Establishment And Preliminary Application Of Physician’s Labor Value-assessing Index System

BACKGROUND:Medical services carry the value of physicians. Physicians not only pay the time and effort, but also bear the risk and stress when they are providing medical services. It is no doubt that all the pay should be rewarded, but unfortunately, the fact is opposite, both health care pricing and physician payment are failed to reflect the value of physicians’ services. As a result, physicians are stimulated to find other ways to increase their income-including prescribing excess drugs and medical tests for patients which lead to the difficulty and costliness in seeing a doctor. In order to solve this problem, it’s need to clarify the physicians’ labor value which containing time, energy, risk, stress and other resource investment of physicians. But at present, research about this aspect is absent, how to measure and evaluate physicians’ labor value hasn’t been reported yet. Therefore, it is necessary to design a scientific and reasonable evaluation index system of physician’s labor value in medical service which can provide a basis for building physician’s labor value based related value scale so that we can measure and evaluate physicians’labor value and lay a foundation for designing physician payment system and medical service pricing system.PURPOSE:To establish a scientific and reasonable physician’s Labor Value-assessing Index System and build a physician’s labor value based related value scale of some medical services.METHODS:Documentary Study, Questionnaire Survey, Expert Interview, Expert Advice, Delphi Method, Expert Value Evaluation Method.1. Establishment of first draft of physician’s labor value-assessing index systemThe method of document investigation was adopted to form theory frame of index system. Based on a survey of 44 doctors, we installed an index pool. Then we established a draft index system by investigating 58 doctors and interviewing 6 specialists in a top three hospital in Guangzhou.2. Establishment of physician’s labor value-assessing index systemWe used Delphi Method to form final assessment system.26 clinical experts (including 18 intra-provincial experts and 8 extra-provincial experts)from six provinces or cities took park in the consultation. We planned to use two or three-round consultations to get the result. As a matter of fact, experts’ decision was in agreement afterl round consultation.3. Preliminary application of physician’s labor value-assessing index systemTo measure the assessment index, we optioned 10 radiology projects: percutaneous catheter coronary angiography, upper gastrointestinal X-ray photography, chest X-ray computed tomography (CT) scan, chest X-ray computed tomography (CT) scan enhancement, three-dimensional CT imaging of small pulmonary nodules, three-dimensional imaging of coronary CT, brain MRI, head of non-enhanced magnetic resonance imaging of arteries, head enhanced MR imaging, magnetic resonance diffusion weighted imaging single organ radiology.13 radiology experts were invited to give the 10 projects a value by comparing with "chest X-ray photography".The physician’s labor value based related value of 10 medical services were calculated according to the value. Finally we established a physician’s labor value based related value scale of 10 medical services.RESULTS:1. The first draft of physician’s labor value-assessing index system was set up.The draft of index system was developed and perfected by integrating results of one-round consultation and professional characteristics. And an index system of physician’s labor value of medical service consisted of 4 items in first level (including time invested, labor input, technical input, risk pressure) and 12 items in second level (including preflight preparation time, operation time, operation after completion of the necessary follow-up time, mental depletion, physical depletion, time costs of education and training, economic costs of education and training, technical difficulty, complex degree, occupational exposure, psychological pressure size, responsibility pressure) was set up.2. Physician’s labor value-assessing index system was establishedExperts’ decisions were in agreement after 1 round consultation. According to the experts’ decision, we didn’t modify the details of the index system. In other words, the content of first draft and final draft are the same.Weights of the items set by expert grading method were:G time invested=0.2444, G labor input=0.2415, Gtechnical input=0.2596, Grisks pressure=0.2546; all secondary indicators weights: Hpreflight preparation time=0.0805, Hoperation time=0.0884, Hoperation after completion of the necessary follow-up time=0.0755, Hmental depletion= 0.1258, Hphysical depletion=0.1157, Htime costs of education and training=0.0662, Heconomic costs of education and traning=0.0594, Htechnical difficulty= 0.0678, Hcomplex degree=0.0662, Hoccupational exposure=0.0855, Hpsychological pressure size= 0.0843, Hresponsibility pressure=0.0848.Positive coefficient of expert consultation was 0.8125. Kendall coefficient was 0.172, p<0.01, authoritative coefficient was 0.8962.3. A physician’s labor value based related value scale of 10 radiology projects was fomulatedBased on investigation, we got the labor relative value scale of 10 radiology projects. In the actual research, we excluded the project "three-dimensional CT imaging of pulmonary nodules". The labor relative value coefficient of 10 radiology projects (including standard project)were:Lchest X-ray photography=1, Lchest X-ray computed tomography (CT)scan=5.78、Lupper gastrointestinal X-ray photography=9.18、Lsingle organ magnetic resonance diffusion weighted imaging=10.29、Lchest X-ray computed tomography (CT) scan enhancement=10.64% Lbrain magnetic resonance imaging=15.81、Lhead arteries non-enhanced magnetic resonance imaging=16.45、Lenhanced magnetic resonance imaging of the head=19.53、Lcoronary CT three-dimensional imaging=28.25、Lpercutaneous catheter coronary angiography-66.27.CONCLUSIONS:All the methods used in this research are scientific; The consistency of expert opinions was good. By the measured research, the index system showed a good function on evaluating the physicians’ labor value of medical service. It is certain that the index system can provide a basis for developing physician’s labor value based related value scale of medical services. Because of time constraints, we didn’t build a physician’s labor value based related value scale including all medical services. However, we will do that in the next stage, thus we can lay the foundation of pricing medical service and designing physician’s payment system.