Performansa dayalı ödeme sisteminde hekimlerin örgütsel adalet algısı (Hekimlerin ödemelere yönelik adalet algısı)

Year 2020, Volume: 18 Issue: 2, 172 - 191, 31.08.2020

Emine Orhaner , Kenan Birsen , Yasemin Kurumlu

https://doi.org/10.20518/tjph.675148

Abstract

Amaç: Bu araştırma, Performansa Dayalı Ödeme Sisteminin hekimlerin örgütsel adalet algısını nasıl etkilediğini ölçmek ve sağlık standartlarının geleceğine yönelik öneriler geliştirmek amacıyla yapılmıştır. Yöntem: Kesitsel tipteki bu araştırma, hem Sağlık Bakanlığı hem de Üniversite Hastanesini temsil eden, uzman hekim ve üzeri statüye sahip 312 geçerli katılımcı ile yürütülmüştür. Araştırmanın verisi, yüz yüze anket tekniği kullanılarak toplanmıştır. Nicel veri analizinde Mann Whitney U-testi ve Kruskall Wallis H-testi, nitel veri analizinde ise Betimsel Analiz ve Sistematik Analiz uygulanmıştır. Bulgular: Katılımcıların % 68.3’ü Sağlık Bakanlığı Hastanesi hekimi, % 65.7’si erkek, % 76.3’ü kırk yaşın üzerinde, % 46.1’i profesör ve doçent statüsünde, % 45.5’i dahili tıp branşında ve % 88.5’i günlük sekiz saatten fazla çalışanlardır. Hekimlerin Performansa Dayalı Ödeme Sistemine yönelik genel adalet algısı X̄= 2.00 ± 0.50’dir. En şiddetli adaletsizlik, kişilerarası adalet alt boyutunda izlenmiştir (X̄= 1.51). Performans ödemelerinin adilliği açısından en dezavantajlı grup, temel tıp branşlarıdır. Katılımcılar, performans ödemelerinin sağlık ekonomisini sürdürülebilirliği olmayan bir alana sürüklediğini ve mesleki saygınlığı kaybettirdiğini düşünmektedir. Sonuçlar: Hekimlerin, daha adil bir ödeme sistemine acilen ihtiyacı vardır. Yeni sistem, kolektif bir bakış açısına sahip olmalı, hekimler ve politikacılardan oluşan Üst Kurul tarafından tasarımlanmalıdır. Etik çerçevenin ideal forma taşınabilmesi için hekimlerin sabit ücretleri reel piyasa koşullarına hizalamalı ve ödemeler finansal olmayan motivasyon araçları ile desteklenmelidir.

Keywords

Performansa Dayalı Ödeme Sistemi, Örgütsel adalet, Hekimlerin örgütsel adalet algısı

Thanks

Araştırmamızın istatistiksel analiz aşamasında değerli katkılarını esirgemeyen Hacı Bayram Veli Üniversitesi Sağlık Yönetimi Bölümü Araştırma Görevlisi Sayın Semih ISLICIK'a teşekkür ederiz.

Organizational justice perception of medical doctors about the performance based payment system (Physicians’ perception of justice for payments)

Abstract

Objective: This research aims to measure how Performance-Based Payment System affects the organizational justice perception of medical doctors and improve ideas for the future of healthcare standards. Methods: This descriptive research is conducted with 312 eligible specialist medical doctors and higher status participants, working at a hospital of the Ministry of Health in Ankara and a University Hospital. The data collection method of the study is face-to-face surveys. Mann-Whitney U-test and Kruskall Wallis H-test are used for quantitative data analysis. Descriptive and systematic analyses are carried out for qualitative data. Results: Among the participants 68,3% of the participants are medical doctors who are working in hospital of Ministry of Health, 65,7% is male, 76,3% are forty years old and over, 46,1% is professor or associate professors, 45,5% is working on internal medicine and 88,5% is working more than 8 hours in a day. Overall perception of medical doctors on performance-based payment system is X̄= 2.00 ± 0.50. Interpersonal justice perception is monitorized as most emphasized inequality (X̄= 1.51). In terms of the fairness of performance payment, women medical doctors and basic medical science doctors are the most disadvantaged group. Participants are thinking that performance payments will be unsustainable for the health economy and degrading the occupational reputation. Conclusions: Performance-Based Payment System negatively affects medical doctors perception of organizational justice. The most severe consequence of this is the losses medical doctors in personal rights. A fairer payment system is needed for the health system and the ethical framework to be moved to the ideal form.

