I 摘要 随着医改方案在全国各地陆续推行，我国各大公立医院需要主动适应新医改的发 展趋势，不断满足医务人员的各种激励诉求，努力发现医务人员在激励方面的具体问 题，采取有针对性的激励措施，提升医务人员的工作满意度，从而进一步提升公立医 院的整体工作效率，提高公立医院的核心竞争力。本文以X公立医院为例，在公立 医院医疗改革的背景下，首先阐述了新医改方案对公立医院医务人员激励机制的影 响，新医改方案对医务人员激励机制的要求。其次分析了X公立医院当前激励机制 的现状，包括医院的基本情况，医院绩效改革前后差别，医院激励机制效应分析。然 后发现了X公立医院在激励机制中的问题，包括激励方式选择以内、外激励为主， 激励因素确定缺乏科学性，薪酬激励中绩效工资内部比例分配不均衡，考核评价标准 以业务收入为导向。最后对X医院激励机制进行了优化设计，提出了医务人员激励 机制优化的总体思路，医务人员激励机制优化的方案以及医务人员激励机制优化方案 的实施保障。 关键词：医改；公立医院；医务人员；激励机制 Abstract III Abstract Withtheimplementationofmedicalreformprogramsinvariouspartsofthecountry, majorpublichospitalsinChinaneedtoactivelyadapttothedevelopmenttrendofnew medicalreforms,continuouslymeetthevariousincentivedemandsofmedicalstaff,and strivetofindspecificincentivesformedicalstaff,andtaketargetedmeasures.Incentive measurestoimprovethejobsatisfactionofmedicalstaff,therebyfurtherimprovingthe overallworkefficiencyofpublichospitalsandthecorecompetitivenessofpublichospitals. ThisarticletakespublichospitalXasanexample.Inthecontextofpublichospitalmedical reform,itfirstexplainstheimpactofthenewmedicalreformplanontheincentive mechanismofmedicalstaffinpublichospitals,andtherequirementsofthenewmedical reformplanfortheincentivemechanismofmedicalstaff.Secondly,itanalyzesthecurrent incentivemechanismofXpublichospitals,includingthebasicsituationofthehospital,the differencebeforeandafterthereformofhospitalperformance,andtheanalysisofthe effectsoftheincentivemechanismofthehospital.ThenIdiscoveredtheproblemsinthe incentivemechanismofXpublichospitals,includingthechoiceofincentivemethods, mainlyinternalandexternalincentives,thelackofscientificdeterminationofincentive factors,theunevendistributionofperformanceandsalaryinsalaryincentives,andthe appraisalandevaluationstandardswereguidedbybusinessincome..Finally,the optimizationdesignoftheincentivemechanismoftheXhospitalwasputforward,andthe generalideaoftheoptimizationoftheincentivemechanismofmedicalstaffwasput forward. Keywords:Medicalreform;publichospitals;medicalstaff;incentives 目录 V 目录 摘要.....................................................................................................................I Abstract...........................................................................................................III 1绪论................................................................................................................1 1.1选题背景..................................................................................................................1 1.2研究的目的和意义..................................................................................................2 1.2.1研究目的............................................................................................................................2 1.2.2研究意义............................................................................................................................3 1.3研究方法、思路及内容..........................................................................................4 1.3.1研究方法............................................................................................................................4 1.3.2研究思路............................................................................................................................5 1.3.3研究内容............................................................................................................................5 1.4文献综述..................................................................................................................5 1.4.1国外研究现状....................................................................................................................6 1.4.2国内研究现状....................................................................................................................8 2新医改方案对公立医院医务人员激励机制的影响及要求.....................11 2.1新医改方案对公立医院及医务人员激励机制的影响.......................................11 2.1.1新医改方案对大多数公立医院的影响.........................................................................11 2.1.2新医改方案对公立医院医务人员激励机制的影响.....................................................12 2.2新医改方案对公立医院医务人员激励机制的要求...........................................12 2.2.1新医改方案对激励方式的要求......................................................................................13 2.2.2新医改方案对薪酬激励的要求......................................................................................13 2.2.3新医改方案对成长激励的要求.......................................................................................13 2.2.4新医改方案对考评激励的要求.......................................................................................13 3X公立医院当前激励机制的现状...............................................................15 3.1医院基本情况........................................................................................................15 3.2医院绩效改革后的现状........................................................................................15 3.2.1激励方式方面...................................................................................................................15 3.2.2薪酬激励方面..................................................................................................................16 3.2.3成长激励方面..................................................................................................................17 3.2.4考评激励方面..................................................................................................................18 3.3医院激励机制效应分析........................................................................................18 重庆理工大学硕士学位论文 VI 3.3.1问卷回收情况..................................................................................................................18 3.3.2医务人员对激励机制的感知分析.................................................................................21 3.3.3医务人员获得付出不平衡体现.......................................................................................23 3.3.4医务人员行为：逐利行为与风险规避.........................................................................25 4X公立医院在激励机制中的问题...............................................................27 4.1激励方式选择以外激励为主................................................................................27 4.2激励因素确定中的科学性缺乏.............................................................................28 4.3薪酬激励中绩效工资内部比例分配不科学.........................................................28 4.3.1绩效工资制度的激励作用没有得到有效发挥..............................................................29 4.3.2基础性绩效的比例分配远远高于奖励性绩效..............................................................29 4.4考核评价标准以业务收入为导向.........................................................................30 4.4.1考核指标体系...................................................................................................................30 4.4.2奖惩措施...........................................................................................................................30 5X公立医院医务人员激励机制的优化设计..............................................33 5.1医务人员激励机制优化的思路............................................................................33 5.1.1公益性实现的激励目标为指导....................................................................................