Research On Incentive And Compensation Of Rural Doctors In The Medical Reform

Nearly a million rural doctors in our country bear the duty of providing basic medical and public health services for farmers. So how to give full play to their role in this system is the key to the success of Chinese rural health services. After2011, the medical reform policies gradually covered the basic village clinics, and rural doctors who were market-oriented changed to be the government agent to supply basic health services. Thus we use the different incentives before and after the reform for rural doctors as clues, and explore the characteristics of the supply behavior of doctors and the reasons behind, then assess the impact of the current reform policies.We firstly discuss the quasi-public nature of the basic medical service which characterizes its uncertainty, fairness, information asymmetry and significant positive externalities. Rural doctors also always establish close relationship with the villagers and independently undertake medical risks. Based on these rural doctors’characters, Chamberlain (3962) monopolistic competition model is introduced to analysis rural doctors" services under the market-oriented conditions. The results are as follows: Firstly, rural doctors who choose to stay in the medical market may meet their own reservation utilities. Secondly, the basic medical services they provide are in higher price and lower quantity compared to socially optimal level. Thirdly, simply seeking the interest of drugs would lead to drug abuse. Fourthly, due to a variety of factors will weaken the monopoly power and profitability of rural doctors, their overall income level is low, so they don’t have enough funds to improve their existing state.After the Essential Drugs System is set up in village clinics all around our country, rural doctors become a government agent serving basic medical care and public health services, and government compensation are main source of their income. So referring to the theory of Incentive and Restraint, multi-task principal-agent model is introduced to help analyze each optimal behavior of the government and rural doctors in the new medical reform. Then we deduce the optimal incentive compensation strategies for rural doctors. On this basis, we did a field research of rural clinics in Zhongxiang to further understand how the reform influences them. Referring to the Survey of Chinese rural doctors living conditions, following problems are present: first, inadequate government compensation leads to lower enthusiasm for rural doctors providing basic.nodical services. Second, the public health arranuements assigned bv the government are not reasonable. Third, the doctors’ enthusiasm of offering medical care is lower. Last but not least, arrears in compensation happen and rent-seeking behaviors of some relevant government departments exist.Combined with the multi-task principal-agent model analysis results, policy recommendations are put forward in order to improve the management of rural doctors. On the one hand, a reasonable increase needs to be made in both fixed and variable compensation for rural doctors. Adequate compensation for the construction of village clinics should also be carried out. On the other hand, compensation regulatory system should be improved to guarantee the payment of compensation. And an establishment of a reasonable medical risk sharing mechanisms for rural doctors is necessary, furthermore, young doctors need to be encouraged to serve in rural areas.