Keywords

Performance-Based Payment System, Organizational Justice, pysycian' justice perception

References

• Kaynaklar 1. Porter ME, Teisberg EO. Redefining Health Care. Massachusetts: Harvard Business School Press, 2006. p. 17.
• 2. Eichler, R. Can “Pay for Performance” Increase Utilization by the Poor and Improve the Quality of Health Services? Discussion paper for the first meeting of the Working Group on Performance-Based Incentives Center for Global Development. 2006. p.21-22.
• 3. Witter S, Toonen J, Meessen B, Kagubare J, Fritsche G and Vaughan K. Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation. BMC Health Services Research 2013; 13: 367.
• 4. Marcotte, L., Hodlofski, A., Bond, A., Patel, P. and Sacks, SA. Intı practice: How Advocate Health System Uses Behavioral Economics To Motivate Physicians In Its Program. Healthcare 2017; 5(3): 129-135.
• 5. Rosenthal MB, Frank RG, Li Z and Epstein AM. Early experience with pay-for-performance from concept to practice. Journal of American Medicine Association 2005; 294(14): 1788-1793.
• 6. Rusa L, Ngirabega JD, Janssen W, Bastelaere SV, Porignon D and Valdenbulcke W. Performance-based financing for better quality of services in Rwandan health centres: 3-year experience. Tropical Medicine and International Health 2009; 14 (7): 830-837.
• 7. Soeters R, Griffiths F. Improving government health services through contract management: A case from Cambodia. Health Policy 2003; 18(1): 74-83.
• 8. OECD. Better Ways to Pay for Health Care. Paris: OECD Publishing, 2016.
• 9. Mendelson A, Kondo K, Damberg C, Low A, Motuapuaka M, Freeman M, O’Neil M, Relevo R and Kansagara D. The effects of pay-for-performance programs on health care use, and processes of care: A systematic review. Annals of Internal Medicine 2017; 166(5): 341-353.
• 10. Van Herck P, De Smedt D, Annemans L, Remmen R, Rosenthal MB and Sermeus W. Systematic review: effects, design choices, and context of pay-for-performance ın health care. BMC Health Services Research 2010; 10: 247.
• 11. Eijkenaar F, Emmert M, Scheppach M, Schöffski O. Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy, 2013; 110(2-3): 115-130.
• 12. Petersen LA, Woodard LD, Urech T, Daw C and Sookanan S. Does pay-for-performance ımprove the quality of health care? Annals of Internal Medicine 2006; 145(4): 265-272.
• 13. Eldridge C and Palmer N. Performance-based payment: some reflections on the discourse evidence and unanswered questions. Health Policy and Planning 2009; 24(3): 160-166.
• 14. Green EP. Payment systems ın the healthcare ındustry: an experimental study of physician ıncentives. Journal of Economic Behavior & Organization 2014; 106: 367-378.
• 15. Adams JS. Inequity in Social Exchange. New York: Behavioral Research Service General Electric Company, 1965.
• 16. Scheffler S. Equality & Tradition. New York: Oxford University Press, 2010.
• 17. Greenberg J. Determinants of perceived fairness of performance evaluations. Journal of Applied Psychology 1986; 71(2): 340-342.
• 18. Greenberg J. Organizatioanl justice: Yesterday, today and tomorrow. Journal of Management 1990; 16(2): 399-432.
• 19. Colquitt JA. On the dimensionality of organizational justice: A construct validation of a measure. Journal of Applied Psychology 2001; 86(3): 386-400.
• 20. Folger R, Cropanzano R. Organizational Justice and Human Resource Management. California: Sage Publications, 1998.
