Research On Family Doctor’s Salary Compensation Mechanism Under The Background Of "Two Permissions" Policy

Objective:Through literature research and site investigation,sort out the main practices of family doctor salary reform in typical areas and the current salary status under the background of the "two permissions " policies,explore the current status of family doctor salary compensation in typical areas,and analyze the compensation of family doctors by the "two permissions " policies It summarizes the effects and problems of different models on family doctors’ salary compensation,and puts forward suggestions for improving the family doctor’s salary compensation mechanism.Contents:The first is to sort out the salary compensation situation of family doctors in different regions,including the implementation of the "two permissions" related policies and the status of family doctors’ salary compensation in different regions;the second is the analysis of the effect of the "two permissions" policy on family doctors’salary compensation;the third is to propose policy recommendations for improving the compensation mechanism for family doctors.Methods:Through literature research and analysis,domestic and foreign family doctors’salary reform,compensation mechanism and other relevant theoretical and practical data.Using intentional sampling,select typical areas where family doctors contracted services have achieved certain results and the implementation of the "two permissions"is at different levels for on-site investigation.Take qualitative interviews to understand local practices and existing problems,collect policy documents related to the "two permissions" and survey forms of health administrative departments and primary medical and health institutions,and use questionnaires to understand family doctors’satisfaction and work enthusiasm for changes in income brought about by the policy.A total of 8 districts(counties)and 13 community health service centers were surveyed this time.A total of 8 survey questionnaires from health administration departments,13 survey questionnaires from primary medical and health institutions,and 13 primary medical and health institutions’ salary statistics were collected.276 questionnaires for family doctors.The quantitative data was first analyzed by the Chi-square test and the rank-sum test,and statistically significant(P<0.05)variables were included in the Logistic regression model to analyze the difference between family doctors’satisfaction and work enthusiasm for income changes brought about by policies under different salary compensation mechanisms.The impact of the remuneration policy reform on doctors has led to differences in remuneration compensation mechanisms in different regions with the implementation of the "two permissions".Results:1.Implementation of "two permissions" related policiesIn the 8 regions surveyed,6 regions have implemented the "two permissions"policy,and 2 regions have not implemented the "two permissions" policy.Their performance levels,revenue and expenditure balance allocation,contracted service fee financing allocation,etc.There are differences.2.The status quo of family doctors’ salary compensation under different modesThe "Two permissions" policy mainly acts on the incentive performance pay of family doctors.According to the breakthrough degree of the total performance salary in the research area,the research area is divided into a complete deregulation group,a high proportion group and a low proportion group according to the proportion of incremental performance.The regions with the best contracted service fee income to family doctors’ salary compensation are the high-proportion group,and the regions with the best incentive performance income to family doctors’ salary compensation are the low-proportion group.3.Analysis of the effect of "two permissions" policy on family doctor’s salaryIn terms of satisfaction with the changes in income brought about by the policy,the satisfaction of family doctors in the full liberalization group and the high-proportion group were better than those in the low-proportion group.In terms of work enthusiasm,89.7%and 84.9%of the survey respondents in the high-proportion group and the complete liberalization group respectively believed that their work enthusiasm had improved after the reform.In general,the income satisfaction and work motivation of family doctors in the complete liberalization group and the high-proportion group were better than those of the low-proportion group.From the perspective of the provision of contracted services,the area that has not implemented the "two permissions" provides more contracted services because the contracted service fee acts as an incentive to increase the total amount of performance wages.Recommendations:To break through the "two permissions" policy,we must first break through the performance ceiling and increase the total performance salary level;improve the pricing and financing mechanism of contracted services,increase the compensation effect of contracted service fees on family doctors;and further increase the balance of income and expenditure allocation ratio of primary medical and health institutions,increase the income level of incentive performance for family doctors;reasonably determine the proportion of incentive performance,and give play to the incentive role of performance pay.Conclusion:This study investigated the areas with different implementation levels of the "two permissions",analyzed the compensation of family doctors and analyzed its mechanism,and found that family doctors pay more attention to breakthroughs in the overall income level.Therefore,the implementation of the "two permissions" in various regions the difference is mainly reflected in the total level of performance wages,which is not yet reasonable in some areas;the compensation level of family doctors’ compensation by contracted service fees needs to be improved;areas with higher reward performance have higher motivation and motivation for family doctors;the balance of income and expenditure used for personnel allocation will help increase family doctors’ reward performance income,is the core to effectively play the role of staff motivation;the increase in the total performance will help improve family doctors’satisfaction and work enthusiasm for income changes brought about by the policy;the degree of breakthroughs in the "two permissions" policy and the compensation level of family doctors are also affected by some macro and meso factors.It is necessary to break through the cap of total performance wages,improve the pricing and financing mechanisms of contracted services,further increase the distribution ratio of revenue and expenditure balances of primary medical and health institutions,reasonably determine the proportion of rewarding performance,give play to the incentive role of performance wages,and improve the compensation mechanism for family doctors.