Chief consultant of medical management: Qin
First, the "four-wheel drive" medical reform in the new era
1. single wheel drive: establishing modern hospital management system
The Guiding Opinions on Establishing Modern Hospital Management System No.67 [20 17] issued by the State Council clearly points out that by 2020, a new type of public hospital operation mechanism and governance mechanism will be basically formed, in which decision-making, execution and supervision are coordinated, balanced and mutually promoted, so as to promote the healthy development of social medical services and promote the standardization, refinement and scientificity of hospital management at all levels.
2. One-round drive: strengthening party building in public hospitals.
The Opinions on Strengthening Party Building in Public Hospitals issued by the Central Committee of the Communist Party of China clearly put forward that the Party's leadership over public hospitals should be effectively strengthened, and public hospitals should implement the president responsibility system under the leadership of the Party Committee. Party committees and other college-level party organizations play a leading role in guiding the direction, managing the overall situation, making decisions, promoting reforms, and ensuring implementation. Implement the party's basic theory, line and strategy, implement the party's health and health work guidelines, implement policies and measures to deepen the reform of the medical and health system, adhere to the public welfare of public hospitals, and ensure the correct direction of hospital reform and development;
3. One-round drive: strengthen the performance appraisal of public hospitals.
The Opinions on Strengthening the Performance Appraisal of Tertiary Public Hospitals issued by Guo Ban Fa [2065438+09] No.4 takes the performance appraisal results as an important basis for the development planning, major project establishment, financial input, appropriation, total performance pay and medical insurance policy adjustment of public hospitals, and is closely combined with hospital appraisal, the construction of national and regional medical centers, and the evaluation and appointment of party secretaries, presidents and medical insurance policies of public hospitals. Strengthen the orientation of performance appraisal, promote the implementation of public welfare in hospitals, realize the integration of budget and performance management, and improve the medical service capacity and operational efficiency.
4. Single-wheel drive: strategic purchase of medical insurance
With the establishment of the National Medical Insurance Bureau, whether it is the expansion of anticancer drugs and the national price reduction, or the 4+7 unified procurement bidding, or the DRG payment system reform pilot, the strategic procurement of medical insurance is making efforts to realize the "cage for birds", making room for improving the price of medical services and leading public hospitals to change from extensive management mode to refined connotation quality improvement.
Second, the performance characteristics of medical reform in the new era
1. Characteristics of traditional performance incentives
The traditional medical insurance charging system is based on the post-project payment model, and the medical insurance department has the total medical insurance control and average cost assessment for the hospital. Due to the low price of medical technical services, hospitals save money and medical insurance does not reward. Cooperate with the medical insurance payment system, and stimulate the hospital to obtain reasonable compensation through the drug price difference (now all zero bonus) and medical technology inspection. The performance of hospitals also focuses on stimulating extensive scale income growth. Only by doing more projects and earning more money can we get more achievements. Generally, performance management modes such as "single commission, balance of payments (or cost accounting) commission and project division" are adopted. In addition, due to the extensive medical insurance and hospital management, the value of doctors can not be fully reflected. The social compensation mechanism of "kickback" of drugs and consumables plays a compensatory role, which promotes the high medical expenses and greatly increases the risk of depletion of medical insurance funds.
2. What are the characteristics of medical reform in the new era?
As an important measure of the new medical reform, DRG medical insurance payment is a prepayment method based on value medical care, which is completely different from the traditional post-project payment and has a great impact on hospital performance management. It is urgent to study and pay attention to the payment policy of DRG medical insurance. The characteristics of DRG medical insurance payment system affect the performance decision-making and even the sustainable development of hospitals.
(1) Drugs become hospital expenses.
At present, the assessment of drug proportion is a temporary measure of macro-control. The centralized procurement of strategic drugs by the National Medical Insurance Bureau has made room for rational drug use and price adjustment of medical services, paving the way for the reform of DRG medical insurance payment system. With the reform of DRG medical insurance payment system, drugs become the cost of hospitals, which forces the enthusiasm of hospitals to manage drugs and urges the performance appraisal to need bank support.
(2) Consumables become hospital costs.
