Designing Research Of Evaluation-based Rural Doctors Contract Service Payment Mechanism

Background:Since pilot work of rural doctors contracts service has carried out on April of 2013 in China, rural doctors provide continuous, convenient and integrated family service for residents after they signed the contracts with doctors which is in favor of the implementation of basic public health services and the establishment of grass-roots first consultation system. The number of contracting residents and workload of rural doctors have both increased with promoting the pilot work, meanwhile the lack of effective incentive mechanism which reflected in the shortage of compensation policies and the incomplete evaluation system that restricted the working enthusiasm of rural doctors which further led the contract service become a mere formality and the quality and level of service is hard to assess,and may hinder the progress of pilot work in rural areas around the country.Objective: Firstly,analyzing the current status of rural doctors payment and the evaluation to get the payment method, payment subject, way of evaluation, evaluation index system and main problems of contract service.Secondly, constructing the contract service evaluation index system which service quality and effect as the key.At last, on the basis of index system, designing of a new payment mechanism intends to pay the compensation funds for doctors according to the evaluation result, thus payment mechanism will play an incentive role to rural doctors.Method:Through the review of literature, learning the current research situation of payment mechanism and evaluation index, studying the connotation of mechanismdesign and method of index construction. Performing field investigation by holding forum and interviews to acknowledge the progress of pilot work as well as current payment and evaluation way of contract service. Completing the selection of evaluation index and the calculation of index weights by Delphi, and then to construct the rural doctors payment evaluation index system.Results: The subjects of payment system in sample county are national finance and the new rural cooperative medical system.Income of rural doctors comes mainly from the basic public health service funds, financial subsidy and outpatients cost.There is only 14% of the sample counties pay the contract service subsidies for rural doctors.Main payment method: pay most of compensation first,and the rest will pay after the evaluation of doctors. All the sample counties had formulated the basic public health service assessment methods, samples that carried out the evaluation work of contract service took accounted for 70%,only 14% samples evaluate the basic medical service. The evaluation work of rural doctors is mainly based on the service quantity, only 53% and 38% of the samples set up the evaluation indexes including service quality and satisfaction. Based on the current research of evaluation index system, study constructed the rural physician payment evaluation index system according the investigation results by Delphi,which took the quality and effect of service as the key content.The number of service quality and effect index is 27, accounting for half number in all the third level indexes. The weight of contract service index is the largest among all the first level index,and resident satisfaction index is secondly, and resources index is minimal.The weight of service quality index is 0.3968, which is the largest index weight of all the second level indexes. The design of new payment mechanism for contract service of rural doctors is based on evaluation,link the evaluation results with the doctors income.This mechanism has important significance to improvedoctors’ initiative of contracted services,ensure effective utilization of the medical insurance fund and the public health service funds.Conclusion: Rural doctors contracted services are still in the pilot phase, the reform of payment mechanism couldn’t accomplish at one stroke.And the reform will developed by the cooperation of administrative department of public health, department of human resources and social security, township hospitals and rural doctors, and the supporting of related policy. The study put forward the following 5 suggestions for rural doctors contracted service payment mechanism reform:1.making compensation policy to promote the payment of compensation funds.2.designing personalized service to expand diversified ways of compensation.3.taking the rural doctors team as the object of payment and evaluation.4.improving service ability and quality of rural doctors.5.utilizing the evaluation results synthetically.