Zhang Bowen, Ma Liang, Ma Wenjie, Kang Dingding, Mao Yiqing
The affiliated cancer hospital of Zhengzhou university & Henan cancer hospital, Zhengzhou, China.
College of Public Health, Zhengzhou University, Zhengzhou, China.
BMC Health Serv Res. 2024 Dec 18;24(1):1581. doi: 10.1186/s12913-024-12080-y.
The World Health Organization asserts that incentives significantly impact physicians' participation in healthcare initiatives. China introduced incentive programs to boost involvement in urban-rural medical consortia. However, research is limited on: (a) the effectiveness of these incentives on physicians' willingness to continue participating, (b) disparities in incentive levels between county and provincial hospitals, and (c) the varying impact of incentives on physicians' continued participation in county versus provincial hospitals. This study aims to address these issues and suggest appropriate strategies.
An online survey in Henan Province, Central China, was conducted among 1,837 physicians, comprising 1,088 respondents from county hospitals and 749 respondents from provincial hospitals. Participants reported their demographic characteristics, altruism, collaborative projects, incentive levels and willingness to continue participating. Chi-square and multinomial logistic regressions were used to determine the incentive factors of participants' willingness.
(a) For all participants, the level of economic returns, position and professional title promotion, skills improvement were positively associated with willingness to continue participating in urban-rural medical consortia. (b) County-level hospitals had lower level of various incentives for urban-rural medical consortium projects than provincial hospitals. (c) County-level physicians who had a high level of position and title promotion, professional skills improvement and provincial physicians who had a high level of economic returns and rewards had a high level of willingness to continue participating in urban-rural medical consortia.
This study demonstrates that the current financial incentives in provincial hospitals and non-financial incentives in county hospitals are efficacious in enhancing physicians' willingness to continue participating. This information can assist policymakers in hospitals at different levels in developing or improving incentive mechanisms.
世界卫生组织称，激励措施对医生参与医疗保健倡议有重大影响。中国推出了激励计划以促进参与城乡医疗联合体。然而，关于以下方面的研究有限：(a) 这些激励措施对医生继续参与意愿的有效性；(b) 县级医院和省级医院激励水平的差异；(c) 激励措施对县级医院和省级医院医生继续参与的不同影响。本研究旨在解决这些问题并提出适当策略。
在中国中部河南省开展了一项在线调查，共1837名医生参与，其中1088名来自县级医院，749名来自省级医院。参与者报告了他们的人口统计学特征、利他主义、合作项目、激励水平以及继续参与的意愿。采用卡方检验和多项逻辑回归来确定参与者意愿的激励因素。
(a) 对于所有参与者，经济回报水平、职位和职称晋升、技能提升与继续参与城乡医疗联合体的意愿呈正相关。(b) 县级医院对城乡医疗联合体项目的各种激励水平低于省级医院。(c) 职位和职称晋升水平高的县级医生、专业技能提升水平高的县级医生以及经济回报和奖励水平高的省级医生继续参与城乡医疗联合体的意愿较高。
本研究表明，目前省级医院的经济激励措施和县级医院的非经济激励措施在提高医生继续参与的意愿方面是有效的。这些信息可以帮助不同层级医院的政策制定者制定或完善激励机制。
