不同行政隶属关系公立医院绩效薪酬形成机制的差异

Differences in the formation mechanism of performance-based compensation in public hospitals with different administrative affiliations

摘要

目的：公立医院薪酬改革的目标之一是缩小公立医院的薪酬差距，本研究从不同行政层级的公立医院出发，探究绩效薪酬形成机制的差异。方法：2024年6—11月，采用目的性抽样，对某直辖市国家级、省部级、地市级三个行政层级的 14 家公立医院进行 43 场深入访谈，采用扎根理论进行分析。结果：通过三级编码，共提炼出 7 个核心范畴（外部约束、战略定位、市场能力、业务结构、激励制度、管理能力、人员特征），共同作用于公立医院的绩效薪酬分配，但其在不同层级的医院之间呈现差异。行政层级较高的公立医院或免于工资总额约束，或在总额框架内仍保留较大的可分配空间，依托高位的战略定位，形成了强大的市场能力与高溢价业务结构，采用计量到个人的增量激励模式，激励范畴覆盖医教研全链条；较低层级的公立医院则面临议价能力不足、患者来源局限、补偿途径单一的三重约束，业务结构以低溢价项目为主，不得不采用岗位履职模式，激励范畴收窄至基础质量，面临激励脆弱与人才流失的困境。结论：不同层级公立医院在绩效薪酬决定机制上呈现结构差异，改革政策在传导过程中遭遇层级化制度环境、市场能力与管理能力的分层过滤，使其在政策下的表现不同。

Abstract

Objective：One of the explicit goals of public hospital salary reform is to gradually and steadily narrow the salary gap among public hospitals.This study，taking public hospitals at different ad-ministrative levels as its starting point，seeks to investigate the differences in the formation mechanisms of performance-based pay. Methods：From June to November 2024，a purposeful sampling strategy was adopted.A total of 43 in-depth interviews were conducted across 14 public hospitals located in a certain municipality directly under the central government.These hospitals covered three administrative tiers：the national level，the provincial and ministerial level，and the prefectural and municipal level.All interview data were analyzed using grounded theory methodology. Results：Through three-level coding，a total of seven core categories were extracted：external constraints，strategic positioning，market capabilities， business structure，incentive systems，management capabilities，and personnel characteristics.These seven factors jointly influenced performance-based salary distribution in public hospitals，but their speci-fic manifestations and interactions showed marked differences across hospitals at different administrative levels.Specifically，public hospitals at higher administrative levels might be fully exempt from wage total amount constraints，or，even when operating within the total framework，still retained a considerably large distributable space.Relying on their high-level strategic positioning，these hospitals developed strong market capabilities and a business structure dominated by high-pricing medical services.They adopted a metric-based，incremental incentive model that allocated rewards directly to individual physi-cians，with the incentive scope covering the entire chain of medical care，education，and research.In contrast，public hospitals at lower administrative levels faced triple constraints：insufficient bargaining power in the healthcare market，limited and unstable patient sources，and a single compensation pathway heavily reliant on service volume.Their business structure was mainly composed of low-pricing projects with limited profitability.Consequently，they were forced to adopt a position-based performance model，where the incentive scope narrowed to basic medical quality，leaving these hospitals struggling with fragile incentives and persistent talent loss. Conclusion：Public hospitals at different administrative levels present structural differences in their mechanisms for determining performance-based salaries.During the top-down transmission of reform policies，the hierarchical institutional environment，together with strati-fied market capabilities and management capacities，acts as a multi-layer filter.This filtering process leads to heterogeneous policy performances across different hospital tiers.

关键词

公立医院 / 薪酬改革 / 绩效薪酬 / 行政层级

Key words

Public hospital / Salary reform / Performance-based pay / Administrative hierarchy

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