Added some healthy materials. Under the post-project payment and settlement system, most health materials are paid by medical insurance, so it is profitable for hospitals to use health materials more. With the zero price difference of health materials, DRG medical insurance payment and medical service price adjustment, health consumables have become hospital costs.
(3) Medical technical examination becomes the cost of the hospital.
The prepaid mode of DRG disease has a great influence on the income of medical technical examination in hospitals. The more medical technical examination a hospital does, the greater the cost of medical technical examination, the less disposable funds the hospital has, and the income of medical technical examination changes from income to cost. The performance of hospitals needs to pay more attention to the change of medical insurance payment from encouraging medical technology income.
(4) Pay for value medical care
In the traditional system mode of total medical insurance budget control plus average cost control, it is not cost-effective to control the hospital according to the average cost for serious illness or serious illness, but it is cost-effective for minor illness or minor illness, which is easy to lead to "picky" and shirk referring patients. DRG is mainly based on value medical care, and payment is made according to the total number of DRG, RW\CMI, time efficiency index, cost efficiency index and low-risk mortality rate. It requires high service ability and service efficiency, so performance incentives need to adapt to the changes in medical insurance payment methods.
(5) affecting the source of hospital income.
Under the traditional budget control mode of total medical insurance, the share of hospitals in medical insurance income is relatively fixed. Different from the payment mode of DRG, the payment of medical insurance according to DRG poses a higher challenge to medical services and service efficiency, and plays a competitive control role of "insiders". The higher the efficiency, the higher the income and the less the income. Therefore, the change of payment method has affected the hospital's income. Especially in the face of the limitation of medical insurance funds, improving the efficiency of the use of medical insurance funds and ensuring the safety and controllability of medical insurance funds will become more and more strict in hospital income-driven management and control. Therefore, it puts forward a higher challenge to performance incentive.
Third, the "five changes" of hospital performance incentive are forced.
The reform of traditional medical insurance payment method The reform of DRG medical insurance payment system is imminent. With the external performance evaluation of public hospitals, hospital management is forced to achieve "five major changes", and the traditional hospital performance management model is facing "iterative upgrade". Establishing a salary system that conforms to the characteristics of the medical industry is the last mile of medical reform. How to design a better hospital salary performance system and drive it back to the natural attribute of value medical care has become a common concern of health managers and medical staff, and it is also a detour of medical reform.
1. transformation 1: the development mode changes from scale expansion to quality and efficiency.
At present, China's economic development has changed from high-speed to medium-high-speed, and the mode of economic development is changing from scale and speed to quality and efficiency. Facing the acceleration of population aging and the change of chronic disease spectrum, both national economy, financial investment and medical insurance fund need to adapt to the big environment, and the development model of hospitals must also adapt. The performance incentive of hospitals should shift from guiding the expansion of hospital scale to driving the development mode, to the development mode of connotation, quality and benefit, and to refined management.
2. Transformation 2: The management mode changes from extensive administrative management to all-round performance management.
Performance incentive guides the hospital management mode to change from extensive administrative management to all-round refined performance management, and speaks with data. By strengthening information construction and replacing experience management with modern management, the level of refined, precise and lean management can be improved.
3. Transformation III: From stimulating development and construction to expanding distribution, increasing the income of medical staff.
In order to achieve siphon in traditional hospitals, the main funds are used for hospital construction and equipment purchase, and matched with performance incentives. Facing the peak of hospital construction, performance incentive should use more funds to improve the treatment of medical staff and fully mobilize their enthusiasm.
4. Transformation 4: The orientation of service function changes from quantitative medical service to hospital function orientation.
According to the functional orientation of the hospital, the performance incentive has changed from the current quantitative medical service to the functional orientation.
5. Transformation 5: The service concept has changed from "disease-centered" to "patient health-centered"
Performance incentive should make the current hospital "disease-centered", adapt to the national strategic transformation of healthy China, and transform to "patient health-centered".
In a word, with the external performance appraisal exerting force on the performance appraisal of public hospitals, the internal performance appraisal of hospitals has been forced to transform and upgrade, and the function expansion and upgrading of "workload efficiency scoring performance management model based on value-based medical care" in Yu Fang medical management will surely become the "main theme" of hospital performance management in the new medical reform era.