| 引用本文：姚强,焦月芳,张晓丹,等.医生薪酬支付方式对医疗服务行为的影响研究——一个范畴综述[J].中国卫生政策研究,2025,18(4):25-35 |
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| 医生薪酬支付方式对医疗服务行为的影响研究——一个范畴综述 |
| 投稿时间：2025-04-03 PDF全文浏览 HTML全文浏览 |
| 姚强1,2,3,焦月芳1,张晓丹1,饶娅琦4,郑慧玲5,夏冕1 |
| 1.武汉大学政治与公共管理学院 湖北武汉 430072 ;2.武汉大学社会保障研究中心 湖北武汉 430072 ;3.国家医保研究院华科基地 湖北武汉 430030 ;4.宜昌市医疗保障局 湖北宜昌 420500 ;5.宜昌市中心人民医院 湖北宜昌 443000 |
| 摘要:目的:系统分析各类医生薪酬支付方式对医疗服务提供行为及结果的影响。方法:采用范畴综述法,以Web of Science和中国知网、维普及万方为数据源,“医生”“薪酬”“支付方式”和“医生行为”等为主题词,检索到相关文献2 255篇,通过制定严格的筛选程序最终纳入70篇相关研究。结果:按项目支付激励医生提供足量服务,但易导致过度医疗；固定薪水与按人头支付有助于控制成本,但易引发服务不足；DRG/DIP在医疗服务数量与质量方面的优势随患者病情加重而减弱。混合支付方式能够有效平衡医疗服务数量与成本,而按绩效支付在医疗质量提升方面总体表现突出。结论:医生薪酬单一支付方式难以实现医疗服务提供行为及结果最优化,且质量导向不足,多种支付方式与质量激励相融合的混合支付体系亟待构建。同时,建议深化医保结余薪酬转化机制改革,充分落实公立医院分配自主权,加快建立与医保支付和绩效考核协同的医生薪酬混合支付方式。 |
| 关键词:医生薪酬 支付方式 激励机制 医疗服务行为 范畴综述 |
| 基金项目:国家自然科学基金面上项目(72174149)；2023年武汉大学学位与研究生教育教学改革研究项目(1203-413200122) |
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| Research on the impact of physician's compensation payment methods on medical service behavior:A scoping review |
| YAO Qiang1,2,3, JIAO Yue-fang1, ZHANG Xiao-dan1, RAO Ya-qi4, ZHENG Hui-ling5, XIA Mian1 |
| 1.School of Political Science and Public Administration, Wuhan University, Wuhan Hubei 430072, China;2.Center for Social Security Studies, Wuhan University, Wuhan Hubei 430072, China;3.HUST Base of National Institute of Healthcare Security, Wuhan Hubei 430030, China;4.Yichang Medical Security Bureau, Yichang Hubei 420500, China;5.Yichang Central People’s Hospital, Yichang Hubei 443000, China |
| Abstract:Objective:To systematically analyze the impact of various physician payment methods on medical service delivery behavior and outcomes. Methods:Based on the scoping review method, 2 255 documents related to “physician”, “compensation”, “payment method”, and “physician behavior” were retrieved from Web of Science, CNKI, VIP, and WanFang databases, and finally 70 studies were included based on scientific screening standards and process. Results:Fee-for-service encourages physicians to deliver an adequate volume of services but is susceptible to overtreatment; salary and capitation assist in controlling costs but can lead to insufficient service provision; the advantages of DRG/DIP in the quantity and quality of medical services weaken as the patient's condition worsens. Mixed payment methods can effectively balance the quantity and cost of medical services, while pay-for-performance is generally outstanding in improving quality. Conclusions:It is difficult for a single payment method to achieve the optimization of medical service delivery behavior and outcomes. A mixed payment system that integrates multiple payment methods with quality incentives must be established urgently. At the same time, it is recommended to deepen the reform of the mechanism for converting medical insurance balance into physician compensation, fully implement the allocation autonomy of public hospitals, and accelerate the establishment of a mixed physician payment method that is coordinated with medical insurance payment and performance appraisal. |
| Key words:Physician's compensation Payment methods Incentive mechanism Medical service behavior Scoping review |
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