It's all about the money? a qualitative study of healthcare worker motivation in urban China

Research output: Contribution to journalArticlepeer-review


  • Yaru Chen
  • Meng Wang
  • Liang Fang
  • Jun Liu
  • Zhidong Xuan
  • Guohong Li

Colleges, School and Institutes

External organisations

  • Health Services Management Centre; University of Birmingham; Birmingham UK
  • Warwick Business School, University of Warwick, Coventry CV4 7AL, UK
  • School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
  • Shihezi City People's Hospital, Urumqi, China.
  • Institute of Social Medicine and Health Management, Henan University, Kaifeng, China.
  • Shanghai Jiao Tong University


BACKGROUND: China's healthcare reform programme continues to receive much attention. Central to these discussions has been how the various financial incentives underpinning reform efforts are negatively impacting on the healthcare workforce. Research continues to document these trends, however, qualitative analysis of how these incentives impact on the motivation of healthcare workers remains underdeveloped. Furthermore, the application of motivational theories to make sense of healthcare worker experiences has yet to be undertaken.

METHODS: The purpose of our paper is to present a comparative case study account of healthcare worker motivation across urban China. It draws on semi structured interviews (n = 89) with a range of staff and organisations across three provinces. In doing so, the paper analyses how healthcare worker motivation is influenced by a variety of financial incentives; how motivation is influenced by the opportunities for career development; and how motivation is influenced by the day to day pressures of meeting patient expectations.

RESULTS: The experience of healthcare workers in China highlights how a reliance on financial incentives has challenged their ability to maintain the values and ethos of public service. Our findings suggest greater attention needs to be paid to the motivating factors of improved income and career development. Further work is also needed to nurture and develop the motivation of healthcare workers through the building of trust between fellow workers, patients, and the public.

CONCLUSIONS: Through the analysis of healthcare worker motivation, our paper presents a number of ways China can improve its current healthcare reform efforts. It draws on the experience of other countries in calling for policy makers to support alternative approaches to healthcare reform that build on multiple channels of motivation to support healthcare workers.


Original languageEnglish
Article number120
JournalInternational Journal for Equity in Health
Issue number1
Publication statusPublished - 7 Jul 2017


  • Motivation, Health workers, Renumeration, Trust relationships, Governance, Human resource management