Personnel reform in Chinese hospitals: policy interdependence and the challenge of coherent incrementalism

Abstract

Health care in China is plagued with problems, including barriers to access, maldistribution of resources, inefficiencies and uneven quality. The management of human resources in the health care system has a significant effect on what happens in the clinic and the ward. The management of staff appointments and the remuneration system are two critical areas that remain problematic although they have received government attention. We argue that new approaches to policy development and implementation are needed to achieve a high-performance health care system. In particular, we suggest a new focus on the challenges of policy interdependence across sectors and among levels of administration. We highlight the need for a clear vision for health care, which would provide direction for the entire reform process, and also for a restructuring of the system of accountability.

中国的卫生改革取得了一定的成绩，但是也面临严峻的挑战，包括医疗服务的可及性，卫生资源的合理利用，以及服务效率和质量等问题。卫生人力资源管理存在的问题反映了由宏观卫生政策的偏差所带来的影响，尤其是人事制度和分配制度改革所暴露的问题十分显著。本文通过对现行卫生人事制度和分配制度的分析，认为要实现好的卫生系统绩效，采取新的政策开发和实施策略非常必要。强调了不同层面、不同领域之间政策相互依赖的重要性。指出卫生改革需要所有相关领域对改革的愿景和方向达成共识，并明确政策实施过程中各方的职责。

Keywords:

• personnel reform
• policy interdependence
• policy reform
• human resource management
• staff appointment systems
• remuneration
• Chinese hospitals

Acknowledgements

The materials and ideas presented in this article draw upon many years of collaboration in teaching and research. We acknowledge gratefully the contribution of our colleagues, George Liu, Vivian Lin and Hui Yang, and all of our students.

Notes

1. China established a three-tiered health care system in the late 1950s. The system was a vertical organised network of community, district and provincial (or city) health units in the urban areas, and of village, township and county health units in the rural areas. The tertiary hospital sector included city central hospitals, municipal centres for disease control, municipal health centres for women and children in the urban areas, and county hospitals, county centres for disease control, county health centres for women and children.

2. There were three schemes of health insurance programmes in China: Government Employment Health Insurance, Labour Health Insurance (LHI) and CMS. Workers employed in the enterprises were insurance by the LHI.

3. This is a commonly used term in government policy documents and health management literatures. Switching to position and performance management means a person's professional title and position are no longer fixed. They should be allowed to float, subject to the performance of the individual. In other words, if a person is under-performing, he should be moved to a lower position and their professional title should be changed accordingly. The salary, in turn, should be adjusted to match the new position and professional title.