Abstract
Background: Township Hospitals (THs) are crucial providers in China’s primary health delivery system. Low job satisfaction of THs health workers has been one of biggest challenges to strengthening the health system in China. Even huge amounts of studies confirmed low remuneration level as a key demotivating factor though few studies have explored the feelings of health workers on how they were paid. Objective: To analyze how the key design of Performance-based Salary System (PBS) influences the satisfaction of health workers on the payment system in China’s THs. Method: A cross-sectional study was conducted in 47 THs in Shandong China, and a total of 1136 participants were recruited. Expectancy theory was applied to design the measurements on designs of PBS. The associations between PBS design and satisfaction of health workers were analyzed by logistic regression. Results: Three key components of PBS design were all related to the satisfaction of health workers. Those health workers who were aware of assessment methods were more likely to be satisfied with how they were paid (OR = 2.44, p < 0.001) compared with those being not aware of the methods. The knowledge on personal performance was also associated with being satisfied (OR = 3.34, p < 0.001). The percentage of floating income in total income was negatively associated with the satisfaction, and one percentage point increase in floating income proportion could result in the possibility of being satisfied decreasing by 2.82% (95%CI −4.9 to −0.7, p = 0.01). Subgroup analysis found that only in those with lower value on monetary income, the negative influence of more floating income was significant. Conclusions: When policymakers or managers apply performance-related payment to incentivize certain work behavior, they should pay attention to the design details, including keeping transparency in the performance assessment criteria, clear performance feedback, and setting the proportion of the performance-related part based on the preference of health workers in certain cultural settings.
Highlights
The percentage of floating income in total income was negatively associated with the satisfaction, and one percentage point increase in floating income proportion could result in the possibility of feeling satisfaction decreased by 2.82% (95%confidence intervals (CI) −4.9 to −0.7, p = 0.01)
The analysis on data from three counties in Shandong Province of China found that the health workers who were aware of assessment methods and had knowledge on personal performance were linked with greater satisfaction with Performance-based Salary System (PBS), and the increase in floating income proportion was linked with decreased possibility of feeling satisfaction
The analysis found that the influence of being aware of assessment and performance on satisfaction was only significant in those health workers with strong preference for financial rewards, and the negative influence of increasing proportion of floating income was only found in those health workers with lower preference for financial rewards
Summary
China’s health delivery system has a hierarchical system corresponding with administrative levels, consisting of health providers in national, provincial, prefecture, county, township (rural areas)/community (urban areas), and village levels. Township hospitals (THs) are taking a pivotal role in the three-tier delivery system of rural areas, connecting the hospitals and village clinics. County and higher hospitals are in charge of providing specialized medical services for the covered population and providing technical supports to medical services provision to lower level hospitals and THs. THs take responsibility in provision of medical services for common diseases and training and supervising the
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