公立医院院长薪酬激励对医院绩效的影响

The effects of salary motivation of public hospital presidents on hospital performance

目的:本文研究院长薪酬激励对医院绩效的影响。方法:采用自然实验方法,选取了院长薪酬与医院绩效挂钩和不挂钩的两个城市,分析了两种模式对公立医院主要绩效指标的影响。结果:(1)在院长薪酬和医院绩效考核结果挂钩的激励机制下,院长薪酬的增长同医院收入增长正相关,但与均次费用和平均住院日没有显著关系;(2)在院长薪酬与医院绩效考核结果不挂钩的机制下,院长薪酬增量与医院绩效指标没有显著关系;(3)院长薪酬与医院绩效结果相挂钩的城市,公立医院门急诊和住院次均费用增加高于院长薪酬与医院绩效结果不挂钩的城市。结论:院长薪酬与绩效指标挂钩与否并没有显著影响医院绩效,说明非经济因素激励也非常重要。院长薪酬同医院绩效指标挂钩会促使医院向考核指标努力,可能忽略医院全面发展。

Objectives:This paper analyzes the impact of hospital presidents salary motivation on hospital performance. Methods:Using a natural experiment method, this paper compares the performance of public hospitals in two cities in China,of which one has an established direct link between hospital performance outcome and hospital presidents remuneration, while salary motivation of hospital presidents in the other city is jointly determined by an overall evaluation of the government agency that manages public hospitals and hospital employees, and is not linked directly to hospital performance evaluation scores.Results:(1)The growth of hospital president remuneration is statistically associated with the growth of hospital revenue, but is not associated with the average expenditure of outpatient visits and inpatient stays under the remuneration system where hospital presidents salary motivationis linked to hospital performance evaluation scores;(2)the growth of hospital president remuneration is not related to any performance evaluation scores under the remuneration system where hospital presidents salary motivation are not linked to hospital performance evaluation scores;(3)the average expenditures of both inpatient stays and outpatient visits under the remuneration system with direct link between hospital presidents salary motivation and hospital performance evaluation score grow faster than the remuneration system without direct link between hospital presidents salary motivationand hospital performance evaluation score. Conclusions: The two types ofsalary motivation methods do not show significant differences in hospital performance, which means that non-economic incentives are also important. Direct linking performance indicators to hospital presidents remuneration could encourage the hospital management focuses on indicative performance, but may result in ignoringthe overall hospital development.