Research On Remuneration System Of General Practitioner Based On The Theory Of Value-based Health Care

[Purpose]General Practitioners(GPs) is an important human carrier to achieve the strategy of Health of China, they can play a huge role to ensure the health of urban and rural residents, and improve the level of primary health services, and promote the transformation of health care model.As a key part of the reform of the GP system, remuneration system, it is important for the improvement of GP service initiative. With the new health care reform process in depth, and establishing the characteristics of the medical profession medical staff personnel remuneration system has gradually become the consensus, the key is that remuneration need to reflect the value of their labor.Based on this, by in-depth analysis of the development of the value-based health care theory, combing with the characteristics of general practitioner services, we can theoretically grasp the composition of GPs labor value and explore the relationship between remuneration of general practitioners and the value of labor. Starting from the value, we design and bulid the framework and appropriate strategies of GP remuneration system which stand on value-based health care theory to provide policy recommendations to GP remuneration system which can fully reflect the labor value of general pratitioners.[Methods]1. The methods of data collection(1) Literature reviewBy searching the database of CNKI, WanFang and PubMed, we summarized the development status and history of GP remuneration system at home and abroad, analyzed the origin and development of value-based health care theory.(2) Experts consultationTeachers in universities, officials in health administrative department and other experts were invited to evaluate the framework and indicators of GP performance assessment in remuneration system.2. The methods of data compilationFirst, value-based health care theory origin and development was smoothed, and the labor value connotation was determined. Based on previous works which have been done, the GP compensation system of historical development and present situation research literature was collected from home and abroad, that can ensure documents involved in all aspects related to GP remuneration system. Second, expert questionnaire was scrutinized logically to check whether the expert evaluation is inconsistent or not.3. The methods of data analysis(1) Experts consultationTeachers in universities, officials in health administrative department and other experts were invited to evaluate the framework and indicators of GP performance assessment in remuneration system.(2) Data analysisSPSS 19.0 was used to statistically analyze the results of expert advice, and ultimately determined the general practitioner performance evaluation index system. [Results]1. The connotation of GP labor valueGP labor value was constituted of general practitioner personal cost(C,V)and value of service object(M). Personal cost of GP includes the consumption of resources and manpower which ensure the service quality, like the land and medical equipment of community health services agencies, general practitioner education and vocational training time and other manpower cost.2. Reference of foreign GP remuneration systemForeign GP pay system had the following characteristics:(1) Foreign GPs overall salary level is about three times the average wage,the higher salary level is an important way to reflect the reaction of the general practitioner labor value;(2) The goal between general practitioners remuneration system and health service system reform is consistent,set the value of health care---imprvement of people health as the incentive target of GP;(3) Value of serviced people is to serve as a starting point in GP performance appraisal and compensation payment,methods of payment act as the focus of reform of GP remuneration system,the health of population act as index of GP performance appraisal and remuneration payment;(4) Construction of GP remuneration system required some basic institutional mechanisms,it need to create a good social atmosphere of professional service.3. The problem of domestic GP remuneration systemThe problem of domestic GP remuneration system included: the proposition of GP value is fuzzy, lack of correct understanding,the design of remuneration system lacked strategic thinking,In institutions as a reference standard, it did not fully consider the characteristics of general practitioners; Salary level and structure is irrational, the level of domestic typical urban general practitioners is flat with social average wage(1 times or so), remuneration structure is simply divided into the basic performance and incentive performance in two parts,it is difficult to fully reflect the labor value of physician services; Performance appraisal service quantity, quality and resident satisfaction act as a major assessment indicators, the indicators of residents of health care cost control and the level of actual health is mixed and not unified,performance appraisal and payment services not fully reflect the value of the object.4. The framework of GP remuneration system based on value-based health care theoryWe set out three aspects: strategic, technical and institutional to construct the framework. From strategic level, the labor value of GP is to maintain the health of mankind. From technical level, the performance appraisal reflects the labor value of GP, Calculation of personal costs of general practitioners and patients' value is a technological way to reflect the labor value of GP.From institutional level, the system was consisted of four aspects such as GP remuneration level and GP remuneration structure and so on, among them, the performance assessment framework should start from service processes and result, the weight distribution of them is 0.524 and 0.476. Service process should include general practitioners contracted services(0.126), basic medical care(0.141) and the public health service(0.134), health risk Intervention(0.123) content. Service result should be divided into population health improvement(0.251) and health expenditure control(0.225) in two parts. [Conclusions]1. GP value was furtherlly defined as general practitioner labor value, it was divided into GP labor cost and clients value, labor cost was consisted of general practitioners and human resource costs consumed by the general practiti oner service, clients value was constituted of the service object health outcome s and experience.2. Not noly the individual cost of GP, but also value of the service objec t should be included in the design of GP remuneration system.Through the per formance appraisal, remuneration can be better linked with labor value, it requi res policy makers to increase indicators of health outcomes and service experie nce in in the design categories of GP performance assessment.3. Consrtuction of GP remusystem system based on the value-based health care theory need mechanical and institutional inconditions. Firstly, the value an d the concept of GP should be noticed.Secondly, the role of government regula tion should be allowed to make a full play in the remuneration system of GP.Internally, by changing compensation design ideas to improve the treatment lev el of GP, adjusting the salary structure and improving health inserance paymen t system.Externally, through the establishment of general practitioners standardiz ed education system and vocational training system,it can promote the establis hment and development of GP remuneration system based on value-based healt h carel theory. [Shortage]This research focused on how the general practitioner remuneration system reflec ts the labor value of labor on the theoretical level. Lack of survey data, it may caus e bias. The labor value of general practitioner is divided into C, V, M three parts. Bu t the research did not study the distribution problem of the three parts which would result in the actual salary system design. When using general practitioner's performanc e evaluation framework built by Delphi method, it is hard to calculate the perf ormance of the general practitioner and put the remuneration distribution into a ction because of the single method and the lack of empirical research.