美国联邦公立医院医生薪酬制度及其对我国启示
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摘要
美国联邦退役军人医疗系统是美国最大的公立医疗系统,有145家医疗中心,1231个门诊部。2016年,该系统有三十一万雇员,为九百多万退役军人提供医疗服务,所有医务人员均为薪酬制雇员。在市场的竞争和社会舆论及国会监督下,该系统从几乎被解散的境地,经30年不断改革,目前医疗服务质量已经超过私立医院。VHA医生全部作为公务员聘用,薪酬由美国联邦立法规定。本文通过VHA医疗系统详细介绍了美国联邦公立医院医生薪酬制度的法律形式和各类专科医生的薪酬水平及晋升方式,讨论分析了我国公立医院薪酬制度改革的方向。
The Veterans Health Administration( VH A) is the largest public healthcare system in the U. S.with 145 medical centers and 1231 clinics. In the fiscal year 2016, it had more than 310,000 salaried employees and served 9. 05 million enrolled veterans. With strong competition from the private sector and pressure from both society and the government, the VHA system has continuously improved its performance during the past 30 years after almost being dissolved. Today, VHA's quality of care is better than other hospitals in the U. S. This paper systematically analyzes the regulation of the salary and promotion systems of doctors in the VHA hospitals, and also introduces the reform direction of doctor salary in China's public hospitals.
The Veterans Health Administration( VH A) is the largest public healthcare system in the U. S.with 145 medical centers and 1231 clinics. In the fiscal year 2016, it had more than 310,000 salaried employees and served 9. 05 million enrolled veterans. With strong competition from the private sector and pressure from both society and the government, the VHA system has continuously improved its performance during the past 30 years after almost being dissolved. Today, VHA's quality of care is better than other hospitals in the U. S. This paper systematically analyzes the regulation of the salary and promotion systems of doctors in the VHA hospitals, and also introduces the reform direction of doctor salary in China's public hospitals.
引文
[1]俞卫.控费必解的难题——医疗费用一匹脱缰的马[J].中国卫生,2015(11):12-15.
[2] Papanicolas I, Woskie L R, Jha A K. Health care spending in the United States and other high-income countries[J].JAMA, 2018. 319(10):1024-1039.
[3] Price R A, Farmer C M. VA Health System Generally Delivers Higher-Quality Care Than Other Health Providers[EB/OL].[2019-12-07] https://www.rand.org/news/press/2018/04/26. html
[4] U. S. Department of Veterans Affairs. Department of Veterans affairs FY 2018-2024 strategic plan[EB/OL].[2019-12-07].https://www. va. gov/oei/docs/VA2018-2024strategicPlan. pdf
[5] U. S. Department of Veterans Affairs. About VA[EB/OL].[2019-12-07] https://www. va. gov/about_va/vahistory. asp
[6] VHA人力资源部网站[EB/OL].[2018-03-12]. https://www. va. gov/OHRM/Pay/archive. asp
(1)包括日本、英国、加拿大、德国、澳大利亚、瑞典、法国、荷兰、瑞士和丹麦。
(2)根据人社部公布的门急诊和出院人次数、均次费用、人口数和通货膨胀率测算。
[2] Papanicolas I, Woskie L R, Jha A K. Health care spending in the United States and other high-income countries[J].JAMA, 2018. 319(10):1024-1039.
[3] Price R A, Farmer C M. VA Health System Generally Delivers Higher-Quality Care Than Other Health Providers[EB/OL].[2019-12-07] https://www.rand.org/news/press/2018/04/26. html
[4] U. S. Department of Veterans Affairs. Department of Veterans affairs FY 2018-2024 strategic plan[EB/OL].[2019-12-07].https://www. va. gov/oei/docs/VA2018-2024strategicPlan. pdf
[5] U. S. Department of Veterans Affairs. About VA[EB/OL].[2019-12-07] https://www. va. gov/about_va/vahistory. asp
[6] VHA人力资源部网站[EB/OL].[2018-03-12]. https://www. va. gov/OHRM/Pay/archive. asp
(1)包括日本、英国、加拿大、德国、澳大利亚、瑞典、法国、荷兰、瑞士和丹麦。
(2)根据人社部公布的门急诊和出院人次数、均次费用、人口数和通货膨胀率测算。