四川省公立医院薪酬制度改革典型经验分析

Analysis of typical experiences of public hospital salary system reform in Sichuan province

目的:分析四川省公立医院薪酬制度改革中的经验做法,归纳四川省公立医院薪酬制度改革的典型模式,为进一步深化改革提供参考。方法:截至2021年10月29日,课题组收集由四川省开展公立医院薪酬制度改革的地市(州)卫生健康委员会和公立医院提交的典型经验材料77份。以《关于深化公立医院薪酬制度改革的指导意见》中提出的,深化改革中需继续落实的5项主要内容为分析框架,具体包括"合理确定公立医院薪酬水平""充分落实公立医院内部分配自主权""建立健全公立医院负责人薪酬激励约束机制""健全以公益性为导向的考核评价机制"和"经费来源",运用社会网络分析法对典型经验材料进行量化分析,运用内容分析法对典型经验材料进行定性分析。结果:社会网络分析结果显示,网络密度为0.272;点度中心度最大者为"充分落实公立医院内部分配自主权"(0.935),中介中心度最大者为"健全以公益性为导向的考核评价机制"(0.870),"建立健全公立医院负责人薪酬激励约束机制"(0.434)和"经费来源"(0.421)的接近中心度较低。内容分析结果显示,所有典型经验材料中,出现频次较高者为"充分落实医院内部分配自主权"(72次)和"健全以公益性为导向的考核评价机制"(67次),出现频次较低者为"建立健全公立医院负责人薪酬激励约束机制"(17次)和"经费来源"(14次);从统一性和协同性2个维度,可将四川省公立医院薪酬制度改革典型模式归纳为精细标准模式、公正价值模式、自主协同模式和循环共生模式。结论:深化公立医院薪酬制度改革,应统一标准,健全公平的精细化考核评价机制;探索多种分配形式,构建内部自主协同激励机制;重视医院负责人薪酬激励机制弱,经费来源渠道较单一的问题。

Objective To analyze the experiences and practice in the reform of public hospital salary system in Sichuan province,summarize the typical modes of such reform in the province,and provide references for further reform.Methods As of October 29,2021,the research group received 77 sets of typical experience materials submitted by the health commissions and public hospitals in Sichuan province on enforcing the reform of the public hospital salary system.The analysis framework was based on the five main elements proposed in the Guidance to Deepening the Reform of the Salary System of Public Hospitals for the purpose of furthering the reform.These five elements refer to"reasonably determining the level of salary in public hospitals""fully implementing the autonomy of internal distribution in public hospitals""establishing and improving the incentive and restraint mechanism for the remuneration of public hospital leaders""improving the assessment and evaluation mechanism oriented to public welfare"and"funding sources".A quantitative analysis was made on the typical experience materials using the social network analysis method,while a qualitative analysis was made on the typical experience materials using the content analysis method.Results The results of social network analysis showed that the network density was 0.272;the highest point centrality was"fully implement the autonomy of internal distribution in public hospitals"(0.935),and the highest intermediary centrality was"improving the assessment and evaluation mechanism oriented to public welfare"(0.870),while the closeness to centrality of"establishing and improving the incentive and constraint mechanism for the salary of public hospital leaders"(0.434)and"funding sources"(0.421)were relatively low.The results of content analysis showed that the ones with higher frequency among all the typical experience materials were"fully implementing the autonomy of internal distribution of hospitals"(72 times)and"improving the assessment and evaluation mechanism oriented to public welfare"(67 times),while the ones with lower frequency were"establishing and improving the salary incentive and constraint mechanism for public hospital leaders"(17 times)and"funding sources"(14 times).In terms of unity and synergy,the typical models of public hospital salary system reform in the province could be categorized as the fine standard mode,the fair value mode,the autonomous synergy mode and the circular symbiosis mode.Conclusions Deepening the reform of the salary system of public hospitals should unify the standards and improve the fair and refined assessment and evaluation mechanism;explore various forms of distribution and build an internal autonomous and synergistic incentive mechanism;pay attention to the weak remuneration incentive mechanism for hospital leaders and the problem of a relatively single source of funding.