| Most of public hospitals’ problems in China arose from the income distribution system.Before the economic reform,the hospital,operating under the planned economy system,could not dominate the balance and paid by the duty grade salary system.The advantages of this distribution method are that the doctors’ income are stable and the hospital have no financial motive.Nevertheless,it will cause the egalitarianism among the hospitals and the employees and might be harmful to doctor’s initiative and efficiency.Since 1980 s,the balance of revenue in hospitals can be used for collective benefits and personal rewards.At that point,the income of healthcare service providers began to be linked to the production efficiency of healthcare services,and hospitals were motivated to increase income and income.In the early part of the century,after years of reform in,there was a high rate of medical costs,unfairness in medical expenses and unfairness in access to health care services,and a limited improvement in the level of medical services.The need for reform of the health care system has become increasingly urgent,and the new health reform of the2009 year has emerged in this environment.Although the new medical reform has continuously reduced the rate of drug increase and reduced the prices of the various hospitals ’ profit-making services,it has not changed the power of the hospital to dispose of the balance freely.In this case,instead of reducing the cost of medical services,hospitals have ensured a steady increase in hospital balances by increasing the per capita workload and by adjusting the composition of the medical services（additional inspection and inspection projects）.The result is that the medical expenses are not controlled,but the doctor-patient contradiction is increasingly fierce.Therefore,to change the profit motive of public hospitals,we must first manage the right to dispose of the hospital balance,and the key to the balance disposal is the remuneration of medical staff（including all bonus income）.If the balance is applied to the medical staff in the strict management of remuneration,that is,the total wage control,as the hospital managers-the government is facing the most important question is: the level of reasonable pay should be? This issue is also a common problem faced by countries around the world.Policymakers face three key issues in the formulation of pay reform policies for doctors in public hospitals.First,under the market economy system,what are the differences of doctors ’ pay levels in developed countries,and what are the main factors that influence pay levels? Second,what are the effects of the differences in the pay levels of doctors in developed countries on the quality of medical services and the supply of doctors? Thirdly,what are the feasible ways to reform the doctors ’ salary in public hospitals?The reform of doctors ’ salary level has been paid attention by scholars and managers.As for the investigation of the present situation of doctors ’ pay level,the previous research generally adopts international comparison method,which directly refers to the proportion of doctors ’ pay and the average income of local society.The reason why the domestic doctors’ income level is low is due to the imperfect of China’s medical and health market,the government’s excessive intervention,the specific decision-making mechanism and the imperfect rules and regulations.But these findings are based on doctors ’ pay levels in other countries,and the problem is that doctors pay levels vary widely across the world.The OECD National Doctors ’ income is a large span of the average wage in the world from 3 to 7.The pure developed country doctor salary level whether absolute or relative value to our country’s reference significance are limited.Therefore,we need to analyze the doctors ’ labour market in depth,to clarify the factors affecting the level of doctors ’ pay,to analyze which part of the doctor’s remuneration comes from the objective economic development rules should be followed and retained,which part is due to market imperfections caused by price distortions,the need for policy intervention.Our second step is to analyze the relationship between the salary level of doctors in developed countries and the quality of medical service,while the supply of doctors ’ labor is an indirect factor affecting the quality of medical services.As for the difference of doctors ’ pay levels in developed countries,we first describe the basic situation of doctors ’ pay levels in the OECDcountries and our country（2016 year）.We used the relative pay level of the average doctor’s salary and the social average pay to compare the difference in pay between countries.Data show that there are significant differences in the absolute and relative levels of physician pay in typical countries of the OECD,including differences between specialties.However,relevant research suggests that the level of physician pay in these countries and the performance of the entire National Health Service system are not simply correlated.Therefore,the reform of the salary level of doctors in China cannot be used for reference.The relevant conclusions of the regulation analysis of the national medical labor market in the OECD countries still have some reference value and important reference significance for the reform of doctors ’ salary level in China.As an economy with a vast territory and a significant imbalance in economic development,there are significant differences in the level of medical technology between regions in China.Institutional factors such as the establishment of medical and technical personnel cause the flow of doctors ’ labor between regions more difficult than other countries.This policy-shaped market segmentation is,to some extent,similar to the market segmentation among the OECD countries.When analyzing the average salary level data of the provincial and municipal doctors in China,we find that although the absolute salary level of our