摘要
目的了解浙江省基层医疗卫生机构补偿机制在改革试点地区的公平性、实施绩效、激励性与可持续性情况。方法以利益相关者理论、公平理论、期望理论、可持续发展理论为基础,构建补偿机制改革试点评估指标体系。采用焦点小组访谈法,对各改革利益主体进行访谈。同时,收集4个试点地区基层医疗卫生机构的财政补偿情况、收支情况、工作当量等内容。对定量资料进行描述性统计。结果共开展了12场访谈,访谈了92人。研究发现,改革采取了合理的资金分配比例(保基本人员经费比例低于50%)及不同医疗机构的差异调节系数(1.0~1.8)等措施,保障了改革的公平性;机构和职工工作当量的提升(4个试点地区在岗人员工作当量数的平均值由前一年的3843.5万工作当量增至4259.0万工作当量)体现了改革的绩效成果。而政策的激励性和可持续性是当前改革的薄弱环节,主要原因是机构内部的分配制度未开展相应的改革。结论以当量法为基础的补偿机制改革改变了医务人员以往对资金分配的认知。其倡导的"多劳多得,优绩优酬"的理念与信息化管理,有效提高了基层医务人员的积极性和基层医疗卫生机构的运行效率。
Objective To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province,in terms of fairness,performance,incentive mechanism and sustainability in pilot areas.Methods Evaluation indicators were constructed based on stakeholder theory,fairness theory,expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires.Meanwhile,the financial compensation,income and expenditure and work equivalent data were collected from such institutions of the four pilot areas,with quantitative data subject to descriptive analysis.Results This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform;the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform.The incentive and sustainability of the reforms were the weak parts.These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms.Conclusions The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds.The principle of"more pay for more work"and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions,thus,making reform generally scientific and reasonable.
作者
黄敏卓
李园园
胡晓茜
顾钰璇
甄雪梅
孙雪姗
魏景明
董恒进
Huang Minzhuo;Li Yuanyuan;Hu Xiaoqian;Gu Yuxuan;Zhen Xuemei;Sun Xueshan;Wei Jingming;Dong Hengjin(Center for Health Policy Studies,Zhejiang University School of Medicine,Hangzhou 310058,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2020年第1期5-9,共5页
Chinese Journal of Hospital Administration
关键词
基层医疗卫生机构
补偿机制
工作当量
评估
浙江省
Primary healthcare institutions
Compensation mechanisms
Work equivalents
Evaluation
Zhejiang province
作者简介
通信作者:董恒进,Email:donghj@zju.edu.cn。