• 21. Heponiemi T, Manderbacka K, Vanska J and Elovainio M. Can organizational justice help the retention of general practitioners? Health Policy 2013; 110(1): 22-28.
• 22. Greenberg J. Using explanations to manage impressions of performance appraisal fairness. Employee Responsibilities and Rights Journal 1991; 4(1): 51-60.
• 23. Goleman D, Boyatzis R, Mckee A. The Power of Emotional İntelligence. E-book, 2004.
• 24. Büyüköztürk Ş. Sosyal Bilimler İçin Veri Analizi El Kitabı. 12. Basım, Ankara: Pegem Akademi, 2010.
• 25. Bryman A. Social Research Methods. 4th Edition, New York: Oxford University Press, 2012.
• 26. Murray JB, Ozanne JL. (Rethinking The Critical İmagination) Handbook of Qualitative Research Methods İn Marketing. (Editor) In: Belk RW. Edward Elgar Publishing Limited. USA 2006.
• 27. Mohamed SA. The relationship between organizational justice and quality performance among healthcare workers: a pilot study. The Scientific World Journal 2014; Makale ID: 757425-7 sayfa.
• 28. Krauth C, Liersch S, Jensen S, Amelung VE. Would German physicians opt for pay-for-performance programs? A willingness-to-accept experiment in a large general practioners’ sample. Health Policy 2016; 120 (2): 148-158.
• 29. Akçakanat T. Üniversite hastanelerinde çalışan öğretim üyelerinin performansa dayalı ek ödeme sistemine yönelik tutumları üzerine bir araştırma. Doktora Tezi, 2013.
• 30. Yuzden GE, Yıldırım J. A qualitative evaluation of the performance-based supplementary payment system in Turkey: physicians’ perspectives. Journal of Health Management 2014; 16(2): 259-270.
• 31. Küçük A, Gökçınar D, Aksoy E, Albayrak D, Erdem D, Akan B, Göğüş N. Performansa göre ek ücret ödemesinin anestezi uygulamalarına etkileri. Turkish Journal of Anaesthesiology and Reanimation 2012; 40 (5): 262-268.
• 32. Cihangiroğlu N, Şahin B, Naktiyok A. Hekimlerin örgütsel adalet algıları üzerine bir araştırma. ZKU Sosyal Bilimler Dergisi 2010; 6 (12): 67-82.
• 33. Çakır Ö, Sakaoğlu H. Sağlık çalışanlarının performansa dayalı ek ödeme sisteminde ücret adaleti algısı: Tepecik eğitim ve araştırma hastanesi örneği. Çalışma İlişkileri Dergisi 2014; 5(1): 1-21.
• 34. Lee JY, Lee SI, Kim NS, Kim SH, Son WS, Jo MW. Healthcare organizations’ attitudes toward pay-for-performance in Korea. Health Policy 2012; 108(2-3): 277-285.
• 35. Sutinen R, Kivimaki M, Elovainio M, Virtanen M. Organizational fairness and psychological distress in hospital physicians. Scandinavian Journal of Public Health, 2002; 30: 209-215.
• 36. Beach MC, Meredith LS, Halpern J, Wells KB, Ford DE. Physician conceptions of responsibility to individual patients and distributive justice in health care. Annals of Family Medicine 2005; 3 (1): 53-59.
• 37. Heponiemi T, Kuusio H, Sinervo T, Elovainio M. Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. Europan Journal of Public Health 2011; 21(4): 520-525.
• 38. Arı M, Altın Gülova A, Köse S. Örgütsel adalet algısı ile örgütsel bağlılık davranışının ilişkisi: Bir sağlık kuruluşunda araştırma. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi 2017; 10 (1): 43-51.
• 39. Elovainio M, Kiwimaki M, Vahtera J. Organizational justice: Evidence of a new psychosocial predictor of health. American Public Health Association 2002; 92 (1): 105-108.
• 40. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, West CP. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings 2015; 90 (12): 1600-1613.