2018 年第 4 期 第 13 卷

北京市某三甲医院医药分开综合改革实施前后的门诊投诉情况对比分析

Changes of outpatient complaints before and after comprehensive reform of separation of drug sales from medical services in a 3A grade hospital in Beijing

作者：宋涵超林晨曦雷祎刘梅黄潆姗朴玉粉

英文作者：

单位：100191北京大学第三医院医务处（宋涵超），门诊部（林晨曦、雷祎、刘梅、黄潆姗、朴玉粉）

英文单位：

关键词：医药分开；医事服务费；投诉；分级诊疗制度

英文关键词：

• 摘要：

• 目的    探讨北京大学第三医院医药分开综合改革实施前后门诊投诉的变化，分析发生原因，尝试提出对策与建议。方法    对北京大学第三医院2016年4—11月与2017年4—11月门诊投诉数据按照诊疗流程进行分类，对北京市医药分开综合改革实施前后的投诉数据进行对比分析。对门诊投诉接待人员进行访谈，了解改革实施前后门诊投诉发生的变化。结果    北京市医药分开综合改革实施后投诉例数同比增长率呈上升趋势，2016年4月与2017年4月门诊投诉例数分别为67、73例，5月分别为53、62例，6月分别为45、62例，7月分别为39、63例，2017年同比增长率分别为8.96%(6/67)、16.98%(9/53)、37.78%(17/45)、61.54%(24/39)。对2016年4—11月与2017年4—11月投诉数据进行对比发现，投诉构成比变化最大的是退号环节，2016年4—11月为1.42%（6/423），2017年4—11月增加到14.50%（68/469）。关于微信挂号、开处方、医患沟通、费用报销、退费流程的投诉增加，关于服务态度、科室管理的投诉减少。结论    医事服务费是造成门诊投诉内容发生变化的主要原因，推进分级诊疗制度有助于改善医疗服务。

• Objective    To investigate the changes of outpatient complaints before and after comprehensive reform of separation of drug sales from medical services in Peking University Third Hospital; to analyze the causes and discuss the countermeasures. Methods    Records of outpatient complaints between April and November in 2016-2017 were classified according to the treatment process and analyzed before and after Beijing′s comprehensive reform of abolishing drug-markup. Interviews were conducted among desk clerks. Results   There were 67 complaints in April 2016 and 73 complaints in April 2017, the growth rate was 8.96%(6/67); there were 53 complaints in May 2016 and 62 complaints in May 2017, the growth rate was 16.98%(9/53); there were 45 complaints in June 2016 and 62 complaints in June 2017, the growth rate was 37.78%(17/45); there were 39 complaints in July 2016 and 63 complaints in July 2017, the growth rate was 61.54%(24/39); there was a upward tendency of the growth rate. Composition ratio of complaints about deregistration was the most significant change between 2016 and 2017; the deregistration rate was 1.42%（6/423） from April to November in 2016 and 14.50%（68/469） from April to November in 2017. Complaints about WeChat registration, prescription, doctor-patient communication, expense reimbursement and refund process were increased; complaints about service attitude and department management were decreased. Conclusion    Medical service fee is the main cause of outpatient complaints; promoting hierarchical medical system is important in the improvement of medical services.