Opinions of the General Office of the State Council on Establishing and Improving the Compensation Mechanism for Primary Medical and Healthcare Institutions
State Council [2010] No. 62
People's governments of provinces, autonomous regions and municipalities directly under the central government, and the ministries and commissions of the State Council, as well as all institutions directly under the central government:
In order to ensure the smooth implementation of the national basic medicines system, to ensure the smooth operation and development of primary medical and healthcare institutions, and to mobilize the motivation of Primary health care institutions and medical personnel motivation, agreed by the State Council, is to establish and improve the compensation mechanism of primary health care institutions, put forward the following views:
One, the general requirements
In the implementation of the basic drug system in the primary health care institutions, in accordance with the principle of ensuring the effective operation and healthy development of institutions, and to ensure that the principle of reasonable treatment of medical personnel to synchronize the implementation of compensation policies, establish a stable compensation channels and compensation methods. Stable compensation channels and compensation; at the same time adhere to the input for the mechanism, vigorously promote the comprehensive reform of primary health care institutions, and guide the primary health care institutions to take the initiative to change the operating mechanism, improve the quality and efficiency of services, and give play to the basic public **** health services and diagnosis and treatment of common diseases, the function of multiple diseases.
Second, the establishment of a stable and long-term multi-channel compensation mechanism
After the implementation of the basic drug system, the government-run township health centers, urban community health service institutions, such as personnel expenditure and operational expenditure and other operating costs are compensated for through the fees and government subsidies. Basic medical services are mainly compensated through the medical insurance payment and personal payment; basic public **** health services through the government to establish the urban and rural basic public **** health services funding mechanism compensation; recurrent income and expenditure difference by the government in accordance with the "approved tasks, approved income and expenditure, performance assessment subsidies" approach to subsidies. Each region shall, in accordance with the authorized number of staff and service workload, approve the total amount of wages with reference to the average wage level of local institutional staff. The government is responsible for the capital construction funds, equipment acquisition funds, personnel funds and operational funds for the public **** health services it undertakes for the township health centers and urban community health service institutions it organizes, as approved by the state. Prices for medical services are set according to the cost of services after deducting government subsidies, reflecting the reasonable cost of medical services and the value of skilled labor, and are gradually adjusted into place. Recurrent differences in income and expenditure arising after compensation in accordance with the above principles shall be subsidized by the Government after performance appraisal.
(1) The implementation of the government's special subsidies to primary health care institutions. Development and construction expenditures for government-organized primary medical and health care institutions, such as capital construction and equipment purchases, shall be arranged in full by the government in accordance with the development and construction planning for primary medical and health care institutions.
Implementation of basic public **** health service funding. 2010, governments at all levels shall implement basic public **** health service funding in accordance with the standard of no less than 15 yuan per capita; from 2011 onwards, the standard of per capita funding shall be further increased, and a stable mechanism for guaranteeing the funding of basic public **** health services shall be established. Health and finance departments should improve the performance evaluation mechanism, according to the number and quality of services and other performance will be basic public **** health service funding timely and fully allocated to the primary health care institutions.
Primary medical and health institutions to undertake the task of disposing of public **** health emergencies by the government in accordance with the cost of services approved subsidies.
The expenditures required for personnel funds (including funds for retired personnel), personnel training and personnel recruitment in primary healthcare institutions shall be reasonably subsidized by the financial sector in accordance with the government's health investment policy, relevant personnel training planning and personnel recruitment planning.
(2) Adjustment of fee items, fee standards and health insurance payment policies for primary health care organizations. Adjustment of primary health care institution fees, the existing registration fees, consultation fees, injection fees (including intravenous infusion fees, excluding drug fees) and pharmacy service costs merged into a general diagnosis and treatment fees, no longer a separate pharmacy service fees, the merger of the contents of the project by the national price authorities in conjunction with the health, human resources and social security and other relevant departments to specify the provisions. The fee for general consultation and treatment can be adjusted appropriately on the basis of the sum of the original itemized fee, and the proportion of payment by health insurance can be reasonably determined on the premise of not increasing the existing personal burden of the masses. Specific charges (the national average of about 10 yuan) and health insurance payment policy by the provinces (autonomous regions and municipalities) price supervisors, health, human resources social security and finance and other relevant departments to take into account the implementation of the basic drug system in the region's primary health care institutions, the service capacity utilization rate, the cost of medical personnel labor, health insurance affordability and other factors. Adjustments to medical service fees and health insurance payment policies can be implemented in primary healthcare organizations that have implemented the basic drug system and have carried out basic health insurance outpatient coordination. Other services provided by primary healthcare organizations will continue to be charged according to the existing items and standards. For the original fee items that have been merged into the general diagnosis and treatment fee, no additional or disguised fees shall be charged. Health, human resources and social security, price and other relevant departments to develop specific regulatory measures to prevent the primary health care institutions to repeat charges, decomposition of prescription overcharging.
