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An analysis of China’s physician salary payment system

Journal of Huazhong University of Science and Technology [Medical Sciences] volume 33, pages 309–314 (2013)Cite this article

Summary

Physician payment system (PPS) is a principal incentive system to motivate doctors to provide excellent care for patients. During the past decade, physician remuneration in China has not been in proportional to physician’s average work load and massive responsibilities. This paper reviewed the constitution of the PPS in China, and further discussed the problems and issues to be addressed with respect to pay for performance. Our study indicated that the lower basic salary and bonus distribution tied to “profits” was the major contributor to the physician’s profit-driven incentive and the potential cause for the speedy growth of health expenditures. We recommend that government funding to hospitals should be increased to fully cover physicians’ basic salary, a flexible human resource and talent management mechanism needs to be established that severs personal interest between physicians and hospitals, and modern performance assessment and multiplexed payment systems should be piloted to encourage physicians to get the more legitimate compensation.

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References

  1. Lesser CS, Fineberg HV, Cassel CK. Analysis and commentary physician payment reform: principles that should shape it. Health Affairs, 2010,29(5):948–952

    PubMed  Article  Google Scholar 

  2. Yip WC, Hsiao W, Meng Q, et al. Realignment of incentives for health-care providers in China. Lancet, 2010,375(9720):1120–1130

    PubMed  Article  Google Scholar 

  3. Jacobson M, Earle CC, Price M, et al. How medicare’s payment cuts for cancer chemotherapy drugs changed patterns of treatment. Health Affairs, 2010,29(7):1391–1399

    PubMed  Article  Google Scholar 

  4. Shahinian VB, Kuo YF, Glbert SM. Reimbursement policy and androgen-deprivation therapy for prostate cancer. New Eng J Med, 2010,362(19):1822–1832

    Article  Google Scholar 

  5. Neumann M, Bensing J, Wirtz M, et al. The impact of financial incentives on physician empathy: A study from the perspective of patients with private and statutory health insurance. Patient Edu Couns, 2011,84(2):208–216

    Article  Google Scholar 

  6. Ministry of Health of China (2009). The standing conference of State Council of China adopted guidelines for furthering the reform of health-care system in principle. [Accessed Feb. 16, 2010 at http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s3582/200901/38889.htm (Chinese)]

    Google Scholar 

  7. Ge YF, Shi G, Lei HH. Evaluations and suggestions on health system reform in China. Zhongguo Fazhan Gaishu (Chinese), 2005,7:1–14

    Google Scholar 

  8. Zhao L. Dilemma and Future: The way of public hospital reform in China (Chinese). Beijing: Science Press, 2011

    Google Scholar 

  9. Fixing the public hospital system in China: China health policy note. 9 Fixing the public hospital system in China: China health policy note. Washington DC: The World Bank, 2010

    Google Scholar 

  10. Center for Health Statistics and Information. Chinese health statistical digest. Beijing: Ministry of Health, People’s Republic of China, 2011 (Chinese)

    Google Scholar 

  11. Ministry of Health, Ministry of Finance, and General Bureau of Labor. Income distribution system reform schemes for institution staff. Beijing, 2006 (Chinese)

    Google Scholar 

  12. Zhou EM. Analysis of advantages and disadvantages of bonuses distribution models in hospital. Zhongguo Weisheng Jingji (Chinese), 2005,24(268):40–41

    Google Scholar 

  13. Zhang Y, Zhang NJ. Status and crux of payment system in hospital. Zhongguo Yiyuan Yuanzhang (Chinese), 2009,15:52–54

    Google Scholar 

  14. Leng J. Introspection and discussion of bonus distribution models in hospital. Weisheng Jingji Yanjiu (Chinese). 2011,7(289):51–53

    Google Scholar 

  15. Cheng KW. Status and reform tendency of bonus distribution in public hospital. Zhongguo Yixue Daobao (Chinese). 2006,3(22):93–94

    Google Scholar 

  16. Ministry of Health of China. Regulation of strengthening the financial sector management, economy accounting and distribution management of medical institutions. Beijing, 2004

