (OR = 1.99, 95%CI 1.33, 2.88; OR = 1.5, 95%CI 1.05, 2.13 respectively).
CONCLUSION
This study suggests a deeper understanding of physicians' daily experience of the private-public mix and it's consequences, and could provide a platform for future studies. Further studies on physician's role in health privatization processes are needed, and could aid policymakers in their efforts to strengthen healthcare systems around the world.
背景
在许多国家，公共医疗体系中引入私人元素，包括私人保险，已经十分常见，其影响也得到了充分研究。然而，对于促使系统内的主要角色——医生——向患者推荐私人服务的动机，我们知之甚少。本研究旨在探讨导致公共体系内医生向患者推荐私人服务的各种动机，并考察其与专业和投入程度的可能关联。
方法
共有 197 名来自公私部门的专科医生参与了一项横断面电话调查，内容涉及他们对自己的行医方式、私人保险、获得医疗服务的途径和工作满意度的态度。使用广义估计方程（GEE）和逻辑回归模型，分析了对购买私人保险的推荐意向与对患者的投入程度之间的关联性。
结果
我们的研究结果表明，如果医生对公共工作感到满意，他们更不可能向患者推荐私人保险（OR=0.92，95%CI 0.89，0.94）。医生认为私人保险对患者有益，更有可能向患者推荐（OR=1.65，95%CI 1.16，2.35）。医生对自费患者的投入程度与他们被信任和重视的感觉有关（OR=1.99，95%CI 1.33，2.88；OR=1.5，95%CI 1.05，2.13）。
结论
本研究深入了解了医生在公私混合医疗体系中的日常体验及其后果，并为未来的研究提供了一个平台。需要进一步研究医生在医疗私有化过程中的作用，这将有助于政策制定者加强全球各地的医疗体系。
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