(3) the implementation of the primary health care institutions of the recurrent income and expenditure difference in subsidies. After the implementation of the government special subsidies and adjustments to medical service charges, primary health care institutions of recurrent income is still insufficient to make up for the difference in recurrent expenditures, by the government in the annual budget in full, the implementation of the first pre-appropriation and then settlements, and the establishment of a stable subsidy channels and long-term subsidy mechanism. Each locality shall, in accordance with the Government's health input policy, formulate specific measures for the approval of recurrent income and expenditure and for the subsidization of the difference, taking into account local realities. The balance of income and expenditure of primary medical and health-care organizations should be retained or surrendered in accordance with the regulations. Areas with the conditions can implement the two lines of income and expenditure, basic medical services and other income in full, to carry out basic medical and public **** health services required recurrent expenditures approved by the government and full arrangements.
Three, vigorously promote the comprehensive reform of primary medical and health care institutions
(a) Clearly define the functional positioning of primary medical and health care institutions. Primary health care institutions mainly provide basic public **** health services and basic medical services, its diagnostic and treatment subjects, the number of beds, departmental settings, staffing, infrastructure construction and equipment should be appropriate to its functional positioning. The Ministry of Health shall formulate guidelines as soon as possible to clarify the functions and scope of services of primary medical and health-care institutions. For primary medical and health care institutions whose service capacity has exceeded that of basic medical services and public **** health services, especially some township health centers that serve a large population and whose service capacity has reached the standard of a second-class hospital, they may be turned into public hospitals, or their resources that have exceeded their functional positioning may be integrated into county-level hospitals; they may also adopt a purchased-service approach to the basic medical services and public **** health services that they undertake compensation. Primary medical and health care institutions are encouraged to provide Chinese medicine and other appropriate technologies and services.
(2) Improve the personnel allocation system of primary health care organizations. To strengthen the staffing management of primary medical and health care institutions, as soon as possible to complete the approval of staffing standards. Each region can be counties (cities, districts) as a unit to approve the total establishment of primary health care institutions, by the county-level organization and preparation departments in conjunction with the health administrative department combined with the actual workload co-ordination, dynamic adjustment of the staffing of the primary health care institutions. On the basis of the authorized staffing, primary medical and health care institutions shall be instructed to implement an employment system and a job management system that focuses on the scientific establishment of posts, competitive recruitment, salary determination by post, and contract management. Relevant policies are to be studied and formulated for the proper placement of unremployed staff, with the related costs to be studied and resolved by local governments in accordance with the relevant national regulations. At the same time, the implementation of the basic drug system of primary health care institutions to implement the performance pay system in place simultaneously.
(3) Give full play to the role of medical insurance in promoting the comprehensive reform of primary medical and health care institutions. Relying on urban and rural primary medical and health care institutions, we are accelerating the outpatient coordination of basic medical insurance, incorporating general diagnosis and treatment fees into the scope of payment, and gradually increasing the reimbursement ratio of the expenses incurred by insured persons attending primary medical and health care institutions, so as to further guide the public to seek medical treatment at primary medical and health care institutions. It is also promoting the reform of health insurance payment methods, exploring payment methods such as capitation payment, payment by type of disease, and total prepayment, and guiding primary health care institutions to proactively carry out their services, strive to improve the quality of their services, and reasonably control the cost of their services.
(4) Establishment of assessment and incentive mechanisms for primary medical and healthcare institutions. Provinces (autonomous regions and municipalities) should formulate performance assessment methods for primary medical and healthcare institutions, conduct comprehensive and quantitative assessments of primary medical and healthcare institutions based on indicators such as management performance, the quantity and quality of basic medical and public ****health services, the satisfaction of service recipients, and the improvement of residents' health status, and link the assessment results to the arrangement and allocation of funds. Funding arrangements may be deducted for poor performance appraisals, and appropriate incentives may be given for good performance appraisals. Primary health care institutions should be urged and guided to strengthen internal management, reinforce income and expenditure management, and strictly cost accounting and control.
