医院奖金分配模式的利弊评析

医院奖金分配模式如何改革?改革的重点和难点在哪里?通过对医院3种奖金分配模式，即按科室收支结余分配模式、按工作量分配模式、按生产要素分配模式的利弊分析，指出医院奖金制度改革重点应放在改革分配模式上．应建立复合指标体系、科学民主决策机制、科学的生产要素评估机制，解决目前奖金分配面临的各种问题。     

促进医院可持续发展|革新医院奖金核算模式的设想

奖金核算在医院经营管理中日益重要。本文在分析医院现行奖金分配模式的基础上,提出建立一套全新的奖金核算方案,不仅可以进一步激发科室人员开源节流的积极性,而且有助于加强综合绩效考核。尝试着将奖金核算与医院管理融为一体,从而形成科学的激励约束机制。     

对医院奖金分配模式的反思与探讨

首先对医院原有的奖金分配模式进行剖析,进而提出了在成本核算基础上进行绩效评价的奖金分配办法,建立相关的数学模型,并提出具体操作方法,希望为医院管理者提供一种新的奖金分配思路。     

非营利性医院奖金分配模式研究

[目的]探索取消科室奖金分配直接与科室收入挂钩的医院奖金分配模式。[方法]以工作当量取代经济收入,采用等权重秩扣比评价方法,评价各科室的工作质量指数,根据科室工作质量指数对科室奖金进行再分配。[结果]采用科室工作质量指数来计算工作质量奖金,工作质量好的科室奖金可比原来增加3％左右,工作质量差的科室奖金减少3％左右。[结论]采用工作质量指数来分配奖金,可以促使医院工作导向转向以提高工作量和工作质量为核心。     

浅谈医院奖金分配模式

奖金分配是医院经济管理中的重要问题，适当的分配模式能激发职工的潜能和工作积极性，反之则会影响职工的工作积极性，甚至会引起职工的矛盾，影响医院的社会效益和经济效益，进而会阻碍医院的发展。     

以RBRVS为基础考核体系在医院绩效管理中的运用

随着医疗改革事业的推进,医院实行的收支结余计提奖金的绩效分配模式已不适应现代医院的管理的需要,本文介绍了以RBRVS为基础的考核模式在医院绩效考核分配中的应用及存在问题,对医院实行RBRVS为基础的绩效考核模式进行了探讨。     

工改后医院奖金分配模式探讨

卫生系统实行工资改革后，医院的分配形式发生了重大变化，以往的奖金的一部份转移到活工资，剩下的部份再用医院传统的“以收减支，结余提成”的分配模式已不能适应工改后的实际情况，必须进行改革。笔者认为，新的分配模式应充分体现“效益优先，兼顾公平，按劳分配”的原则，具体探讨如下。１、定额计奖，超定额分成。按各临床科室头两年的月平均净收入实绩结合计划期物价变动指数确定下达月净收入定额。因为奖金是超额劳动的报酬，所以完不成定额者不发奖金，活工资在３０％以内下浮；超定额者则按比例分成，分成比例一般三七开，以确保…     

基于科室绩效评价的医院奖金分配系统变革

医院奖金分配制度始终随着医院改革的发展不断调整和完善[1] ,并为我国医院的更深层次变革和发展做出更大的贡献。本文将我院所进行的基于科室绩效评价的医院绩效工资分配模式介绍出来 ,希望能为持续变革提供一种新的思路和借鉴。一、我院开展科室绩效评价改革奖金分配的实践[2 5](一 )基于科室绩效评价的绩效工资分配模式的设计1.我院以科室、部门为单位 ,初步分为临床科室、医技科室、辅助科室 (主要包括不创收但以前划归医技类的科室 ,如统计室、病案室等 )和行政后勤部门 4个部分进行分别设计 ,对每科室、每部门均建立自己的绩效评价和…     

以效率为主导的医院奖金分配模式的探索

近年来，在医疗市场化的背景下，医院的分配机制过度倡导经济效益，淡化了公立医院的公益性特征。该文着重介绍以效率为主导的奖金分配模式的总体思路和实践经验，从改革的宗旨原则、方案设计和实施、评价和调整以及归纳的心得体会等方面进行了阐述。     

结合医院绩效评价的医院奖金分配数学模型

目的探讨医院奖金分配的数学模型,为医院奖金分配提供科学依据。方法从奖金构成的数学实质入手,拓展模型结构,使奖金构成能体现绩效评价结果。结果这一新的奖金分配模型,在理论上完全满足医院奖金分配的实际应用条件。结论医院奖金分配能在此模型的指导下完全量化,并能充分发挥奖金的调配作用。     

基于工作量的医院奖金分配改革实践与探讨

本文分析了“成本核算、结余提成”奖金分配方案存在的弊端,提出了以工作量为基础,侧重手工操作、治疗收入,激励急诊收住,鼓励疑难危重收治,对工作量采用阶梯核算的奖金分配新模式。通过某医院一年多的实践,探讨医院奖金分配制度改革相关问题。     

The influence of bonus payments to doctors on hospital revenue: results of a quasi-experimental study

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.     

