Study On Compensation Mechanism Reform Of Primary Health Institutions In Zhejiang Province,China

Objective:In 2015,Zhejiang Province carried out pilot reforms of compensation mechanism for primary health institutions in Haiyan County,Shengzhou County,Yiwu County and Jiangshan County.The purpose of this study was to evaluate the scientific nature of the policy,acceptability,fairness,performance,incentive and sustainability by interviewing leaders who were related to decision making,ehiefs of primary health institutions,and primary medical staff;to assess whether the reform of the research sites is in line with theoretical expectations;to find the highlights and existing problems of the current reform and propose suggestions for improving the compensation mechanism of primary health institutions.Methods:This study constructed the theoretical framework and evaluation indicators of research based on stakeholder theory,fairmess theory,new public management theory,expectation theory,and sustainable development theory.Focus group interviews were conducted with 20 leaders who were related to decision making,24 chiefs of primary health institutions and 48 medical staff,which collected qualitative interview materials such as stakeholders'perceptions and acceptances,fairmess,performance outcome,incentive and sustainability of the policy.NVivoll.O was used to extract,encode,and organize qualitative materials.The questionnaire was used to census all primary health institutions in pilot counties,such as institutional income and expenditure,institutional work equivalents,then a database and descriptive analysis were made in excel.Results:This study found the reforn policy had a good scientific nature,which met the needs of local requirements and the requirements of the country's deepening reforms,and combined the successful experience of intermational public management with advanced theories to design reform policy.The reform had nice acceptability.Different stakeholders at the research sites had clear understanding of the reform and supportive attitudes to it,and the level of informatization and the standardization work equivalent of services are closely related to the acceptability.The reform had sound fairmess and performance outcomes,reasonable proportion of funds allocated and adjustment factors of different primary health institutions guaranteed the reform concept of more work with more pay and the normal operation of primary health institutions with low work equivalents due to objective factors;the increase of 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 intermal distribution system of primary health institutions didn't carry out corresponding reforms,the control of surplus revenues used for performance appraisal reward,non-fixed price of a work equivalent,and impact of private health institutions.Conclusions:The practice of compensation mechanism reform of primary health institutions at the four research sites has good scientific nature,acceptability,fairness and performance results,but the incentive and sustainability of the reform were still flawed.It's recommended to strengthen the funding and talent investment of informatization construction for establishing a medical information system that meets the needs of reform,establish a performance appraisal and salary distribution system that is compatible with the equivalent purchase method within the primary health institutions,increase the amount of performance salary and the salary of staff without a quota position,guarantee the increment of reform funds with multi-channel,use scientific calculations to develop standardized work equivalents and its unit price,and innovative delivery model of basic public health service to cope with the challenges.