The effect of ethical sensitivity in health institutions on the perception of performance-based additional payment system: A research on physicians

With the emergence of neoliberal policies in the health sector, the health sector has become a sector that operates with market conditions as well as its preventive and therapeutic features. The health sector is a field that requires serious expertise, and physicians, who are indispensable in this field, are supported with additional payments in the new structure, with the aim of increasing the performance of the system, realizing the delivery of quality health services and accordingly creating patient satisfaction. As a component of the health transformation program initiated in 2003 in Turkey, a performance-based supplementary payment system has been implemented. The purpose of this research relies on the relationship between physicians' ethical sensitivities and performance-related earnings. During the study process, the "PBA Physician Perception Scale" was developed on how physicians perceive the performance-based payment system, and it was collected and analyzed by giving it together with the "Moral Sensitivity Scale". SPSS programs were used in the analysis of the data and Lisrel programs were used in the structural equation modeling.The PBAPS Physician Perception Scale, which was developed during the research process, consists of four dimensions such as physician performance, service quality, patient satisfaction, physician satisfaction, and physician satisfaction questions were reverse coded. As a result of the study, it has been determined that with the increase of the ethical sensitivity of the physicians, their job satisfaction will decrease and the physicians who do not receive performance pay and those who do show the same performance. As a result, it was concluded that physicians were not satisfied with the performance system, but the system made positive contributions to the health system in terms of quality service, patient satisfaction and employee performances.