我国公立医院医生薪酬制度改革的逻辑分析——以福建省三明市为例

公立医院改革是医改的关键任务,根据进展来看,药品零差率销售与调整医疗服务价格的改革措施存在显著的效果边界,不能从根本上切断和改变医生诱导需求的内在动机。调整公立医院薪酬制度进而调动医务人员的改革积极性被认为是下一步改革的关键,也是公立医院改革最深层的机制问题。本研究从三明市公立医院改革整体政策框架入手,理清包括薪酬制度改革在内的各项改革政策措施的内在逻辑,分析其作用边界,并明确依靠薪酬制度改革解决深层次机制问题的逻辑基础,说明割裂的依靠某个或几个政策无法取得整体性的改革效果,对公共政策体系性和整体性的深入认识,有助于对当前公立医院改革的核心节点和进展步调进一步达成共识。

A logical analysis of the reform of physicians'compensation system in public hospitals in China:A case study of Sanming City,Fujian Province

Public hospital reform is the key to medical reform in China,and it is found that there is an obvious effect boundary between the"zero margin drug profit"and adjustment of medical service price reform,after looking back to progresses in these years.Mainly because it is not reasonable to cut off and change the internal motivation of supplier-induced demand,by the above two polices,It is of great concern to arouse medical staff''s enthusiasm about public hospital reform,by adjusting the remuneration system of the public hospital,which is also the most deep-seated mechanism problem of Public hospital reform.Starting from the overall policy framework of Public hospital reform in Sanming city,this study illuminates the inherent logic and margin of effect between the policies of reform of physicians''remuneration system.From the analysis,it has been realized that physicians''compensation system is the logic foundation of deep-rooted institutional problem.The present study draws a conclusion that it is not realistic to make great achievement by one or more policies.Meanwhile,it is rational to reach consensus on key links and progress of reform,by the deep understanding and analysis of public policy integrality.