doctors is significantly behind that of the OECDcountries,the ratio of the average salary to the average disposable income of the provincial and municipal doctors in China（i.e.relative pay level）is basically in the the lower level in the relative horizontal range of physician remuneration in the OECD.In the study of the determinants of doctors ’ pay levels and the relationship between doctors ’ pay level and medical service quality,due to the lack of domestic doctors ’ salary level data,we selected two panel data sets,17 OECD typical countries durning 1995-2012 and 34 OECD countries durning 2000-2016,to do empirical anlysis.The research of the determinants of doctors ’ pay level is based on the basic labor market theory of classical economics,neo-classical economics and institutional economics,and considers that the doctor labor market is influenced by market factors,institutional factors and social factors in three aspects.By reviewing the theory of market segmentation and introducing the theory of modern market segmentation,the paper divides the institutional factors into two parts: market structure factors and labor mobility factors.At the same time,the paper introduces the hypothesis of the independence of the factors of labor force in the market and the social factors,and obtains the sufficient conditions for the segmentation of labor market in the market: the influence of factor liquidity on the market price is not zero.Therefore,we can prove that the labor force in the market has a significant effect on the market price,which shows that there is a significant segmentation of the industry market.The empirical results show that the endogenous market in the labor market of medical service supply industry still plays a significant role.At the same time,the doctor labor market and the whole labor market have a significant segmentation phenomenon,namely,the market structure and labor factor flow in the system factors have a significant impact on the operation of doctors ’ labor market.The mobility of labor factors has an impact on the labor market of medical service supply industry,and the labor force factor Mobility and the price of the market-doctor pay is negatively related.The impact of labor force factor mobility barriers on doctors ’ pay in doctors ’ labor market is more in the period before graduating from medical school,and the influence of medical college graduates to obtaining doctors ’ licenses is not significant.The ultimate goal of the study of the labor market is to serve the product market,the relationship between doctors ’ pay level and medical service quality is to start with the traditional Western economics production function and introduce the labor function of the quality correction.Given the impact of physician pay on the quality of doctors ’ labour output-medical services,we have incorporated the remuneration factor into the doctor’s labour market,resulting in two paths to pay levels that affect the quality of labour: the total labor supply and the quality-adjusted Labour index,The correlation equation of medical service output（including quantity and quality two aspects）and doctor’s labor income level was constructed.When studying the relationship between the remuneration of doctors and the quality of medical service,we divide the quality of medical service（the quality index of the into global,general,specialist three dimensions）as the dependent variable,the physician pay level in the corresponding medical field as the core explanatory variable,and the related covariance variables are also introduced.The study found that the impact of doctors ’ pay levels on the quality of medical services was limited: the level of doctors ’ pay had a significant effect on the quality of some global medical services and the quality of general / Primary care services,while there was no significant effect on the quality of medical services in emergency.That is,the level of physician pay varies in different healthcare services,which might relate to the characteristics of the medical service product itself,or to the special production function structure of the medical service industry.The influence of doctors ’ pay level on the quality of medical service emphasizes the long-term comprehensive and basic medical field.The main conclusions of this study indicates following three conclusions.First,it is difficult to copy any developed country doctors pay level directly as the standard of our doctors pay level.But the extent of the relative remuneration of developed countries and the impact on domestic medical services can provide a valuable reference for the reform of our doctors pay;second,The impact of doctors’ pay levels in developed countries suggests that we can use the appropriate policy tools to intervene in the level of physician pay.For example,policies that affect labor market supply-side market forces can be developed to regulate the labor market for doctors,or to control the flow of labor elements in the industry to influence the final price of the market.Third,the appropriate pay policy can improve the quality of medical services.Since the quality of the general practice / Primary Medical service is more sensitive to the level of doctors ’ remuneration,we can improve the quality of medical services by improving the relative income level of the primary doctors.But such policies may have little effect on specialties such as emergency care.In the analysis of the quality of medical service in the emergency department,the control variables include the proportion of specialist physicians,the expenditure of medical service per capita,the number of beds and the ratio of bed to nurse./ These variables,which represent capital investment,have a significant effect on the quality of healthcare service.Therefore,if you want to improve the quality of specialist medical services may be in the hardware or simple labor force of input will receive better results. |
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