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

Year 2020, , 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

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