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Salary Reform: Find a balance between motivation and restraint

   Recently, the Ministry of Social and other four departments issued "on the reform of public hospital pay system reform guidance", emphasizing the exploration to establish the characteristics of China's medical industry to pay the remuneration of public hospitals, medical staff to reflect the value of technical services and knowledge value, At the same time, it pointed out that this work has the characteristics of wide, policy and complicated situation. How to make the medical staff satisfaction at the same time and meet the medical reform goals, it seems that the difficulties of this reform.
   Do the doctor have to raise the salary?
   Relevant sources, the document led by the social sector has developed more than two years of brewing, the biggest bright spot is clear public hospitals can not apply the general institution wage system, but should be in accordance with the "medical institutions to break the current institutions Wage control level, allowing medical service income deducted from the cost and according to the provisions of the funds after the main reward for the use of "requirements, on the basis of the existing reasonable to determine the level of salary and performance of the total wage. In this regard, some industry people interpreted as, in the pilot area, the doctor's salary will be improved.
   For a long time, the level of income of medical staff in public hospitals in China is low, and the status quo of industry characteristics and knowledge value has been criticized. "National Health and Family Planning Financial Information" shows that in 2015, China's public hospitals in the average annual wage income of employees is 89,000 yuan, including urban hospitals, district hospitals, county hospitals were 105,000 yuan, 81,000 yuan and 6.6 Million, primary health care institutions for 55,000 yuan. In addition to service price distortions, by the hospital performance payroll limit, but also public hospital medical staff pay low reason. Last year, a provincial hospital in Guangxi, according to the local community to the hospital approved the total performance of the total wage, the hospital medical staff to control the annual salary of less than 30,000 yuan.
   "'Allow two' reflects the recognition of the characteristics of the medical industry, recognition of medical staff salaries should be higher than the general public institutions." Medical reform experts Yazhen that only the establishment of a scientific and rational pay system to attract more talents into health Industry, in order to fundamentally alleviate the problem of insufficient quality medical resources, the formation of strengthening the industry supervision, the development of medical professional evaluation system of the basic conditions.
   Zhang Guangpeng, director of the Health Workforce Research Center of the National Health and Family Planning Commission, said that in recent years, the demand for social medical services has increased significantly, the workload of medical workers has increased accordingly. Classification management. In the process of reform of the remuneration system, we should consider the factors such as job responsibilities, service quantity, quality of service and so on, and combine with the decentralized hospital personnel management rights, give the hospital salary distribution autonomy.
   Where did the money come from?
   To raise money for medical staff, where money comes from is one of the key issues. "Guidance" proposed that the reform of the pilot work required funds through the original channel to resolve. Some view that the document in the financial security of the "dry goods shortage", the doctor of the road will still be "long and hard." In this regard, should Yazhen think, look at the documents, in fact, can be found in Fujian Sanming medical staff remuneration system reform ideas and practices, has been fully absorbed.
   Ya Ming said that Sanming as a benchmark for the reform of public hospitals in the medical staff pay system reform, the first breakthrough, from the squeeze drug circulation areas of water, to "Teng cage for birds" to adjust the price of medical services to improve the financial situation of public hospitals to ensure that Salary system reform of the funding channels, the simultaneous introduction of the president goal of the annual salary system reform, professionals (doctors, pharmacists, technicians) target annual salary system reform, and annual salary system linked to the results of performance appraisal, "Practice, until the extension of the" full goal of the annual salary system "and" staff distribution points ", in fact," guidance "practical version.
   Obviously, the future funding of medical personnel will be mainly from the income of public hospitals to adjust the income structure, reflecting the value of medical services, medical services, medical services to enhance the price, rather than rely on increased financial investment.
   In the relevant seminar, the National Health and Family Planning Commission of the relevant person in charge of institutional reform has stressed that a substantial increase in the value of medical service technology, to meet the four conditions, that the burden of the people can not increase the overall health insurance fund can not wear the end of the hospital income Can not be reduced, the government can not afford to finance, "so the 'three medical linkage' is particularly important, through the extrusion of drugs, medical equipment, circulation of water, to surgery, care, bed fees to improve the creation of space.
   "At present, China's public hospitals dominate or reflect the value of labor technology accounted for 30% to 35% of the income." Relevant experts said that only this ratio increased to more than 60%, the hospital has sufficient funds to give Medical staff to raise income, while medical staff will also change the treatment behavior. "For the reform of the pilot hospital, the remuneration system reform will inevitably be associated with the 'three medical linkage' depth.
   How to keep up with regulation
   Some experts believe that doctors and hospital managers should be the high-income groups of society from the point of view of the physician's human labor and the current workload situation, as well as the unique contribution of doctors to the elements of productivity, the ultimate pursuit of mankind. But the reform of the remuneration system can not be divorced from the overall framework of medical reform, need to strike a balance between incentives and constraints.
   Yabin said that we must fully consider the complexity and uncertainty of medical services, it is necessary to mobilize the enthusiasm of the service, the implementation of effective incentives to ensure that the total amount of remuneration to a certain level, but also to do the total cap, set the "ceiling" Off in the cage, and resolutely avoid the more hospital income, the level of income will be able to increase the practice of unlimited.
   Therefore, in reducing administrative intervention, the implementation of public hospitals to allocate autonomy at the same time, also need to provide for effective supervision of exports. At present, China's public hospital chiefs pay the prevalence of over-decentralization of the management of the problem, the specific performance of the remuneration of the dean is not as good as its clinical high, lack of performance evaluation system; or the remuneration of the hospital and the overall income linked to the hospital Economic indicators and management of personal interests difficult to understand.
   In this regard, the experts believe that the management team headed by the president as an agent, the remuneration must be decided by the client, that must be determined by the government or government agencies, and not by the agents themselves. Document requirements, the hospital internal distribution to fully reflect the medical, nursing, technical, medicine, tube and other different job differences, reflecting the knowledge, technology, labor, management and other elements of the value, to avoid the big pot, to answer the hospital how to pay the wages of medical personnel ; And how to give the hospital management wages on the issue, then encourage the public hospital authorities to the main person in charge of public hospitals to explore the implementation of annual salary system, which play a leading role in health care reform policy.
   Yazhen believes that through the normative incentive mechanism to mobilize the enthusiasm of medical staff, is to establish a new remuneration system of the core measures. In addition, strengthen the service behavior supervision, such as drug supervision, prescription reviews, health insurance settlement audit control, etc., to promote health insurance payment reform, external supervision for internal incentives, but also can not be ignored.
 
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