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目的:分析上海市卫生人力成本现状及薪酬筹资机制存在问题,提出完善收入分配机制、提高服务绩效的政策建议。方法:利用2008—2013年公立医疗卫生机构财务年报,描述了上海市卫生人员的人力成本总量、水平、结构;并与国内其他行业进行比较。结果:2008—2013年,上海市公立医疗卫生机构人力成本占机构总收入的比重从31.5%下降到28.7%,人均成本从12.1万元增长到19.9万元。医疗机构级别越高,收入越高;收入结构以奖金为主,医疗机构级别越高,奖金所占比例越大,三级医院达76%,社区约为37%。卫生人员收入与从业人员人均收入的比值大于2。结论:上海市各级各类医疗卫生机构人员收入水平差异大,工资结构以奖金为主,与创收未脱钩。建议理顺不同级别医疗机构工资水平,构建以技术为导向、与服务定位相匹配的收入分配机制。
OBJECTIVE: To analyze the status quo of Shanghai’s labor force cost and the existing problems of salary financing mechanism, and put forward the policy suggestions of improving income distribution mechanism and improving service performance. Methods: The financial annual reports of public health institutions from 2008 to 2013 were used to describe the total amount, level and structure of labor costs of health personnel in Shanghai and compared with other domestic industries. Results: From 2008 to 2013, the ratio of manpower cost in Shanghai public medical institutions to total institutional income dropped from 31.5% to 28.7%, and the per capita cost increased from 121,000 yuan to 199,000 yuan. The higher the level of medical institutions, the higher the income. The income structure is mainly based on bonuses. The higher the level of medical institutions, the greater the proportion of bonuses. The tertiary hospitals reach 76% and the community accounts for about 37%. The ratio of health personnel income to per capita income of practitioners is greater than 2. Conclusion: There is a big difference in income level among various medical and health institutions at all levels in Shanghai. The wage structure is mainly based on bonuses, and there is no decoupling from income generation. It is suggested to rationalize the salary levels of medical institutions at different levels and to construct a revenue-sharing mechanism that is technology-oriented and matches the service orientation.