The wage system as an instrument of influence on the quality of primary health care

Abstract

Qualified and motivated employees of a medical organization are a necessary component that ensures the provision of medical care of appropriate quality One of the motivating factors of medical workers for high-quality and efficient work is wages. The purpose of the study. To analyze and evaluate the impact of the remuneration system of medical workers based on labor rationing on the quality of primary health care (PHC) on the example of the state district polyclinics of St. Petersburg. Materials and methods. Based on the reporting data of polyclinics selected by the research bases, the following were studied: the dynamics of the number and staffing of medical workers from 2018 to 2021; the percentage and structure of reasons for refusal to pay for cases of medical care in 2010–2018 and 2020–2021; the dynamics of the detection of malignant neoplasms in the early stages. The results of the patient survey were analyzed in order to assess changes in the quality of primary health care for the adult population after the introduction of a system of remuneration for medical workers based on labor rationing. Results. After the introduction of a new wage system based on its rationing, a number of general positive trends were identified for the studied polyclinics, such as: an increase in staffing of medical personnel in general by 3.5%–8.7%, district internists by 4.6%–42.7%, specialist doctors by 2.8%–12.4%, average medical personnel by 4.5%–17.7%; increase in the proportion of oncological pathology detected at early stages by 13.5%–20.1%; decrease in the share of refusals to pay for medical care cases by 9.3%–32.9%; a decrease in the total number of citizens’ complaints in the form of complaints by 6.0–58.0%, including justified ones. Findings. The introduction of a wage system based on labor rationing has increased the economic and medico-social efficiency of the polyclinics under study, as well as the motivation of medical workers to provide medical care of appropriate quality.