Liu Xingzhu, Mills Anne
Abt Associates Inc, Bethesda, MD, USA.
Appl Health Econ Health Policy. 2003;2(2):91-8.
There is wide consensus that the ways in which providers are reimbursed by third parties will affect their behaviour and, hence, the efficient use of limited resources and the performance of health systems. However, there seems to be little evidence on how payment to hospital-based doctors affects hospital performance. This paper reports a case study conducted in China on the effects of different types of bonus payment to doctors, with a focus on how bonus payment might have affected hospital revenue growth. This has been an increasingly important goal of public hospitals as they have gained increased autonomy. A set of longitudinal quasi-experimental data, and a set of cross-sectional data, both derived from 108 public hospitals, were used for the analysis. It was found that, when a bonus system was introduced, and when the bonus model switched from one with a weaker incentive to provide services to one with a stronger incentive, there was a consistent sudden increase in the rate of growth of hospital revenue. Bonus type was also associated with the size of hospital service revenue. The results highlight the potential risks of linking remuneration too closely with revenue generation, and the need to ensure adequate attention to mechanisms of control and accountability when hospitals are given greater autonomy.
人们普遍认为，第三方对医疗服务提供者的报销方式会影响其行为，进而影响有限资源的有效利用和卫生系统的绩效。然而，关于向医院医生支付薪酬如何影响医院绩效的证据似乎很少。本文报告了一项在中国进行的案例研究，该研究关注不同类型的医生奖金支付的影响，重点是奖金支付如何影响医院收入增长。随着公立医院获得越来越多的自主权，这已成为公立医院日益重要的目标。分析使用了一组来自108家公立医院的纵向准实验数据和一组横断面数据。研究发现，当引入奖金制度，且奖金模式从服务激励较弱的模式转变为激励较强的模式时，医院收入增长率会持续突然上升。奖金类型也与医院服务收入规模相关。研究结果凸显了将薪酬与创收联系过紧的潜在风险，以及在赋予医院更大自主权时确保充分关注控制和问责机制的必要性。
