化解医患纠纷构建和谐医患关系之博弈探究

【Abstract】wWw.shuoshilunwen.com Under the background of constructing harmonious society,and facing to the reality of the intense doctor-and-patient relationship,we are all searching for a way of common wins between doctor-and-patient in our contemporary society.To investigate the relation of doctors and patients and change the medical moral and ethic radically,dissolve the medical dispute,promoting medical reform,which he a great theoretical and practical significance.We bring forward the idea of establishing harmonious doctor-and-patient relation,just because once medical relationship turn to intense,or even worse,the relation will collapse utterly.We firstly use the data to show that how the present medical situation is and the major causes of the existent problems.Especially the extent of intense medical relationship now has been upgraded into evil medical dispute.Medical dispute is an important factor causing the relation between doctors and patients becoming intense and worsened,and now its trend is getting worse and worse—evil medical dispute happened everywhere,which should arouse our deep concern seriously.In the theme of constructing harmonious society and "Year of Hospital Management",the causes of evil medical dispute happened could be classified into three categories:first,from medical fellows;second,from the patients;and another is the third party.The causes from the hospital include:fellows conduct inaccurate medical actions "cover the truth and keep the mouth closed" make a chance for evil medical dispute.The factors from patients include:self interest impulse,patient’s subjective expectation and reality far-unmatched.The cause comes from the third party—the patient could not be satiied with the normal way.It has biases between the social environment,public opinion orientation,and reality.In response to causes the analysis these three areas easily lead to conflicting reasons for patient.Medical managers should do something.There is a set of stringent measures.—to arouse the medical safety awareness and to the doctors pay attention to medical safety;we improve medical disputes quickly with a series of systems to protect the interests of doctors and patients;relevant departments also should do something.We analyze 315 medical dispute cases,happened in Nanfang Hospital in the city of Guangzhou during the years from 2004 to2006,with the method of statistical description,and describing the data by proportion.The number of medical dispute cases increased gradually year by year.The departments and hospital personnel involving in to the cases were wider,the causing causes more complicated.We classify the causes of the dispute neatly and find out six problems listing as follow:insufficient communication;carrying out the regulation laxly;poor medical service quality;medical fee problems and other tiny problems.We strongly advise the medical service institution should hold four critical points:carrying out medical regulation strictly;improving the treatment the medical service quality,and nursing level,enhancing the communication with patients.Analyzing the influencing factors of medical disputes,it should provide the countermeasures for the hospitals to conduct medical affairs and coordinate the contradiction between doctors and patients.It also benefits for the hospital to adjust the relation the doctor and patient and to enhance the hospital management. Once the medical dispute happed,the patients maximize the request to meet with themselves,on the contrary,the doctor minimum medical requirements for the purpose of compensation.All practices will be subject to the impact of other acts.It is reflected that the parties he a relation of decision-making role respectively.This,in essence,is an act Game.Asymmetric information between doctors and patients fights against the phenomenon.It shows that the game of interests between the doctor and patient primarily applicable incomplete information dynamic Game.The main different interests can be seen as the process of dealing with different types of game.Therefore,we can use game theory research methods to explore Doctor-Patient Relationship.That the patient how to "balance - imbalance -balance" under the law to live with the theoretical feasibility.We use the method to explore the two situations below.The first situation:Doctors and patients game directly.Doctors are classified of responsible fellows or not to the job.The patients are also classified of two types--cooperation or non-cooperation.The second situation:introducing of third parties--medical institutions, insurance agency,and drug distribution agencies -to make them gamed respectively. We apply the game model to analyze three situations-- game between doctors and patients,game between doctors and hospital,and game between patients and patients-- to calculate which party gains and which one loses.We analyze the typical phenomenon of the game between the doctor and patient,for instant:benefit game between doctors and patients when patients send "red packet" to doctors,patients choose doctors when they hospitalize.According to the categories,we should draw seven conclusions from the study:ConclusionⅠ:for the patient,thus the expectation for the treatment’s great.So, Ue+Uh-R＞-Cp is easy to understand.If the patient cooperates with the doctor for his treatment,he should take the advantage.At the same time,the cost of responsibility which doctors choose is larger than those of irresponsibility in general,that is, C1＞C2,therefore,R-C1＜R+Rs-C2.So the Nash balance of a Game Theory between doctors and patients should be expressed as—doctors,patients(irresponsibility, corporation)ConclusionⅡ:The Games between doctors and patients happen again and again, the patient could judge whether the doctor is responsible or not.If he finds that the doctor is irresponsible,his expectation to the doctor will low down and his will