Effective Contract and Motivation
Can Reforms Improve the Work of Russian Doctors?


Chirikova A.E.

Dr. Sci. (Sociol.), Chief Researcher, Institute of sociology of FCTAS RAS, Moscow, Russia. chirikova_a@mail.ru

Shishkin S.V.

Dr. Sci. (Econ.), Prof., Head of department of Health Care Administration and Economy, Director of the Centre for Health Policy, National Research University Higher School of Economics, Moscow, Russia. shishkin@hse.ru

DOI: 10.31857/S013216250004952-0
ID of the Article: 7653


For citation:

Chirikova A.E., Shishkin S.V. Effective Contract and Motivation: Can Reforms Improve the Work of Russian Doctors?. Sotsiologicheskie issledovaniya [Sociological Studies]. 2019. No 5. P. 36-44



Abstract

Since 2012 the reform of the salary system of workers in the budgetary sphere, called the introduction of an effective contract, has been implemented in Russia. The paper presents the results of a study of the reform impact on the labor motivation of physicians. Empirical data are obtained by conducting in-depth interviews with physicians and heads of state medical institutions in Moscow and one of the regions in the European part of the country in 2016. The study revealed multidirectional impact for physicians’ readiness to work more and better by effective contract. There are three groups of doctors. The first and largest group: physicians who feels a positive impact of motivation incentives for physicians’ motivation at work. The second group: physicians who are convinced that an effective contract does not affect their motivation. The third group: physicians who believe that effective contract has led to a weakening of physicians’ motivation. The article gives an explanation of the results of the study. Results of the study also clearly show that the changes in the physician’s remuneration system aimed exclusively on the growth of salary of doctors are necessary, but not sufficient. The impact of an effective contract on the achievement motivation (the desire to improve their professional capabilities and results) was different for experienced and young doctors. The most pronounced increase in the achievement motivation was observed for the majority of young doctors. A special part of the research paper is devoted to informal payments which influence physicians’ motivation. The research has shown that these payments may smooth motivational effect caused by the new rules of remuneration. This fact is typical for Moscow, while in the region, this effect is not clearly expressed.


Keywords
physicians’ motivation; effective contract; achievement motivation; informal payments

References

Chaix-Couturier C, Durand-Zaleski I., Jolly D., Durieux P. (2000) Effects of Financial Incentives on Medical Practice: Results from a Systematic Review of the Literature and Methodological Issue. International Journal for Quality in Health Care. No. 12: 133–142.

Chirikova A., Shishkin S. (2002) Informal Payments in Medicine: a New Look at the Old Problem. Obshchestvo i economika [Society and Economy]. No. 10-11: 239–291. (In Russ.)

Deci E., Ryan R.M. (1985) Intrinsic Motivation and Self­Determination in Human Behavior. New York: Plenum Publishing Co.

Dieleman M., Harnmeijer J.W. (2006) Improving Health Worker Performance: in Search of Promising Practices. Geneva: WHO.

Franco L. M., Bennett S., Kanfer R. (2002) Health Sector Reform and Public Sector Health Worker Motivation: a Conceptual Framework. Social Science & Medicine. No. 8: 1255–1266.

Fress P. (1975) Experimental Psychology. The Law of Optimum Motivation. Moscow: Progress. (In Russ.)

Gordeeva T. (2006) Psychology of Motivation to Achieve. Moscow: Smysl; Izd. tsentr Akademiya. (In Russ.)

Gosden T., Pedersen L., Torgerson D. (1999) How Should We Pay Doctors? A Systematic Review of Salary Payments and Their Effect on Doctor Behaviour. QJM: An International Journal of Medicine. No. 1: 47–55.

Hayford K. Review of Alternative Compensation Methods for Health Workers. (2009) In: Vujicic M., Ohiri K., Sparkes S. Working in Health: Financing and Managing the Public Sector Health Workforce. Washington: The World Bank: 233–252.

Hekhauzen H. (2001) Psychology of Motivation to Achieve. Saint-Petersburg: Rech. (In Russ.)

Huilleryy E., Sebanz J. (2014) Performance Based Financing, Motivation and Final Output in the Health Sector: Experimental Evidence from the Democratic Republic of Congo. Sciences Po Department of Economics. Discussion paper 2014–12. Paris.

MacClelland D. (2007) Human Motivation. Saint-Petersburg: Piter. (In Russ.)

Informal Payments for Medical Care in Russia. (2003) Moscow: MONF; NISP. (In Russ.)

Okello D.R.O. (2014) Trust and Motivation in the Health Sector: a Systematic Review. University of Cape Town.

Paul F. (2009) Health Worker Motivation and the Role of Performance Based Finance Systems in Africa: A Qualitative Study on Health Worker Motivation and the Rwandan Performance Based Finance Initiative in District Hospitals. Development Studies Institute. London School of Economics and Political Science. Working Paper Series.

Petersen L.A., Woodard L.D., Urech T., Daw C., Sookanan S. (2006) Does Pay-for-performance Improve the Quality of Health Care? Annals of Internal Medicine. No. 4: 265–272.

Shishkin S., Temnitskiy A., Chirikova A. (2008) The Motivation of Russian Physicians and the Impact of the National Project on It. In: Shishkin S. (ed.) Russian Public Health: Physicians’ Motivation and Public Accessibility. Moscow: NISP. (In Russ.)

Shprenger R. (2004) Myths of Motivation. Exits from the Impasse. Kaluga: Dukhovnoye naslediye. (In Russ.)

Scott A., Sivey P., Ouakrim A.D., Willenberg L., Naccarella L., Furler J., Young D. (2011) The Effect of Financial Incentives on the Quality of Health Care Provided by Primary Care Physicians. Cochrane Database of Systematic Reviews. No. 6: 7–9.

Shen J., Ogawa K., Takahashi H. (2014) Examining the Tradeoff between Fixed Pay and PerformanceRelated Pay: A Choice Experiment Approach. Review of Economic Analysis. No. 6: 119–131.

Temnitskiy A. (2018) Changes in the Labor Motivation of Doctors under the Conditions of the Introduction of Effective Contract. Sotsiologicheskie issledovaniya [Sociological Studies]. No. 4: 90–102. (In Russ.)

Tsounis A., Sarafis P., Bamidis P. (2014) Motivation among Physicians in Greek Public Health-Care Sector. British Journal of Medicine & Medical Research. No. 5: 1094–1105.

Willis-Shattuck M., Bidwell P., Thomas S., Wyness L., Blaauw D., Ditlopo P. (2008) Motivation and Retention of Health Workers in Developing Countries: a Systematic Review. BMC Health Services Research. No. 8: 247.

Yerkes R.M., Dodson J.D. The Relation of Strength of Stimulus to Rapidity of Habit-formation. Journal of Comparative Neurology and Psychology. 1908. Vol. 18: 459–482.

Content No 5, 2019