公立医院薪酬制度改革评估指标体系构建与实证研究  

Construction and empirical study of the evaluation index system for the reform of salary system in public hospitals

作　　者：刘剑[1] 王彦 乌兰 邓剑伟[3] 邓文浩 杨添安[3] Liu Jian;Wang Yan;Wu Lan;Deng Jianwei;Deng Wenhao;Yang Tian′an(Dean office,Shuangqiao Hospital,Chaoyang District,Beijing 100021,China;Health Professionals Sub-Center,Beijing Chaoyang District Talent Service Center,Beijing 100025,China;School of Management and Economics,Beijing Institute of Technology,Beijing 100081,China)

机构地区：[1]北京市朝阳区双桥医院院办,北京100021 [2]北京市朝阳区人才服务中心卫生专业人才分中心,北京100025 [3]北京理工大学管理与经济学院,北京100081

出　　处：《中华医院管理杂志》2023年第9期684-691,共8页Chinese Journal of Hospital Administration

基　　金：国家自然科学基金(71974011,72174022);2021年度北京市朝阳区科技计划(CYSF2120)。

摘　　要：目的构建公立医院薪酬制度改革评估指标体系并进行实证研究,为深化公立医院薪酬制度改革提供参考。方法基于医疗保障系统框架和《关于开展公立医院薪酬制度改革试点工作的指导意见(人社部发〔2017〕10号)》要求构建初步指标体系,采用专家咨询法确定公立医院薪酬制度改革评估指标体系。选取北京市朝阳区参与公立医院薪酬制度改革的代表性医院,应用该指标体系进行实证研究,在医院信息系统中提取客观指标评估所需的改革前(2016年至2017年)和改革后(2018年至2019年)的相关数据;基于指标体系中的主观指标自行设计问卷,对医院职工、门诊和住院患者进行调查。对医院收支、医疗费用、薪酬水平及满意度等指标进行描述性分析,改革前后相关数据的比较采用单因素方差分析。结果本研究构建了包含薪酬水平与结构、薪酬治理与信息建设、卫生人力与服务提供、医疗产品与技术4个一级指标、8个二级指标以及38个三级指标的公立医院薪酬制度改革评估体系,其中客观指标28个,主观指标10个。对4家代表性公立医院的评估结果显示,人力成本、卫生材料收入、治疗收入、护理收入、医事服务费占总收入的比例均较改革前增加,差异具有统计学意义(P<0.05);出院患者例均医疗费用、药品收入(不含中药饮片)占总收入的比例较改革前降低,差异具有统计学意义(P<0.05);门诊患者次均医疗费用和手术收入占总收入的比例的差异无统计学意义(P>0.05)。不同性别、工作年限、学历职工的薪酬水平差异无统计学意义(P>0.05),而不同年龄、专业、专业技术职称、雇佣类型职工的薪酬水平差异具有统计学意义(P<0.05)。636名职工的实际薪酬为期望薪酬的56.26%,其薪酬满意度总得分为(3.33±0.86)分,公共服务动机、工作满意度和医疗服务质量得分分别为(3.52±0.78)分、(3.72±0.65)�Objective To construct an evaluation index system for the reform of public hospital salary system and conduct empirical research,for reference in deepening the reform of public hospital salary system.Methods Based on the building blocks of health systems and the Guiding Opinions on Pilot Work of Public Hospital Salary System Reform(Human Resources and Social Security Ministry〔2017〕No.10),a preliminary index system was constructed.And the expert consultation method was used to determine the evaluation index system for public hospital salary system reform.The authors selected representative hospitals in Chaoyang district of Beijing with reform experiences of such salary system,and applied this index system for empirical research.Objective indexes were extracted from the hospital information system,which were used to evaluate relevant data before the reform(from 2016 to 2017)and after the reform(from 2018 to 2019);a questionnaire was customized based on the subjective indexes in the index system,which was used for a questionnaire survey on hospital staff,outpatient patients,and inpatients.A descriptive analysis was made on such indexes as hospital revenue and expenditure,medical expenses,salary levels,and satisfaction.The comparison of relevant data before and after the reform was conducted using one-way ANOVA.Results This study constructed a public hospital salary system reform evaluation system,comprising 4 first-level indexes,8 second-level indexes,and 38 third-level indexes.second-level indexes were salary level and structure,salary governance and information construction,health manpower and service provision,medical products and technology.There were 28 objective indexes and 10 subjective ones.The evaluation results of 4 representative public hospitals showed that the proportion of labor costs,hygiene materials income,treatment income,nursing income,and physician service fees to the total income increased as compared to that before the reform,with statistical significance(P<0.05);The average medical expense

关 键 词：医院 公立 薪酬制度改革 医疗保障系统框架 指标体系 北京市朝阳区 

分 类 号：R197.32[医药卫生—卫生事业管理]