    Google Scholar 

  17. Li JW. Gain and loss of bonus distribution in China’s public hospitals. Zhongguo Yiyuan Guanli (Chinese), 2007,23(10):654–655

    Google Scholar 

  18. Zhang CP. Focus on perfecting clinicians’ compensation system. Zhongguo Weisheng Jingji (Chinese), 2009,28(8):49–51

    Google Scholar 

  19. Lynn N, Sarah T. Physician Payment: Current system and opportunity for reform. AARP Public Policy Institute. Washington DC, 2009

    Google Scholar 

  20. The National Bureau of Statistics. China Health Statistical Yearbook 2010. Beijing: Statistics Press, People’s Republic of China, 2010

    Google Scholar 

  21. Fang LJ. Pressed between planning and market: the salary system and its institutional environment of public hospital in China. Zhongguo Weisheng Zhengce (Chinese), 2011, 4(12):32–38

    Google Scholar 

  22. Ministry of Health of China (2011). Notice of expand the pilot scope of doctor multi-sited practice. [Accessed July 25, 2011 at http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohyzs/s3578/201107/52434.htm (Chinese)]

    Google Scholar 

  23. Gui H. Doctor multi-sited practice: Difficult to implement. Zhejiang Daily. 2011 [Accessed July 30, 2011 at http://zj.people.com.cn/GB/15287114.html (Chinese)]

    Google Scholar 

  24. Tian Y, Hua LJ, Chao WM. Chinese doctors’ salaries. Lancet, 2008,371(9624):1576–1577

    PubMed  Article  Google Scholar 

  25. Communist Party of China Central Committee. State Council implementation plan for the recent priorities of the health care system reform (2009–2011). Beijing: Government of the People’s Republic of China, 2009 (Chinese)

    Google Scholar 

  26. Yip WC, Hsiao WC, Chen W, et al. Early appraisal of China’s huge and complex health-care reforms. Lancet, 2012,379(9818):833–842

    PubMed  Article  Google Scholar 

  27. Wang GY, Song JH. Clinicians performance appraisal and scheme design. Zhongguo Yiyuan Guanli Zazhi (Chinese), 2007,23(9):622–624

    Google Scholar 

  28. Zheng CP, Zeng SW. Building the clinicians’ performance appraisal indicator system. Weisheng Ruan Kexue (Chinese), 2009,23(5):583–586

    Google Scholar 

  29. Han CF, Tian M. Study on combination of BSC and KPI in clinician performance appraisal in orthopedic hospitals. Yixue Xinxi (Chinese), 2011,1(2):295–296

    Google Scholar 

  30. Lv JK. The application of BSC in physicians performance assessment. Xiandai Yixue (Chinese), 2007,124:25–27

    Google Scholar 

  31. Lu HJ, Li L. Construction and application of doctor performance appraisal mode. Zhongguo Shuzi Yixue (Chinese), 2008,3(6):53–54

    Google Scholar 

  32. Wang YQ. Exploration on distribution reform and performance assessment. Zhongguo Weisheng Renli Ziyuan (Chinese), 2011,10:39–41

    Google Scholar 

  33. Ding JS. Physicians in Shaoxing asked for salary collectively: Call for improving physician performance assessment mechanism. Zhongguo Yixue Qianyan (Chinese), 2009,25:3

    Google Scholar 

  34. Ji CL. It is hard to implement: The comprehensive performance assessment in new health reform scheme. Shoudu Yixue (Chinese), 2009,7:17

    Google Scholar 

  35. Zhang ZH. When performance lose efficacy. Zhongguo Weisheng Chanye (Chinese), 2009,10:60–67

    CAS  Google Scholar 

  36. Li YX. Study on physician performance assessment status of public hospitals. Xiandai Yiyuan Guanli (Chinese), 2011,5(44):16–19

    Google Scholar 

  37. Wei H. Payment reform in Chengdu: Patient’s satisfaction decides 30% of doctor’s salary. People’s Daily. 2010 [Accessed April 2, 2010 at http://finance.qq.com/a/20100402/001917.htm (Chinese)]

