Satisfaction of Township Hospitals Health Workers on Performance-based Salary in China

Abstract

Background: Township hospitals (THs) are crucial primary health care providers in China health delivery system. Low job satisfaction of THs health workers has been one of biggest challenges to strengthening the primary health system in China. Even huge amount of studies confirming THs health workers ranked low remuneration level as one most important demotivating factor, few published studies explored the feelings of health workers on existing payment method design -- a kind of Performance-based Salary System. Objective: To analyze how key design of PBS influences the satisfaction of health workers with the intention to provide policy suggestions on how to improve the design of PBS, the motivation and performance of health workers in primary healthcare facilities. Method: This study is a cross-sectional study, conducted in 47 THs in Shandong China. A total of 1,136 PCPs were recruited in the quantitative analyses. Expectancy theory was applied to design the measurements on designs of PBS. We analyzed the associations between PBS design and satisfaction of health workers using logistic regression. Results: The three key components of PBS design were all related to the satisfaction status of health workers. Those health workers 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 assessment criteria and targets. The knowledge on personal performance was also associated with being satisfied with the payment methods (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 feeling satisfaction decreased by 2.82% (95%CI -4.9 to -0.7, p=0.01). And when we grouped the health workers based on their value on monetary rewards, we 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 tried to apply the performance-related payment methods to incentivise certain work behavior, they should pay attention to some design details, including keeping transparency in the performance assessment criteria, clear performance feedback each health worker, and setting the proportion of performance-related income based on the preference of health workers in certain cultural setting.