The Research Of Compensation Incentive Mechanism And Model Of Dotctors In Public Hospitals

[Purpose]As the core component of public hospitals and the leading provider of medical services,doctors’ incentive mechanism has always been the core issue of public hospital reform.However,the literature analysis shows that there are still many limitations and gaps in the current research,such as insufficient analysis of incentive system,unclear comprehensive mechanism with different influencing factors in the traditional performance incentive tools.The purpose of this study is to establish the adequate salary incentive mechanism for doctors in public hospitals,including salary incentive mechanism,incentive model and evaluation tool based on the identification of their influencing factors.It also puts forward some policy suggestions on the salary incentives that meet the overall requirements of medical reform and the development needs of public hospitals.[Methods]1.Literature review.Use the literature databases such as pubmed,web of science.This paper systematically retrieved,summarized and analysed the relevant research and practical experience of the doctor’s salary incentives in public hospitals.2.Field survey.Take the pilot cities of public hospital reform as the research area.The typical areas were Zhuhai,Wuhan,Yichang and Xiangyang City.In these cities,eight tertiary general public hospitals were selected,two tertiary general public hospitals respectively in one city.697 doctors were investigated on doctors’ salary incentive mechanism by questionnaire survey.The local health statistical reports and relevant documents of salary system reform in public hospitals were also collected.Besides,main information on 63,483 medical records from 2015 to 2017 were extracted.3.Expert consultation.48 senior administrators,leaders and doctors in clinical departments with rich experience in the research of doctor’s salary system were interviewed about the design,progress and main problems of hospital salary system by Semi-structured interview.Another 30 similar professionals were invited to screen and identify the influencing factors and the indicators for the doctor salary incentives model.4.Analytical methods.Structural equation model was used to construct the influencing factors model and path map of doctor’s salary incentive in public hospitals;DEMATEL decision-making test method and analytic hierarchy process were used to determine the influencing factors and the weight of indicators related the salary performance system,and to form the doctors’ salary incentive model and tool.[Results]1.The average income of doctors monthly in public hospitals in the survey area was 10,392 Chinese Yuan.Only 12% were satisfied with the salary.47% of doctors earned more than 8,000 Chinese Yuan a month.About 60% of doctors’ performance and bonus income were more than 60% of their total income.53.7% of doctors’ income also decreased due to the recent hospital reform.It was also found that impacts of different institutions,academic qualifications,titles,departments and working years on doctors’ salary income and wage satisfaction were significant(P<0.01).And the wage income had different degrees of influence on doctors’ job satisfaction,job stress load perception,salary perception and turnover intention(P<0.05).Doctors in a middle income level(5,001-8,000 Chinese Yuan)had the highest job satisfaction(?2=21.57,P<0.05).2.Path analysis of doctors’ compensation incentives mechanism.SEM results showed that the model of the effect of salary incentive on job satisfaction and turnover intention was acceptable: RMESA=0.043;CFI=0.991;TLI=0.986;WRMR = 0.940.It was found that the higher the salary level,the lower the doctor’s perception of work burden and stress(β=-0.171,p<0.001),the more positive the perception of the objective environment of work(β=-0.505,p<0.001),the more perceived the salary Positive(β=-0.545,p<0.001);the higher work stress and burden,the lower job satisfaction(0.341,p<0.001);the more positive the salary perception,the weaker the intention to leave(-0.016,p=0.037).Work burden and stress interacted with job objective environment perception(β=0.570,p<0.001);salary perception and work burden and stress significantly interacted(β=0.580,p<0.001);compensation perception and work objective environment perception interacted(β=1.041,p<0.001);job satisfaction and turnover intention negatively interacted with each other(β=-0.299,p<0.001).So the core of doctors’ compensation incentives mechanism are the higher the salary level,the lower the level of workforce and stress perception of medical staff,and the more active the society evaluation,the more active hospital performance and salary perception,firstly;then the compensation perception and work burden and stress,and social evaluation and hospital performance behavior perception interact.3.It was found that workload,service safety and work cost at the hospital level were the top three driving factors of doctor’s salary incentive model;employee satisfaction,work difficulty,work efficiency and hospital development were the four result factors of doctor’s salary incentive.In addition,from the centrality point of view,hospital development and work difficulty were the two most important key factors in the doctor’s salary incentive model by DEMATEL decision-making test method.At the doctors’ inpatient service level,it was also found that the low risk group mortality,the number of service personnel and the number of DRGs groups were the top three motivation factors for doctors’ inpatient service salary performance incentives.Time efficiency,Case Mix Index(CMI)and cost efficiency were 3 result factors.Work difficulty and workload were the two core elements that determine the incentives for doctors to stay in hospital.Therefore,the design of the doctor’s salary incentive model in public hospitals should fully consider the work difficulty coefficient.4.Construct an inpatient service salary performance evaluation tool,based on the analysis of doctors’ compensation incentive model in public hospitals.This tool constructed the service capacity(0.4),efficiency(0.3)and safety(0.3)as the general dimension.It constructed the workload(0.25),work difficulty(0.20)as the service capacity sub-dimension,constructed the work cost(0.20)and work efficiency(0.15)as the efficiency sub-dimensions,constructed the mortality as safety dimension.It constructed the DRGs group number(0.28),actual number of people responsible(0.2),CMI(0.18),cost consumption index(0.10),time consumption index(0.12),and lowrisk group mortality(0.12)as the indicators of the inpatient service salary performance incentive evaluation.The tool was used at the three levels of department,doctor group and post,which showed the results were consistent with the professional assessments,reflecting the applicability and effectiveness of the tool.[Conclusion]1.The average monthly income of doctors in public hospitals in the survey area is lower compared with some countries and there is unreasonable structure.Among them,only a small number of people are satisfied with the current salary income,and the influencing factors on salary income incentive are complex.2.The mechanism of influencing factors of salary incentive for doctors in public hospitals has been established,and it has been proved that the higher the salary level,the lower the perception level of workload and stress,the more positive the perception of objective working environment and salary for medical staff;salary perception and workload and pressure,and perception of objective working environment interact.3.Construct a doctor’s salary incentive model:the hospital development and work difficulty are the most critical core elements at the hospital level in the model.Work difficulty and workload are the core elements at the individual level.4.Based on the performance evaluation system and weight of DRGs,this paper constructs a performance incentive evaluation tool of doctors’ hospitalization service salary incentive,including three dimensions of service ability,efficiency and safety,and five evaluation indicators of DRGs group,actual number of persons in charge,CMI,cost consumption index,time consumption index and mortality rate of low-risk group.The empirical results show that the tool can be used to evaluate the performance of inpatient service salary incentive in public hospitals and has strong operability.It is suggested that the tool may be popularized in practice.[Innovation and Deficiency]1.Innovation:(1)Based on the relevant influencing factors of doctor’s salary incentive in public hospitals identified and the ways to realize the incentive,as well as the conceptual model,this paper uses structural equation model to construct the model of influencing factors of doctor’s salary incentive and its impacts on the outcomes.In the model,the doctor’s salary incentive has a positive correlation with doctor’s job satisfaction and a negative correlation with turnover intention,and their pathways are the higher the salary level,the lower the level of workforce and stress perception of medical staff,and more active the society evaluation,more active hospital performance and salary perception.And those factors such as the compensation perception and work burden and stress,and social evaluation and hospital performance behavior perception interact.(2)Construct the doctor’s salary incentive models featured in hospital development and work difficulty as the most critical core elements of the model at the hospital level,and work difficulty and workload as the core elements in the model at the individual level.(3)Construct a performance tool for doctors’ salary incentives in public hospitals based on the doctor’s salary incentive models.2.Limitations(1)The key to build the model is to identify and screen the key factors of the influence of doctor’s salary incentive.In this study,many methods such as experts’ consultant,structural equation and DEMATEL were used to screen and identify the relevant factors.There are still some factors that should be taken into account and need further study.(2)Influenced by the objective conditions,this study selected four pilot areas of public hospital reform with a total of eight tertiary public hospitals for research.The data,collected on the front page of medical records and the sample of questionnaires,have certain regional characteristics and corresponding limitations,which can not fully represent the overall condition.It is still necessary to expand the research areas in the follow-up study and supplement the existing research in order to validate the salary mechanism,model and tools of public hospitals constructed in this study.(3)In this study,the CMI of DRGs was used to measure the difficulty coefficient of doctors’ in-patient service.However,due to the lack of research on the relevant measurement index of nurses,technicians and other employees in public hospitals,it is impossible to scientifically reflect the quality of work of relevant staff by using similar measurement criteria.There are some limitations in its application.