    Google Scholar 

  38. Wang ZP. More than 90% performance evaluation in hospital is just a scale plate for salary. Zhongguo Yiyuan Yuanzhang (Chinese), 2009,5:86–87

    Google Scholar 

  39. Wagstaffa A, Yip WC, Lindelow M. China’s health system and its reform: a review of recent studies. Health Economy, 2009,18(2):s7–s23

    Article  Google Scholar 

  40. Yang Y. A survey on job satisfaction of doctors in Nanjing. Zhongguo Yiyuan Guanli (Chinese), 2008,28(3):31–33

    CAS  Google Scholar 

  41. Huang W. Study on the grass-roots core doctors’ satisfaction in underdeveloped area of Guangdong. Zhongguo Weisheng Fuwu Guanli (Chinese), 2011,4(274):304–306

    Google Scholar 

  42. Wang Y, Yang XS. Cross-sectional study on job burnout, job satisfaction and related factors among medical workers. Zhiye Yu Weisheng (Chinese), 2011,27(19):2168–2171

    Google Scholar 

  43. Sun DY, Wang XY. Medical staff’s working status description and problem analysis. Zhongguo Yiyuan (Chinese), 2011,15(8):25–27

    Google Scholar 

  44. Cai RP. 400 thousand people give up to be doctor: Is salary high or low? 2008[Accessed July 7, 2008 at http://www.chinanews.com/jk/kong/news/2008/07-07/1304319.shtml (Chinese)]

    Google Scholar 

  45. McGregor T. China’s doctors worthy of higher pay. China-World Affairs Column, 2011[Accessed July 25, 2011 at http://english.cri.cn/6909/2011/07/25/2743s650260.htm]

    Google Scholar 

  46. The fourth survey of China’s physicians status. Chinese Medical Doctor Association, 2011[Accessed Aug 2, 2008 at http://www.cmda.gov.cn/wangshangzhuanti/xiehuixinwenzhuanti/zyzkdy/(Chinese)]

    Google Scholar 

  47. Ji CL. Clinicians performance assessment: High salary is not the goal. Shoudu Yixue (Chinese), 2009,9:22–23

    Google Scholar 

  48. Higgins A, Zeddies T, Steven SD. Measuring the performance of individual physicians by collecting data from multiple health plans: the results of a two-state test. Health Affairs, 2011,30(4):673–681

    PubMed  Article  Google Scholar 

  49. Werner RM, Kolstad JT, Stuart EA. The effect of pay-for-performance in hospitals: lessons for quality improvement. Health Affairs, 2011,30(4):690–698

    PubMed  Article  Google Scholar 

  50. Ministry of Health of the People’s Republic of China. China health undertakings statistical bulletin, 1999–2010 [Accessed Sep. 12, 2011 at http://www.moh.gov.cn/publicfiles/business/htmfiles/zwgkzt/pgb/index.htm (Chinese)]

    Google Scholar 

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Authors and Affiliations

  1. School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Li-mei Ran, Lan Yao & You-mei Feng

  2. Outpatient Department, Affiliated Hospital of Guiyang Medical College, Guiyang, 550001, China

    Li-mei Ran

  3. Guizhou Cancer Hospital, Guiyang, 550001, China

    Kai-jian Luo

  4. Department of Neurology, Shanghai First People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China

    Yun-cheng Wu

Authors
  1. Li-mei Ran
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  2. Kai-jian Luo
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  3. Yun-cheng Wu
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  4. Lan Yao
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  5. You-mei Feng
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Corresponding author

Correspondence to You-mei Feng.

Additional information

This project was supported by Guiyang Science and Technology Correspondent Program of China (No. 2012207).

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Ran, Lm., Luo, Kj., Wu, Yc. et al. An analysis of China’s physician salary payment system. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 33, 309–314 (2013). https://doi.org/10.1007/s11596-013-1116-9

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  • DOI: https://doi.org/10.1007/s11596-013-1116-9

Key words

  • physician payment system
  • incentive mechanism
  • China