(E) fully mobilize the enthusiasm of medical personnel. After the implementation of the basic drug system, to ensure that the reasonable level of income of primary medical personnel will not be reduced. To guide the primary health care institutions to adhere to the more work more pay, merit pay, focusing on key positions, the backbone of the business and make outstanding contributions to the staff tilt, appropriate income gap; the establishment of job responsibility and performance-based, the number and quality of services and service users satisfaction as the core of the assessment and incentive system, and the results of the assessment and the implementation of the performance-based pay system, the staff bidding for a job is closely integrated. Localities should fully listen to the views of staff of primary medical and health care organizations when formulating policies related to the streaming of personnel and competing for jobs. To provide grass-roots medical personnel with more training opportunities, long-term grass-roots health technicians in the promotion of titles, treatment policies and other aspects of the appropriate tilt, and timely help to solve practical difficulties. To strengthen the policy publicity, so that the majority of medical personnel to understand, support and actively participate in the reform of primary health care institutions.
Four, multi-channel to increase the subsidies to rural doctors
The village health office mainly through the government to purchase services in the form of reasonable subsidies. The health department shall, on the basis of the approved capacity of the village health office to undertake public **** health service projects and the number of people served, arrange for a certain proportion of the workload of the basic public **** health services to be undertaken by the village health office and implement the corresponding funding. In promoting outpatient coordination of health insurance, localities may include outpatient services of eligible village health offices in the scope of reimbursement under the New Rural Cooperative Medical Insurance Program (NRCMI). Regions carrying out the pilot program of new rural social pension insurance should actively include eligible village doctors in the insurance coverage. Localities are encouraged to provide some support for village health offices in terms of housing construction, equipment purchase and personnel training, and to adopt various forms of subsidies for rural doctors. Where possible, village health centers that are integrated into villages can be included in the implementation of the basic drug system and the implementation of compensation policies.
For non-government-run primary health care institutions, localities should provide reasonable subsidies for the public **** health services they undertake through government purchase of services, etc., and include qualified institutions among them in the scope of the medical insurance fixed-point scope, and implement the same medical insurance payment and reimbursement policies as those for government-run primary health care institutions.
Fifth, the establishment of a sound primary health care institutions compensation mechanism of the work requirements
(a) Strengthen the organizational leadership. All regions, the relevant departments to establish and improve the compensation mechanism of primary health care institutions as the implementation of the basic drug system and the comprehensive reform of primary health care institutions to implement the key links, the government subsidies into the financial budget and capital expenditure plan in full arrangements, timely adjustment of medical service charges and health insurance payment policy, as soon as possible to establish a stable, long-term, reasonable compensation mechanism of primary health care institutions. The compensation mechanism for primary healthcare organizations should be established as soon as possible. Provinces (autonomous regions and municipalities) should formulate specific measures for the compensation of primary healthcare institutions in their respective regions within 30 working days after the issuance of this opinion and report them to the Office of the Leading Group of the State Council for Deepening Reform of the Medical and Healthcare System, the Ministry of Finance, the Ministry of Health and the Ministry of Human Resources and Social Security for the record.
(2) Implementation of compensation responsibility. Provincial people's governments should be the establishment of primary health care institutions compensation mechanism, to ensure that the normal operation of primary health care institutions and medical personnel reasonable treatment level of overall responsibility. Provinces (autonomous regions and municipalities) should take into account the affordability of the local financial and health insurance funds at all levels, reasonably determine the charges and standards for medical services, specify the proportion of local financial sharing at all levels and specific methods, and increase subsidies to impoverished areas. Municipal and county-level people's governments shall make full arrangements in their budgets for the timely disbursement of subsidies to be borne by their own finances, and shall conscientiously implement the adjusted medical service charges and health insurance policies. The central financial authorities shall provide subsidies by means of "awards in lieu of subsidies" to support the implementation of the basic drug system in various places. Finance at all levels can take the first advance and then settle the subsidy funds issued in a timely manner, to ensure the smooth implementation of the basic drug system according to the planned progress.
(C) strengthen supervision and guidance. The State Council to deepen the reform of the medical and health system leading group office in conjunction with the financial, health, human resources and social security departments to strengthen the work of the local inspection and guidance, regular assessment, summarize the experience in a timely manner, and continue to improve the policy. Provinces (autonomous regions and municipalities) should promptly report the implementation of this opinion to the State Council to deepen the reform of the medical and health system leading group office.
Office of the State Council
December 10, 2010