Salary System Of Public Hospitals: Problem, Strategy And Policy

BackgroundIt was over 10 years since the present public hospitals' salary system of China was carried into execution in 1993. The system, lagging behind the social economic development severely, has accumulated lots of problems. Of late years, medical organizations' leaders have implemented lots of revolutions and researches of the distribution system inside their organization according to their own conditions, the approach such as: to practice merit pay process, to consider production factors in distributing, to practice annuity process, to set post salary, etc. More or less, All these measures implement the principles like distributing according to one's performance, giving priority to efficiency with due consideration to fairness. But according to the particularity in medical occupation, the upper problems are still unsolved thoroughly. It becomes necessary to carry out a further study on the Public Hospitals' Salary System, and to bring out a salary system that more adapt to medical vocation's characters, which may contribute a lot to promote the medical service system innovation.Objective1. To analyze the current status, problems and causes of the domestic public hospital's salary distribution system.2. To analyze the characters of the foreign public hospital's salary system and find the referencable ones.3. To develop and demonstrate basic theoretic frame and viewpoints of public hospital's salary system under current situation.4. To develop and demonstrate the method of public hospital's salary system. This study was funded by NSFC and MOH.Research MethodsThe instructive method of this study is "policy-making scientific program", which is widely acknowledged by academic circle of management. The "policy-making scientific program" is based on the scientific research and include 6 parts as following: 1) demonstrating policy problems in impersonality; 2) analyzing influence factors and ultimate reasons; 3) scientifically making policy in allusion to problem reasons; (4) strictly demonstrating the policy feasibility; 5) making policy implementation more logically; 6) evaluating policy and feeding back the evaluation information. As apractice research that was compounded by policy and scientific research, the technique route of this study will follow the "policy-making scientific program". In the every tache of the program, there have different key issues and different data collecting and analyzing methods. More details are showed in the relative parts of dissertation.Data Collecting Ways1. Literature reviewBy reviewing the related periodicals, books, government documents and the content of government website, I collected the elementary theory, viewpoint, influence factors, concrete method and current condition about salary system of domestic and foreign public hospitals. Totally 1022 papers were collected from 1994 to 2003, which is from the database of CNKI, VIP, MEDLINE and the related website of China, the USA, England and Singapore.2.Expert consultationGovernment officials, hospital managers and academic expert with much experience of human affairs work or correlative fundamental research were chosen to form the expert committee, and to develop the elementary theory frame, viewpoint, plan and implementation methods concerning salary system of public hospitals. 38 experts and leaders were consulted.3. Spot checkUsing the method of multi-stages group sampling, 484 public hospitals were chosen from Jiang Su, Zhe Jiang, Jiang Xi, Shan Xi, Si Chuan, Qing Hai and Gui Zhou. We mainly investigated two aspects contents of the sample organization, one was the basic situation and the financial report of the sample organization in 2003; the otherwas basic information about staff and their yearly income. The sample included 121514 workers from sample public hostpitals.4. Intent surveyIn view of the basic situation of the sample organization in 2003, we selected presidents of hospitals and directors who were responsible the operation of hospitals, to fill in a leadership intent investigation table. Totally 2,511 leaders of the organization were investigated. Moreover we selected Jiangsu, Hunan, Sichuan three provinces as the sample province, in each of them we stochastically chose 1 city; in each city we stochastically chose 1 county. In the sample province we stochastically selected 1 public hospital; in the sample city we stochastically chose 1 public hospital and 2 community health service center; in the sample county we stochastically selected 2 township health center, in each sample organization we stochastically selected half staff to fill in a staff intent investigation table. Altogether 3,328 staffs were investigated.Data Analysis methodsBesides the convention method of statistical analysis, Q-type-clustering method was employed to establish the post wages sequence. In the process of measuring the standard of post wage of the medical organization, we will use the method of constructing the mathematical model and simulation, confirm the quantitive relation between influence factor of salary assignment and the standard of it, and provide the evidences for drafting salary assignment standard.Brief Introduction of Study Result1. This study concludes and demonstrates the pivotal problems existing in the current salary system, which were lower fixed value, irrational factors to calculate salary, and narrower wage gap. The problem of lower fixed value is the core problem. There were very serious badness resulted from the three kinds of problems, such as "Hong Bao", backhander, mess, lacking of inspirits, neglecting one's own responsibility due to excessive attention of the technical post, and so on. There are 82.6% of leaders and 80.1% of workers considering that the reform of the salary system of public hospitals was lag behind, and 95.6% of leaders and 89.7% of workers agreeing that the reform was imperative under the situation.2. This study developed and demonstrated the purpose, objectives, principles, and idea of salary system reform. The purpose of salary system reform is eliminating the three pivotal problems mentioned before, and then establishing effective inspiriting and restricting system which can attract people and promote them changing reasonably. The objective of the reform is identifying personal value, confirming the distribution element; ensure the appropriate gap of income and the criteria of admittance and inspection. And the principal of the reform is equitable, comparable,rising normally and effective restriction. There are 83% of leaders in hospitals considering that if these principals are put into practice, the reform can resolve the three pivotal problems.3. This study puts forward and demonstrates the reform ideas: Ascertain the total amount of salary based on the standard of officeholders. The components of salary structure should include basic wage, post wage, age wage and performance wage. They account for 21.0%, 47.3%, 6.5%, and 25.2% of the total respectively. The wage of the professionals, the mangers and the common workers should be considered separately. The administrator of medical vocation should make out the criteria of wage which is all the same in the whole country, and the local governments embody difference by different local subsidy. Artificial person should be paid by years based on the risk he faced, his responsibility and performance, and the coefficient of post wage is 1.4. The interrelated departments of the government should make out the principal controlling the gross of basic wage and post wage, and supervise it by different government levels. Taking 70% of the surplus for the total gross of performance bonus of the wage in public hospitals, and the influence factors of post wage are the knowledge and skill, the responsibility and pressure, the ability of analysis and judgment, the complex of the work, the extension of impact, the ability of communication, the ability of innovation, the request of physical force, and the risks existed. All of these are demonstrated again and again, and they are approbated by the leaders and the workers conformably.4. This study develops the calculating method for post wage. It involves six steps. The first step is ascertaining the weight of these above factors; next is ascertaining the real marks and levels of all the impact factors of post wage; the third step is ascertaining the relative marks and levels of all the impact factors of post wage; the fourth step is ascertaining the average grades of the post wage in the whole country; the fifth step is ascertaining the wage levels of different grades and different levels; the six step is ascertaining the grades of post of different class of hospitals. We develop corresponding method for each step, and establish a sequence of post wage which includes 12 grades and 9 levels in each grade, and establish the corresponding relationship between the 12 grades of post wage and the 121 posts of public hospitals.5. Simulative calculation tables indicate that the whole country's wage levels of the people worked in hospitals will be elevated by 10% according to our calculating methods. The average wage of the highest post wage grades is 20 times of the average wage of the lowest post wage grades, they are from 4587.1 yuan to 86033.5 yuan.