不让三明医改“逾淮为枳”，关键在于薪酬制度改革

Core Insights - The article highlights the contrasting realities of healthcare reform in China, particularly focusing on the successful case of Sanming in Fujian province versus the struggles faced by grassroots medical institutions in Shandong province due to insufficient funding and performance bonuses [1][2][3]. Group 1: Healthcare Reform in Sanming - Sanming's healthcare reform has shown positive results by addressing the financial challenges faced by medical institutions, particularly through measures like eliminating drug markups and establishing a comprehensive medical insurance system [2][3]. - The reform aims to shift the focus from a treatment-centered approach to a health-centered model, which requires a change in the compensation structure for medical staff [4][5]. - The success of Sanming's reform is attributed to the establishment of a unified salary system across different levels of healthcare institutions, which has improved the motivation of healthcare workers [5][6]. Group 2: Challenges in Grassroots Healthcare - Grassroots healthcare institutions in Shandong are struggling with delayed salary payments and a lack of performance bonuses, leading some medical staff to seek additional income through side jobs [1][2]. - The financial difficulties stem from a misalignment in medical insurance payments, where hospitals are required to cover a significant portion of costs upfront, leading to substantial debt [3][4]. - The article emphasizes that the core issue lies in the imbalance of medical resource allocation, with funds being concentrated in higher-tier hospitals, leaving grassroots institutions underfunded [3][4]. Group 3: Key Elements of Sanming's Reform - Sanming's reform includes a significant increase in the fixed salary component for medical staff, reducing the reliance on performance-based pay linked to patient volume [5][6]. - The reform has created two key funding pools: one from reducing inflated drug prices and another from bundled payment systems that incentivize cost-saving measures [7][9]. - The implementation of a bundled payment system allows for more efficient use of medical insurance funds, promoting a shift towards preventive care rather than reactive treatment [9][10].