Li Jia, Qin Xianjing, Wang Haipeng, Yuan Beibei
Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
Guangxi Medical University, Nanning, Guangxi, China.
BMJ Open. 2025 Jun 25;15(6):e090145. doi: 10.1136/bmjopen-2024-090145.
The study aimed to examine whether pay-for-performance (performance-based payment (PBP)) may crowd out intrinsic motivation by analysing the association between the proportions of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers in China.
A cross-sectional survey. The primary outcome was intrinsic motivation, measured using the intrinsic motivation subscale of the 15-item work motivation scale.
The study involved 1927 primary healthcare workers from 31 institutions in Weifang city, Shandong province, China.
The proportion of PBP was the primary intervention variable. Additionally, subanalysis was conducted across different performance dimensions, including whom to incentivise and the domain of performance measured.
The results revealed a complex relationship between the proportion of the PBP component of the total salary and intrinsic motivation levels among primary healthcare workers. Overall, higher PBP proportions were associated with increased intrinsic motivation scores (β=0.49, p<0.05), particularly when incentives targeted groups rather than individuals (β=1.04, p<0.05) and when both the quantity and quality of care were included in performance measurement (β=0.61, p<0.05). However, when performance was measured solely based on the number of healthcare visits, a significant negative impact on intrinsic motivation was observed (β=-1.19, p<0.05).
This study underscored the importance of designing PBP schemes to enhance performance without undermining intrinsic motivation among primary healthcare workers. PBP schemes should not only focus on increasing financial incentives but also incorporate incentive methods that acknowledge healthcare workers' professional contributions and expertise. These findings were crucial for policymakers and healthcare administrators aiming to optimise PBP schemes to enhance performance and ensure the sustainability of the effectiveness of these schemes by preserving intrinsic motivation among China's primary healthcare workers.
本研究旨在通过分析中国基层医护人员工资中绩效薪酬部分的比例与内在动机水平之间的关联，探讨绩效薪酬制是否会挤出内在动机。
横断面调查。主要结果变量为内在动机，采用15项工作动机量表的内在动机子量表进行测量。
本研究涉及中国山东省潍坊市31家机构的1927名基层医护人员。
绩效薪酬比例是主要干预变量。此外，还针对不同的绩效维度进行了亚分析，包括激励对象以及绩效衡量领域。
结果显示，基层医护人员工资中绩效薪酬部分的比例与内在动机水平之间存在复杂关系。总体而言，较高的绩效薪酬比例与内在动机得分增加相关（β=0.49，p<0.05），特别是当激励对象为群体而非个体时（β=1.04，p<0.05），以及当护理数量和质量均纳入绩效衡量时（β=0.61，p<0.05）。然而，当仅根据诊疗次数衡量绩效时，则观察到对内在动机有显著负面影响（β=-1.19，p<0.05）。
本研究强调了设计绩效薪酬方案以提高绩效同时又不削弱基层医护人员内在动机的重要性。绩效薪酬方案不仅应注重增加经济激励，还应纳入认可医护人员专业贡献和专业知识的激励方法。这些发现对于旨在优化绩效薪酬方案以提高绩效并通过保持中国基层医护人员的内在动机来确保这些方案有效性可持续性的政策制定者和医疗管理者至关重要。
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