四国全科医生薪酬制度对比研究

全科医生作为基层医疗卫生机构主要服务提供者,承担着居民健康"守门人"的职责。大力培养全科医生可助力我国医疗服务模式转型,缓解居民"看病难,看病贵"问题。但当前我国合格的全科医生数量不足,而薪酬水平是影响其从业意愿的主要因素之一。如何让全科医生"下得去、留得住、用得好"是我国基层卫生人才队伍建设亟待解决的问题。本研究通过检索文献、浏览相关国家官方网站,对英国、美国、澳大利亚、中国4个国家全科医生的收入来源、收入水平、薪资支付方式、薪资构成、绩效考核等方面主要特点进行梳理与归纳,旨在为我国全科医生薪酬制度的完善提供决策支持。经研究发现,四国均建立了全科医生薪酬制度及用于考核全科医生服务质量和效果的评价指标体系;四国均采用混合方式向全科医生支付薪酬,以经济手段激励全科医生提升服务质量。另外,美国和中国探索下放医保基金管理权,基层医疗卫生机构可自主将结余基金进行再分配,提高了全科医生的工作积极性;澳大利亚通过设置"差异系数"和奖学金/补助金、免费对偏远地区全科医生开展能力提升培训等方式,增强全科医生岗位吸引力。

Comparative Study of Payment Systems for General Practitioners in Four Countries

As main health service providers in primary care, general practitioners (GPs) undertake the responsibility of gatekeepers for residents' health. Vigorously training GPs will contribute to the transformation of the healthcare delivery model, and the addressing of the issue related to difficult and high cost of getting medical treatment in China. However, the number of qualified GPs is insufficient in China, and low income is a major factor associated with the willingness of medical students to work as a GP. How to take actions to recruit, retain and appropriately employ GPs in primary care is a problem that needs to be addressed urgently in the development of China's primary care workforce. To provide evidence for the improvement of China's payment system for GPs, we collected the information related to the payment for GPs in the United Kingdom, the United States, Australia, and China by reviewing relevant studies and relevant official websites of the four countries, and performed an inter-county comparative analysis of the information in terms of income source, income level, payment methods, payment composition, and performance appraisal. We found that the four countries have the following aspects in common: all of them own a payment system for GPs and an assessment system for service quality and effectiveness of GPs, adopt a mixed payment method for GPs, and use financial incentives to promote GPs to improve the quality of their performance. In addition, the United States and China have explored methods to decentralize the management of medical insurance funds, so that the primary healthcare institutions can independently redistribute the surplus funds which has improved the proactivity of GPs at work. And Australia has set up the "coefficient of difference" and scholarships/subsidies for GPs, and carried out free trainings for improving the service capacities of GPs working in remote areas, to increase the attractiveness of working as a GP.