Does the reform of public hospitals' payment system increase the pay of medical personnel? A nationwide cross-sectional study

Abstract Background The reform of public hospitals' payment system (RPHPS) is the focus of medical reform in China. The current medical personnel payment system was formulated under a framework including the whole public sector, and this cannot meet the demands of necessary reform. In 2017, the government piloted the RPHPS to raise the pay of medical personnel and mobilize their work enthusiasm. Here, we examine whether the RPHPS provides a way to influence the pay of medical personnel and examine the factors determining this pay. Methods This study used data from a cross-sectional survey of 699 public hospitals across 21 provinces of China in 2017, the China Public Hospitals Pay Reform Survey. We used a coarsened exact matching method and hierarchical linear analysis to enhance the comparability between groups. A total of 178,622 medical personnel were included in our study. Results We found that the RPHPS was significantly associated with total annual pay and annual performance pay. Those who worked in the treatment group had significantly higher total annual pay and annual performance pay than those in the control group. The pay of medical personnel was strongly associated with the average salary of an urban worker and the hospital type, and their gender, age, education status, work characteristics, position, professional titles, seniority in years and departments. Conclusion There was a strong relationship between the implementation of the RPHPS and the pay of medical personnel. From a policymaker perspective, this shows that there may be value in further promoting the development of the payment system in public hospitals. The government should scale up the piloted areas for RPHPS and increase the total salary and the total performance-based wage-control level of public hospitals to reflect the value of the technical and labor services provided by medical personnel.