to pay for the medical cost R will be lower,undoubtedly,the doctor’s income will be less than usual.R-C1＜0,but R+Rs-C2＞0,the responsible doctor will get loss,on the contrary,the irresponsible one win the game unfairly.The patient will find the doctor is no longer taking responsibility and his expectation low down continuously,the income of doctor will lower.It should shape a periodical vice circle and adverse choice.ConclusionⅢ:to segment the positive correlation of the profit of hospital and the quantity of medical relevant service,that is,separate pharmacy,medical instrument and inpatient nursing from the hospital function.The hospital should self regulate strictly and enhance the medical quality.Only in this way,could the hospital gain more market quota and economic profit.ConclusionⅣ:General hospitals should strengthen internal supervision to reduce one time game between patients and doctors effectively.Hospital will strengthen the political popularity to cumulate a large number of medical moral and well-repudiated doctors and to create brand hospitals.Reasonably patients will come back to hospital if they need medical care because of the good reputation of the hospital.In community hospitals,in community hospitals,general practitioner and patients repeatedly game.Only in this way may adverse selection reduce.ConclusionⅤ:Supposed that the doctors’ return is negative,while the benefits of patients-not giving "red packets" -are more than those of giving,the Nash balance of Game should be expressed as patients send "red packet" but not accepted by the doctor.Patients will not trouble whether sending "red packets" to doctors or not, doctors will not trouble whether accepting "red packets" or not.Good medical culture shape gradually.ConclusionⅥ:Most hospitals and doctors maintain a long-term relationship repeated games.First,the hospitals he to maintain the reputation of doctors:As to hospital,carrying out explicit regulations is the prime maintain the hospital’s regulation system.This will not only guarantee that the hospital regulatory transparency and openness,so that incentives can be more equitable.Therefore, reasonable regulations and the penalties should be accepted by doctors reasonably, and will not he a negative impact,but benefit to urge doctors to conduct correctly. Secondly,the hospital should be consummate step by step so as to maintain long-term relationships:incentives,or in accordance with such methods.For example:staging regular training for doctors or evaluation of combined operations, and the workload of the commission monetary integration.It is conducive to maintain long-term cooperative relations.Treating those doctors who make medical mistakes kindly,is conducive to solve the problem and maintain stable relation. Finally,hospital should publicize the good moral and technique of the doctor and urge doctors to establish their personal credibilityConclusionⅦ:The asymmetric information between the insurance agency and hospital would be alleviated or even eliminated.The insurance and insurant—patients form a benefit community.The insurance agency should restrict hospital and doctors to over pursue their economic benefits unreasonably.At the same time,it should share the medical risk of hospital and doctors,which can reduce the doctors’ unnecessary psychological burden and reduce the doctor’s protective measure for medication.The government and our society should provide and support this service. ConclusionⅧ:The drug fee should be drop down firstly,and then next be the fee of treatment and check.Cut off the link of doctors and drugs sale is a vital point and low down the medical fee,which is an effective way to release the intense relation of doctor and patient.In sum,this study utilizes to the feedback opinion of the patients collected in a certain hospital during the years of 2004 to 2006.We do medical statistical analysis of 315 medical disputes from the aspects of doctor-and-patient relation,medical quality,medical fees etc.to explore causes of the intense medical relation at present. Under this severe circumstance,Game Theory should be best exemplified the influence and impact of all the parties.The theory and results could provide the idea and advice of constructing harmonious doctor-and- patient relation,dissolving medical disputes and optimize the course of dealing with the disputes.Constructing a harmonious society could not be lack of harmonious medical relationship.Indeed,doctor and patient relationship causes complicatedly.Existing structures,mechanis,the problem is also thinking of changing aspects of the concept,and there are reasons such as poor management and supervision.To solve the problems,all the parties should make efforts together.But the medical institution and fellows are the key point and should make greater efforts.According to the profound analysis of the interest of both patients and doctors, we can find out the rules to solve the practical problems happening in daily work, furthermore,to dissolve medical disputes,to construct harmonious society.Finally,we put forward for the countermeasure and advice about how to construct harmonious medical relation in comprehensive hospital.For instance,the medical fellows should be cared,therapeutically guided and appeased psychologically,spiritually and technically.The fellows also want to need supporting,understanding and make a relaxed personal relationship. Medical institution should adapt certain corresponding measurements based on its own characteristics in each and every tache:Improving the moral and technology level of the medical fellows,regulating all the medical affairs,communicating with the patients and their family actively,providing perfect medical service and hing the idea of patient-oriented.Only in this way,can the medical relation polish up and promote effectively health service management developing sustainable consistently healthily.