公立医院薪酬分配制度分析

Analysis of salary distribution system in public hospitals

目的分析公立医院薪酬分配制度改革可能产生的问题和挑战,并探讨改革注意事项。方法查阅国家卫生部发布的《中国卫生统计年鉴》和国家统计局发布的《中国统计年鉴》,运用文献研究的方法分析2003—2010年医院的收支情况,并比较公立医院与其他单位就业人员的工资增幅。对上海市18家三级医院医务人员的工作量收集情况进行了现场调查。结果政府对公立医院的投入不足10%,明显少于人员的支出(>26%),药品收入仍超过医院收入的45%。现有薪酬分配制度能保证人员的积极性但可能导致费用快速增长;绩效工资制度的总量会有3.26%～7.38%的缺口,高收入科室人员的绩效工资比重会下降20%,从而产生激励不足;岗位工作量考核的数据不易获得,标准难以确定。结论现阶段公立医院薪酬分配挑战与机遇并存,加强政府投入的同时公立医院需强化自身管理工作,必须寻求绩效工资与现有分配制度之间的平衡,并且谨慎选择岗位工作量的计量标准与方法。

Objective To analyse the challenge in reform of salary distribution system in public hospitals, and put forward suggestions. Methods Annuals released by the Ministry of Health and National Bureau of Statistics of China were retrieved, the incomes and expenditures of hospitals between 2003 and 2010 were analysed, and the salary increase of staff in public hospitals was compared with that in other institutions. On-site survey on workload of medical staff in 18 municipal hospitals in Shanghai was also conducted. Results The input of government in public hospitals was less than 10%, which was significantly lower than the salary expenditures （〉26%）, and the income of drugs still accounted for 45% of the total income of hospitals. The performance-based pay system and workload evaluation proposed in medical reform posed significant influence on current salary distribution system, which would result in shortage by 3.26% to 7.38%. The data of workload were hard to obtain, and the standard was hard to determine. Conclusion Both opportunities and challenges exist in current salary distribution system in public hospitals, and hospital management should be enhanced to balance between current salary distribution system and performance-based pay system.