基于考核主体、竞争模式与信息披露方式的医生绩效评估策略研究

Strategy of physician performance appraisal based on appraisers,competition,and information

高质量发展背景下,政府如何在公立医院及医生的绩效评估中兼顾医疗卫生行业存在政府与市场双重失灵制约的客观现实,设计科学的机制和策略去激励医院或医生提高绩效,是我国现代医院管理制度建设中的关键难题之一,也是医疗卫生行业政府管制急需解决的问题之一.本文构建理论模型,从评估主体、信息披露方式,以及是否引入竞争等维度分析了公立医院改革背景下对医生进行绩效评估的策略选择问题.研究发现,医生自主评估、医生之间存在竞争、医生主动上报信息,且政府负责任的情景可能是最理想的评估策略之一,具体而言:1)政府不应该主导评估,而应该完善制度与激励方案;2)医生之间应该存在有序竞争关系;3)医生主动上报信息可能是一种更为有效的绩效信息披露方式;4)政府应该对评估结果进行再次复核,并负有监管责任.本文将医生绩效评估抽象为一个具体的政府管制政策的优化问题,为政府设计公立医院医生绩效机制提供了理论支撑.

How the government designs performance-appraisal strategies for public hospitals and physicians is an institutional and managerial challenge in a regulated health care market under the national planning of high-quality development for public hospitals in China.The pivotal dilemma is the balance between market and government failures to boost the performance of hospitals and physicians using reasonable incentive mechanisms within the institutional arrangement.This study proposes a theoretical framework of strategic selection of doctors’performance appraisal in China,where who are the estimators,how performance information is collected,and whether to introduce competition are three strategic elements in the ongoing public hospital reform.The results show a scenario option in which doctors lead the assessment,competition is encouraged,performance information is self-provided,and the government is responsible for institutional incentives.In detail,1)the government should not lead the assessment but consummates the system and incentive mechanism;2)healthy competition among doctors should be highly promoted;and 3)self-disclosure of performance information from doctors may better eliminate information asymmetry;and 4)the audit deterrence of governmental agencies should be on board.This paper ascribes the performance assessment of doctors to a specific optimization problem of government policy,which provides theoretical support for the government to design mechanisms securing the high-quality development of public hospitals.