社区卫生服务机构岗位聘用制与绩效工资制的实施情况及激励作用研究

王泳仪; 徐玲; 张明吉; 王伟; 贺蕾; 严非

摘要

Objective To understand the implementation situation and the incentive function of contract employment and performance - based payment system in community health service institutions in four provinces and cities of China. Methods This study used a multi - stage sampling method. By purposive sampling method,Shandong Province and Shanghai City were selected from the eastern region,and Anhui Province was selected from the central region. Shaanxi Province was selected from the western region;and the provincial capital city and one prefecture - level city with good community health service development were selected from the three provinces respectively;district was selected from each city (including Shanghai)respectively and seven districts totally. According to the type of holding body and staff size of community health service institutions in each district, stratified sampling was carried out to extract three community health service institutions at most from each layer,and a total of 61 community health service institutions were selected. Using cluster sampling,all the 713 on - duty health workers at the investigation day were selected from each community health service institutions as the subjects,and 6 community health workers were selected as the interview subjects. The self - designed questionnaire included the basic situation of the community health technical personnel,the implementation of the contract employment system,and the implementation of the performance - based payment system. From August to September 2013,self - administered questionnaire was used to investigate the subjects. 713 questionnaires were sent out and 656 valid questionnaires were collected. The effective response rate of the questionnaires was 92. 0%. At the same time of questionnaire survey,in - depth interviews were conducted to evaluate the contract employment and performance - based payment systems. Results Among 61 institutions,27 institutions with holding body of public ownership and 18 with holding body of private ownership had implemented the contract employment system. In these 45 institutions the annual income of off - staff personnel covered (82. 9 ± 16. 6)% of the in - staff personnel,while in the 16 institutions that have not implemented contract employment system,the annual income of off - staff personnel covered (53. 0 ± 17. 4)% of the in - staff personnel,and these two were significantly different (P < 0. 05). Among 34 institutions with holding body of public ownership, 24 had implemented the performance - based payment system. 64. 7% (180 / 278)of the staff in the community health service center and 85. 1% (63 / 74)of the staff in the community health service station believed that the performance appraisal had incentive function. 42. 1% (153 / 363)of community health workers believed that the fairness of income distribution of the institution is good. Conclusion Contract employment system and performance - based payment system play an important role in ensuring the income equality and improving the enthusiasm of the employees,but further exploration in breaking the limitation of authorized strength,disaggregate links between authorized strength and welfare and establishing scientific performance - based payment system are still needed. It is recommend that improve contract employment system and increase income channels to ensure income of health workers;set the proportion of performance salary reasonably to give full play to the guiding role of performance -based payment system.%目的了解我国四省市社区卫生服务机构岗位聘用制与绩效工资制的实施情况及其对社区卫生人员的激励作用.方法本研究采用多阶段抽样方法.采用立意抽样,在东部地区选取山东省、上海市,在中部地区选取安徽省,在西部地区选取陕西省;在3个省各抽取省会所在市和1个社区卫生服务发展较好的地级市;在每个市(包括上海市)各抽取1个区,共7个区.采用分层抽样,在每个区依据社区卫生服务机构举办主体类型和人员规模分层抽样,每层最多抽取3家社区卫生服务机构,共抽取61家社区卫生服务机构.采用整群抽样,在每家社区卫生服务机构选取调查当日所有在岗的社区卫生人员共713例作为本研究对象,并从中抽取社区卫生人员6例作为访谈对象.自行编制调查问卷,问卷主要内容为:社区卫生人员的基本情况;岗位聘用制的实施情况;绩效工资制的实施情况.于2013年8—9月,采用自填式调查问卷进行调查.共发放问卷713份,回收有效问卷656份,问卷的有效回收率为92.0%.在进行问卷调查同时,开展深度访谈,访谈内容为对岗位聘用制和绩效工资制的评价.结果 61家社区卫生服务机构中,有27家公有制举办主体、18家私有制举办主体的社区卫生服务机构实施了岗位聘用制.实施岗位聘用制的45家社区卫生服务机构中,编外社区卫生人员年收入占编内人员年收入的比例为(82.9±16.6)%;未实施岗位聘用制的16家社区卫生服务机构中,编外社区卫生人员年收入占编内人员年收入的比例为(53.0±17.4)%,两者间差异有统计学意义(P<0.05).34家公有制举办主体的社区卫生服务机构中,有24家实施了绩效工资制.64.7%(180/278)的社区卫生服务中心人员、85.1%(63/74)的社区卫生服务站人员认为绩效考核有激励作用.42.1%(153/363)的社区卫生人员认为该机构的收入分配公平性较好.结论岗位聘用制和绩效工资制对保障社区卫生人员的收入公平性、提高积极性起到一定作用;但是要打破编制的限制、解除编制与福利的联系、建立科学的绩效工资制度,还需要进一步探索.建议探索完善岗位聘用制,增加收入渠道,保证社区卫生人员收入,合理设置绩效工资比例,充分发挥绩效工资的引导作用.

社区卫生服务机构岗位聘用制与绩效工资制的实施情况及激励作用研究

摘要

著录项

相似文献

相关主题

期刊订阅