Managed care constraints on psychiatrists' hospital practices: bargaining power and professional autonomy.
Managed care constraints on psychiatrists' hospital practices: bargaining power and professional autonomy.
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管理式护理对精神科医生医院实践的限制：议价能力和专业自主权。
DOI：
10.1176/ajp.153.2.256
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Epstein,SS
中科院分区：
文献类型：
--
作者：
Schlesinger,M;Dorwart,RA;Epstein,SS
保险公司和医院越来越多地参与监测病人的护理，这侵犯了精神科医生在做出临床决策时的自主权。本研究探讨精神科住院病人的做法，以及精神科医生的特点如何影响的类型和程度，这些外部pressures.MethodAbout 2,500精神科医生与积极的医院affiliations进行了调查，通过邮件，作为阿帕的1988年全国精神科医生调查的一个子集。他们被问及医院或保险公司是否向他们施压，要求他们改变住院实践，或试图阻止某些类型的患者入院。精神科医生的背景，从主要调查的特点，被用作自变量在一组ofregression models，与频率不同的约束作为因变量。ResultsMore than three quarter of those surveyed reported pressure from insurers for early discharge; nearly two-third said hospitals limited length of stay.大约一半的人被劝阻不要接纳重病患者、没有保险的人或医疗补助接受者。特征ofpsychiatrists，如长度oftime在实践中，收入，性别，医学院教育在美国以外，与流行的外部pressures. ConclusionsRestrictions精神科医生的做法是普遍的。他们抵抗压力的能力取决于他们的讨价还价能力，对于那些经验相对较少的女性或在美国以外的医学院上学的人来说，这一能力似乎最低。精神科医生似乎愿意用更多的限制来换取更高的收入。严重的病人和那些很少或没有保险的人比其他人更容易受到这些对精神科医生自主权的限制的影响。
ObjectiveThe increasing involvement of insurers and hospitals in monitoring patient care is encroaching on the psychiatrist’s autonomy in making clinical decisions. This study examined the prevalence of constraints on psychiatric inpatient practices, as well as how characteristics of psychiatrists affect the type and the degree of these external pressures.MethodAbout 2,500 psychiatrists with active hospital affiliations were surveyed by mail, as a subset of APA‘s 1988 national survey of psychiatrists. They were questioned about whether the hospital or insurers had pressured them to change their inpatient practices or had attempted to discourage admission of certain types ofpatients. Characteristics of the psychiatrists’ background, available from the main survey, were used as independent variables in a set ofregression models, with frequency of different constraints as the dependent variables.ResultsMore than three quarters of those sur-veyed reported pressure from insurers for early discharge; nearly two-thirds said hospitals limited length of stay; and about half had been discouraged from admitting severely ill patients, the uninsured, or Medicaid recipients. Characteristics ofpsychiatrists, such as length oftime in practice, income, sex, and medical school education outside the United States, were associated with the prevalence of external pressures.ConclusionsConstraints on psychiatrists‘practices are widespread. Their ability to resist pressures depends on their bargaining power, which seems to be lowest for those who have relatively little experience, who are female, or who have gone to medical school outside the United States. Psychiatrists appear to be willing to trade off more constraints for higher incomes. Severely ill patients and those with little or no insurance are more likely than others to be affected by these limits on psychiatrists’ autonomy.