The impacts of public hospital compensation reform on the health workforce compensation and its structure: quasi-experimental evidence in China

The Chinese government piloted the public hospital’s compensation system reform in 2017. It is important for policymakers to understand how this reform has affected the health workforce’s compensation and its structure. We evaluated the impact of the reform on health workers’ compensation levels and structure.

This nationwide study used panel data from the 2016–2017 China Health Workforce Compensation Reform Survey, covering 102 public hospitals and 111,204 health workers across 15 provinces. A difference-in-differences approach combined with propensity score matching was employed to estimate the reform’s impact on compensation and its structure. Primary outcomes were the percentages of base salary and merit salary in total compensation, secondary outcomes included total, base, and merit salary.

Following the reform, the percentages of base salary and merit salary increased by 3.54% and 0.53%, respectively. Total compensation, annual base salary, and annual merit salary increased by 1%, 13%, and 5%, respectively. Compensation levels and structure were associated with the average social wages of urban workers, consumer price index, hospital levels, education, nature of employment, qualifications and departments were found to be associated with compensation and its structure. General hospitals showed the largest increase in the percentage of base salary, while specialized hospitals had greater growth in merit salary. The reform also contributed to an increased performance salary structure for contract and short-tenure staff, although it did not significantly improve their total compensation.

RPHCS has helped reshape salary structures for the health workforce, but has not yet to fully achieved the equity goal of “equal pay for equal work.” Policymakers should refine performance evaluation systems and extend base salary protections to vulnerable groups to promote equitable compensation outcome.

Not applicable.