Study On Remuneration Incentive Mechanism Of General Practitioner Working Group Based On Performance Evaluation

[Purpose]Through literature review, field investigation, expert consultation and other research methods, this paper systematically reviews and summarizes characteristics of the salary system and practical experience of pay-for-performance for General Practitioners in the developed countries. Then, this paper analyzes the status of GPs performance appraisal and salary incentives in the domestic pilot cities, and summarizes the existing problems of GPs salary incentive mechanism. On this basis, strategies to improve GPs salary incentive mechanism based on are put forward.[Methods]1. Literature researchBy retrieving CNKI, Pub Med and Medline, as well as domestic and overseas health policy website related to GPs(such as the UK NHS, Health-OECD, etc.), we collect GP salary system and pay-for-performance related data, literatures and policy documents both at home and abroad.2. Questionnaire surveyUse GP salary data collected in 2014 GPs reform assessment in Wuhan, Guiyang and Shanghai. Select 16 community health service centers in Wuhan according to the scales, staffing and balance of payment, and then select 2-3 GP working Group in each health center. Use self-made questionnaire to investigate all team members aimed to get specific information of salary incentives for each team member.3. Key person interviewInterview the director of relevant department in Wuhan Health and Family Planning Commission, directors of Community Health Service Center and GP team members to learn the current situation of GP working group construction, GP performance evaluation, GP payment system and salary distribution, as well as team members views and satisfaction with current performance-based payment scheme.[Results]1. The salary of General Practitioners in Wuhan, Guiyang and Shanghai increase since the reform began. However, the positive incentive effect of salary is not obvious in some pilot cities, and general practitioner income level is still low, especially compared with the specialists and social average salary.2. The structure of performance-related salary has been optimized. However, in some pilot cities the proportion of incentive payment based on performance is still low, and amount of performance-related salary is limited.3. There are two performance evaluation issues in the salary distribution system(1) Although in some pilot cities the specific performance appraisal scheme has been made, the orientation of performance appraisal is unclear. In some cities, performance appraisal is regarded as just a political task of the reform.(2) The indicators of performance evaluation is not comprehensive and refining enough. Most of the indicators are indicators of structure and process indicators, lack of outcome indicators. Also, indicators concerning medical cost control are not included. Moreover, lack specific and measurable indicators, particularly indicators in disease treatment and ongoing management of the disease.4. Existing problems in the payment incentive mechanism based on performance assessment for service contract fee in Wuhan(1) There is still a wide gap between current income and their ideal income for GP team members. And most of them expressed their un-satisfaction about current income level.(2) The payment incentive mechanism based on performance assessment for service contract fee in Wuhan is not brought into full play.(3) The imperfection of payment incentive mechanism based on performance assessment for service contract fee in Wuhan is mainly shown in two aspects. First, the financial fund allocation cycle is too long. Second, the allocation and use of financial fund in community health care centers lacks of effective supervision.(4) Lack of specific community health care center inner performance appraisal scheme, which also detached from the financial fund allocation between GP team members.[Conclusions]1. Since the limited amount of performance-related salary can't generate effective incentive, the regulating function of insurance funds should be brought into full paly. And the payment pattern of GP physician model needs to be improved, which means that the capitation and pay-for-performance should be introduced into the payment pattern of GP physician model.2. Scientific and normative performance appraisal system of GP working group needs to be established, based on clear orientation of GP performance appraisal system.3. Payment incentive mechanism based on performance assessment for service contract fee should be optimized. And supervision of financial funds allocation needs to be strengthened.4. The range of community residents participating in the GP physician model needs to be enlarged. And pay more attention to consistent observation and research of implementation for GP service contract fee.