Hu Guoheng, Li Ying, Zhao Haining
Yanshan University, Qinhuangdao, Hebei, China.
Yanshan University Research Center for Management Innovation in Beijing-Tianjin-Hebei Coordinated Development, Qinhuangdao, China.
BMC Health Serv Res. 2025 May 30;25(1):772. doi: 10.1186/s12913-025-12942-z.
This study aims to thoroughly examine the impact of workplace violence incidents in healthcare settings on the structure of medical expenses, with a particular focus on specific changes in defensive medical, and to further investigate the resulting patient outcomes.
This study examines a high-profile workplace violence incident in W City, H Province, China, which had widespread societal impact, treating it as an exogenous shock. Utilizing inpatient medical record data from W City, the study constructs a regression discontinuity model to systematically analyze shifts in medical behaviors related to costs and decision-making following the incident, as well as the implications of these changes on patient burden and health outcomes.
The findings indicate that workplace violence incidents lead to significant changes in the structure of medical costs, with a notable increase in comprehensive medical service fees and a significant decrease in invasive treatment fees. Further analysis reveals that such incidents trigger pronounced defensive medicine, including extended hospital stays, increased probabilities of departmental transfers, reduced surgical levels, and higher costs and a greater proportion of traditional Chinese medicine in total expenditures. Additionally, in terms of patient outcomes, workplace violence incidents slightly alleviate patients’ out-of-pocket expenses and payment ratios. However, these incidents significantly worsen patients’ primary health indicators and overall health status at discharge.
Workplace violence against healthcare professionals significantly impact the structure of medical costs and trigger defensive medicine, characterized by a tendency toward conservative treatment approaches and reduced treatment intensity. While such incidents may partially alleviate patients’ financial burdens, they have detrimental effects on patients’ health outcomes. Therefore, to enhance healthcare quality and safeguard patient well-being, it is imperative to implement measures to mitigate workplace violence in healthcare and encourage medical institutions to prioritize scientific and rational decision-making in treatment practices.
本研究旨在全面考察医疗环境中工作场所暴力事件对医疗费用结构的影响，特别关注防御性医疗的具体变化，并进一步探究由此产生的患者结局。
本研究考察了中国H省W市一起具有广泛社会影响的备受瞩目的工作场所暴力事件，并将其视为一种外部冲击。利用W市的住院病历数据，构建回归间断模型，系统分析事件发生后与成本和决策相关的医疗行为变化，以及这些变化对患者负担和健康结局的影响。
研究结果表明，工作场所暴力事件导致医疗成本结构发生显著变化，综合医疗服务费显著增加，侵入性治疗费用显著下降。进一步分析发现，此类事件引发了明显的防御性医疗行为，包括住院时间延长、科室转科概率增加、手术级别降低、成本上升以及中药在总支出中的占比提高。此外，在患者结局方面，工作场所暴力事件略微减轻了患者的自付费用和支付比例。然而，这些事件显著恶化了患者的主要健康指标和出院时的整体健康状况。
针对医护人员的工作场所暴力对医疗成本结构有显著影响，并引发防御性医疗行为，其特点是倾向于采取保守治疗方法和降低治疗强度。虽然此类事件可能部分减轻患者的经济负担，但对患者的健康结局有不利影响。因此，为提高医疗质量和保障患者福祉，必须采取措施减轻医疗环境中的工作场所暴力，并鼓励医疗机构在治疗实践中优先进行科学合理的决策。
