基层卫生综合改革中医务人员收入满意度比较:基于付出——回报失衡视角
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摘要
目的在付出——回报失衡视角下分析基层卫生综合改革前后基层医务人员的收入满意度情况。方法采取机构调查和员工调查相结合方式,随机抽取湖北省某区3个乡级医疗机构进行调查。以2014年为基线调查,2015年开展第二次调查。结果两年相比医务人员的基本医疗在增加,每医师日均担负门急诊人次增长0.45%;医师日均担负住院床日数增长8.83%。公共卫生工作量也呈现增长,家庭签约比例显著增加,高血压及糖尿病规范管理人数分别增长63.19%、53.49%,老年人健康管理人数增长14.18%。由于付出与回报失衡,员工收入不满意率高,2014年调查对象不满意率为77.19%,2015年为65.38%。结论基层医务人员付出——回报失衡问题突出,对收入不满意,技术劳务价值尚未在绩效分配制度中得到充分体现。建议:建立基于技术劳动价值的薪酬制度,动态监测工作量变化情况,完善绩效工资制度,实现付出——回报平衡。
Objective The income satisfaction of the primary medical personnel before and after the comprehensive reform of primary health care institutions was analyzed based on the perspective of effort-reward imbalance. Methods Questionnaire survey was used to investigate three town medical institutions which were randomly selected in one district of Hubei Providence. The baseline survey was carried out in 2014,and the second survey in 2015. Results Two years' results were compared,the workload of daily outpatients visit and inpatient beds of per doctor increased 0. 45% and 8. 83%,respectively. Meanwhile,the public health services also increased with the rise of family signing. The regulatory management of hypertension and diabetes increased 63. 19% 、53. 49%,respectively,health management of the elderly increased 14. 18% The township medical personnel were dissatisfied with their income for the reason of effort-reward imbalance. The dissatisfied rate was 77. 19% in 2014 and 65. 38% in 2015. Conclusion The imbalance of payreturn imbalances among medical personnel at the grass-roots level was not satisfactory,and the value of technical labor has not yet been fully reflected in the performance-distribution system. Suggestion: To establish a salary system based on the value of technical labor,dynamically monitor changes in workload,improve performance-based pay systems,and achieve a pay-return balance.
Objective The income satisfaction of the primary medical personnel before and after the comprehensive reform of primary health care institutions was analyzed based on the perspective of effort-reward imbalance. Methods Questionnaire survey was used to investigate three town medical institutions which were randomly selected in one district of Hubei Providence. The baseline survey was carried out in 2014,and the second survey in 2015. Results Two years' results were compared,the workload of daily outpatients visit and inpatient beds of per doctor increased 0. 45% and 8. 83%,respectively. Meanwhile,the public health services also increased with the rise of family signing. The regulatory management of hypertension and diabetes increased 63. 19% 、53. 49%,respectively,health management of the elderly increased 14. 18% The township medical personnel were dissatisfied with their income for the reason of effort-reward imbalance. The dissatisfied rate was 77. 19% in 2014 and 65. 38% in 2015. Conclusion The imbalance of payreturn imbalances among medical personnel at the grass-roots level was not satisfactory,and the value of technical labor has not yet been fully reflected in the performance-distribution system. Suggestion: To establish a salary system based on the value of technical labor,dynamically monitor changes in workload,improve performance-based pay systems,and achieve a pay-return balance.
引文
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[6]Hausler N,Bopp M,Hammig O.Effort-reward Imbalance,Work-privacy Conflict,and Burnout Among Hospital Employees[J].J Occup Environ Med,2018(24):1287.
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[8]徐恒秋,代涛,陈瑶,等.安徽省基层卫生综合改革实施效果[J].中国卫生政策研究,2013(5):21-26.
[9]杨肖光,代涛,王芳.我国基层医疗卫生机构实施绩效工资的政策分析[J].中国卫生政策研究,2013,6(5):15-20.
[2]国家卫生计生委卫生发展研究中心.基层卫生综合改革重点联系点监测报告[R].北京:2015.
[3]刘立新,祝德红,刘洋.基层医疗卫生服务机构公共卫生人力资源现状[J].公共卫生与预防医学,2014,25(2):121-122.
[4]冉霞,徐济超,杨倩.工作价值观在付出—回报失衡影响中的调节作用[J].西安工业大学学报,2012(07):578-583,589.
[5]Wienert J,Spanier K,Radoschewski FM,et al.Work ability,effort-reward imbalance and disability pension claims[J].Occup Med(Lond),2017,67(9):696-702.doi:10.1093/occmed/kqx164.
[6]Hausler N,Bopp M,Hammig O.Effort-reward Imbalance,Work-privacy Conflict,and Burnout Among Hospital Employees[J].J Occup Environ Med,2018(24):1287.
[7]于晶波,孙强,王永平,等.对两省医生收入满意度和期望收入的分析[J].中国卫生经济,2004(5):41-44.
[8]徐恒秋,代涛,陈瑶,等.安徽省基层卫生综合改革实施效果[J].中国卫生政策研究,2013(5):21-26.
[9]杨肖光,代涛,王芳.我国基层医疗卫生机构实施绩效工资的政策分析[J].中国卫生政策研究,2013,6(5):15-20.