Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Health Econ Policy Law. 2020 Apr;15(2):247-260. doi: 10.1017/S1744133118000506. Epub 2019 Jan 31.
This study qualitatively investigates what factors apart from or in addition to financial incentives can encourage better performance of frontline health care providers. We interviewed health sector managers in Pakistan, Cambodia and China, and they highlighted many potential limitations in the applicability of financial incentives in their contexts. There was a consistent view that providers are not always primarily driven by monetary rewards and that non-monetary rewards - such as recognition from direct supervisors and career development - could have a greater influence on performance. Managers also highlighted several challenges related to the design and implementation of performance management schemes: supervisors may not have performance information necessary to determine which agents to reward; when performance information is available, organisational culture may value other attributes such as social ties or years of experience; finally, concentration of power at higher levels of the health system can reduce supervisors' ability to manage performance, rewards and accountability. Although health sector managers were enthusiastic about measures to improve performance of providers, our study indicated that specific social, cultural and health system factors may mean that non-monetary rewards and structural changes to support a more transparent and meritocratic working environment should also be considered.
本研究从质的角度探讨了除经济激励以外或额外的哪些因素可以鼓励一线卫生保健提供者更好地发挥作用。我们采访了巴基斯坦、柬埔寨和中国的卫生部门管理人员，他们强调了在各自背景下经济激励的适用性存在许多潜在限制。有一种一致的观点认为，提供者并不总是主要受金钱奖励驱动，非金钱奖励——如直接主管的认可和职业发展——可能对绩效有更大的影响。管理人员还强调了与绩效管理计划的设计和实施相关的几个挑战：主管可能没有确定奖励对象所需的绩效信息；当有绩效信息时，组织文化可能会重视其他属性，如社会关系或工作年限；最后，卫生系统较高层次的权力集中可能会降低主管管理绩效、奖励和问责的能力。尽管卫生部门管理人员热衷于采取措施提高提供者的绩效，但我们的研究表明，具体的社会、文化和卫生系统因素可能意味着，也应考虑非金钱奖励和结构性变革，以支持更透明和更择优的工作环境。