基于RBRVS和KPI的绩效考核方案设计

为了改变以收支为导向的传统奖金分配模式,某院运用RBRVS研究方法,结合关键绩效指标,建立了RBRVS-KPI绩效分配模式,明确了临床科室、医技科室及护理工作的关键绩效指标。研究认为,KPI可以更好地弥补RBRVS的劣势,综合运用RBRVS-KPI可以提升医院运营能力,并对RBRVS-KPI存在问题及解决方案展开了探讨。     

基于RBRVS的医院绩效管理体系建设的实践探索

目的:探索公立医院绩效管理体系的建设。方法:通过RBRVS绩效点值、CF值以及间接工作量指标的设定,构建医师、护理和医技人员的奖金核算及绩效管理体系。结果:对比分析新绩效方案实施前后相关数据的变化,发现医院整体工作量明显增长,手术等级结构优化,成本管控收效显著。结论:新绩效方案的实施调动了员工工作积极性,形成医院战略目标导向,控制成本,促进医院智慧信息化管理等正面作用,但如何对临床诊疗工作以及医生、护理、医技人员的劳动进行精准考核,不断改革创新以适应国家医改方向仍值得深入探讨。     

威海市医疗机构床位配置量测算研究

医院床位配置量的测算为制定床位配置标准及区域卫生规划提供了所必需的信息。以往对医院床位配置量的测算仅考虑了床位总量，而没有考虑资源的配置结构和利用效率。该认为这样计算出来的床位配置量存在着不合理之处。因而该利用1997年威海市的调查资料，在考虑床位利用效率及调整配置结构的前提下，测算了威海市医院床位的理论配置量及配置量，并根据规划目标年需求预测值对其进行了调整。目的是提供有关床位配置量的测算方法、分析思路及测算步骤等方面的信息。     

Short term hospital occupancy prediction

Inpatient census, or occupancy, is a primary driver of resource use in hospitals. Fluctuations in occupancy complicate decisions related to staffing, bed management, ambulance diversions, and may ultimately impact both quality of patient care and nursing job satisfaction. We describe our approach in building a computerized model to provide short-term occupancy predictions for an entire hospital by nursing unit and shift. Our model is a comprehensive system built using real hospital data and utilizes statistical predictions at the individual patient level. We discuss the results of piloting an early version of the model at a mid-size community hospital. The primary focus of the paper is on the development and methodology of a second generation of the predictive occupancy model. The results and accuracy of this new model is compared to a variety of other predictive methods based on tests using 2 years of actual hospital data.     

Balancing scarce hospital resources during the COVID-19 pandemic using discrete-event simulation

COVID-19 has disrupted healthcare operations and resulted in large-scale cancellations of elective surgery. Hospitals throughout the world made life-altering resource allocation decisions and prioritised the care of COVID-19 patients. Without effective models to evaluate resource allocation strategies encompassing COVID-19 and non-COVID-19 care, hospitals face the risk of making sub-optimal local resource allocation decisions. A discrete-event-simulation model is proposed in this paper to describe COVID-19, elective surgery, and emergency surgery patient flows. COVID-19-specific patient flows and a surgical patient flow network were constructed based on data of 475 COVID-19 patients and 28,831 non-COVID-19 patients in Addenbrooke’s hospital in the UK. The model enabled the evaluation of three resource allocation strategies, for two COVID-19 wave scenarios: proactive cancellation of elective surgery, reactive cancellation of elective surgery, and ring-fencing operating theatre capacity. The results suggest that a ring-fencing strategy outperforms the other strategies, regardless of the COVID-19 scenario, in terms of total direct deaths and the number of surgeries performed. However, this does come at the cost of 50% more critical care rejections. In terms of aggregate hospital performance, a reactive cancellation strategy prioritising COVID-19 is no longer favourable if more than 7.3% of elective surgeries can be considered life-saving. Additionally, the model demonstrates the impact of timely hospital preparation and staff availability, on the ability to treat patients during a pandemic. The model can aid hospitals worldwide during pandemics and disasters, to evaluate their resource allocation strategies and identify the effect of redefining the prioritisation of patients.

     

山东省县级医院奖金制度变化及其与医院业务收入之间的关系分析

在对山东省所有县级医院普查的基础上，了解了从1975年至1997年间奖金制度的变化情况，采用趋势分析方法，分析了奖金制度转变与医院业务收入之间的关系，并进一步采用抽样调查资料对结果进行了验证。研究结果表明，在过去的20多年中，县级医院的奖金制度经历了无奖金、平均奖、以量定奖和以收定奖的转变。对于不同的医院，其各种奖金制度转变的顺序不尽相同。但调查表明奖金制度由较弱的激励作用转变到较强的激励作用，可使医院业务收入迅速增加，但不同奖金类型的转变，所引起的医院收入的变化模式不同。