我国公立医院在经历了二十多年靠自身创收改善医生薪酬的激励机制之后,2017年人社部等四部门发布了改革试点指导意见,使薪酬制度改革成为公立医院改革的重点。本文从医疗服务的特殊性、医生行业组织形式和薪酬激励机制三个方面来探讨我国公立医院医生薪酬激励机制改革策略。医疗服务的特殊性使得自雇式成为国际医生行业组织形式的主流,但当医疗保障成为社会发展目标之后,医生和患者都必须面对有限公共资源的管理,而科学技术引起的医疗服务专业化使医生对医院的依赖越来越紧密,政府、医院和医生形成了从合同制到政府主办的各种医疗服务组织方式。但无论组织形式如何,由社会(政府)筹资方主导绩效考核,在有限资源下提高医疗服务价值是改革追求的共同目标。我国公立医院医生薪酬激励机制的主要问题是创收导向引起的诊疗方案费用高、效益低,但要转变为绩效导向则必须解决医院现行的经济运营体制,财政、价格和医保应该配套调整政策,让医院在追求服务绩效的改革中,收入同绩效同步增长。
<<The guide for public hospital salary reform jointly developed by four associated ministries focuses the public hospital reform on physician compensation. This article reviews the literature and summarizes physician compensation research in three aspects:special characteristics of medical care,physician organizational structure,and methods on payment incentive. The special characteristics of medical care makes self-employment as the mainstream of physicians’organization form. However,the relationship among government,hospital and physician is increasingly close when medical care gradually becomes public responsibility and both providers and patients are facing the challenge of limited resource. Regardless of the organizational form,a performance evaluation lead by the society and value improvement is the common goal of health system management. The main problem in physician payment incentive mechanism is high cost and low benefit driven by profit seeking incentive in public hospitals. To transfer from profit driven to performance evaluation,the government must reform the financing structure for public hospitals and enhance collaboration among the departments of health,finance,pricing and health insurance.
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