China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.
Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.
Int J Environ Res Public Health. 2021 Nov 15;18(22):11978. doi: 10.3390/ijerph182211978.
Township Hospitals (THs) are crucial providers in China's primary health delivery system. Low job satisfaction of THs health workers has been one of biggest challenges to strengthening the health system in China. Even huge amounts of studies confirmed low remuneration level as a key demotivating factor though few studies have explored the feelings of health workers on how they were paid.
To analyze how the key design of Performance-based Salary System (PBS) influences the satisfaction of health workers on the payment system in China's THs.
A cross-sectional study was conducted in 47 THs in Shandong China, and a total of 1136 participants were recruited. Expectancy theory was applied to design the measurements on designs of PBS. The associations between PBS design and satisfaction of health workers were analyzed by logistic regression.
Three key components of PBS design were all related to the satisfaction of health workers. Those health workers who were aware of assessment methods were more likely to be satisfied with how they were paid (OR = 2.44, < 0.001) compared with those being not aware of the methods. The knowledge on personal performance was also associated with being satisfied (OR = 3.34, < 0.001). The percentage of floating income in total income was negatively associated with the satisfaction, and one percentage point increase in floating income proportion could result in the possibility of being satisfied decreasing by 2.82% (95%CI -4.9 to -0.7, = 0.01). Subgroup analysis found that only in those with lower value on monetary income, the negative influence of more floating income was significant.
When policymakers or managers apply performance-related payment to incentivize certain work behavior, they should pay attention to the design details, including keeping transparency in the performance assessment criteria, clear performance feedback, and setting the proportion of the performance-related part based on the preference of health workers in certain cultural settings.
乡镇卫生院（THs）是中国初级卫生保健系统的重要提供者。THs 卫生工作者的工作满意度低一直是中国加强卫生系统的最大挑战之一。尽管有大量研究证实低薪酬水平是主要的激励因素，但很少有研究探讨卫生工作者对薪酬支付方式的感受。
分析绩效工资制（PBS）的关键设计如何影响中国 THs 卫生工作者对薪酬支付系统的满意度。
在中国山东的 47 家 THs 进行了横断面研究，共招募了 1136 名参与者。期望理论被应用于设计 PBS 设计的测量方法。通过逻辑回归分析 PBS 设计与卫生工作者满意度之间的关系。
PBS 设计的三个关键组成部分都与卫生工作者的满意度相关。那些知道评估方法的卫生工作者更有可能对自己的薪酬感到满意（OR=2.44，<0.001），而不知道评估方法的卫生工作者则不太可能满意。对个人绩效的了解也与满意度相关（OR=3.34，<0.001）。浮动收入占总收入的比例与满意度呈负相关，浮动收入比例增加一个百分点，满意度可能降低 2.82%（95%CI-4.9 至-0.7，=0.01）。亚组分析发现，只有在那些货币收入较低的人群中，更多的浮动收入的负面影响才是显著的。
当决策者或管理者应用绩效相关的薪酬来激励某些工作行为时，他们应该注意设计细节，包括在绩效评估标准、明确的绩效反馈和基于特定文化背景下卫生工作者偏好的绩效相关部分的比例方面保持透明度。
