Study on the Adaptability of Cardiologists Salary System in Chinese Public Hospitals Based on the Chinese Volume-based Purchasing Policy

On January 1st, 2021, the Chinese healthcare system enforced the Volume-based Purchasing (VBP) policy in the heart stents market, which dramatically cut the price of stents by 90%. It will be more affordable for people who suffer from cardiovascular disease. However, before VBP policy, cardiologists’ income mainly comes from two pathways, salary from the hospital and the kickbacks from distributors. The salary for cardiologists dominated relied on the surgery service fee, which is priced by the level of the hospital. The higher level the hospital is, the higher price of the surgery will be. In that case, cardiologists who work in a secondary hospital will still be exposed to the same amount of radiation as those who work in a tertiary hospital but will be paid less. In terms of effectiveness, the VBP policy does reduce some medical bribery but also causes significant loss of income to cardiologists at the same time. Nevertheless, there is no feasible policy to make up for the loss of compensation. Cardiologists, especially in secondary hospitals, are impending to quit from the public healthcare system to private healthcare organizations. This study uses the data both from a secondary hospital and the supplier in a pilot province as a case, focusing on the medical salary system. It uses descriptive analysis and linear regression methods to determine the possible relationship among relative variables in the hospital and the distributor. It will provide a tuning suggestion using a cost method in accounting analysis inside the healthcare cost system to avoid future manpower loss and other unexpected medical behaviors. It indicates that cardiologists are half less paid in the view of income level, compared with their contributions to the hospital, and they are paid lower than what the society estimates regarding the income level to physicians. In terms of salary structure, the current paying package, which contains 30% fixed and 70% performed pay, is the main reason that drives cardiologists to become overtreating and profit-seeking. Kickbacks are the under-table income paid by distributors, which is around 9.7% of the heart stents portfolio but will soon be blocked by the VBP policy. Kickbacks paid by the distributor are almost as much as the salary paid by the hospital. Therefore, if the hospital could shed light on cardiologists’ salary and adjust its structure, it would be more efficient and sustainable to allocate and use the human resource based on the experienced cost accounting in the healthcare system. The author hopes the discussion in this article would provide the inspiration and empirical reference for the salary reform of secondary public hospitals in China.