浙江省级公立医院薪酬现状及其改革成效分析

Public hospitals′ salary status and effectiveness of salary reform in Zhejiang province

公立医院薪酬改革成效不仅关系到医务人员的切身利益,也关系到深化医药卫生体制改革的成效。作者采用2012年至2017年浙江省17家省级公立医院数据,在控制了药品加成率、医院规模和综合与专科医院属性后,从公益性职责履行、服务量、医疗费用、成本控制、服务效率以及医保政策执行角度等,分析了浙江省级公立医院薪酬改革成效。浙江省级公立医院绩效工资增长率低于15%,绩效工资占薪酬总额比例低于70%。医疗服务成本控制、医疗服务效率提升以及医院承担的服务量和公益性职责等,对省级公立医院薪酬影响虽小,但显著正相关。医疗费用和医保政策执行对公立医院薪酬影响虽不显著,但较低的医疗费用和医保拒付率有助于提高公立医院薪酬。浙江省级公立医院薪酬改革虽已初步取得成效,但仍需进一步完善薪酬体制。

The salary reform in public hospital is not only related to the interests of medical staffs, but also to the health care reform. Based on data of 17 provincial public hospitals in Zhejiang province from 2012 to 2017, and having calculated such factors as drug markup rate, hospital scale and general/specialized hospital characteristics, the authors analyzed the effectiveness of public hospitals salaries reform from the perspectives of public duties performance, service quantity, medical expenditure, cost containment, service efficiency, implementation of insurance policies, among others. The growth rate of performance salary in Zhejiang provincial hospitals was less than 15%, and the performance salary accounted for less than 70% of the total compensation. Such factors as cost containment, improvement of efficiency, service quantity and public welfare duties performance impose, though having minimal impact, were found to be significantly positively correlated to such compensation. Given the minimum impact of reforms in health care expenditure and insurance policy on public hospital salaries, lower medical expenditure and insurance refusal rates are conducive to raising such salaries. The salary reform of provincial public hospitals has achieved initial success, yet their salary system calls for further improvement.