Edit this paragraph institutional background
The township health centers are mainly supported by county-level finance and the rural collective economy, and China entered a period of transition after the 1980s, especially in 1992, when the "three powers" of health centers (personnel, financial, and management) were decentralized to the townships, and the lack of collective economic support and the decline of traditional cooperative medical care made the health centers more and more difficult to manage. Due to the lack of collective economic support, the decline of traditional cooperative medical care, and the financial difficulties and lack of input at the township level, the township health centers appeared in a "three-three system" situation. With the advancement and demonstration effect of the reform of the market economic system, township health centers, in order to save themselves, have also been integrated into the flood current of reform, and many health centers throughout the country have adopted the business model of "enterprise reform" such as contracting, leasing, or joint-stock cooperation, etc. In the process of reform, the basic functions of township health centers have been weakened to varying degrees, reversed, and alienated. In the process of reform, the basic functions of township health centers have been weakened, retrogressed and alienated to varying degrees: preventive health care functions have been weakened, basic medical services have been pursued for market efficiency, and the management functions of village health offices have been basically given up; in this way, the township health centers have almost become competitive institutions simply providing medical services, and the township health centers, which are public welfare institutions that provide comprehensive preventive health care and basic medical services for residents of the rural communities, have been alienated into for-profit medical institutions. Such "township health centers" are naturally profit-oriented and have embarked on the path of relying on the market to vigorously develop medical services, and have become competitors on the same starting line as the village health centers, which have also lost all channels of financial compensation and are basically privately run. In this way, the "three-tier preventive health-care network" in rural areas has retrogressed in the fragmentation and decentralization of the "bottom of the network" and the "hub". Thus become farmers preventive health care slippage, "difficult to see a doctor, see a doctor expensive" an important background.
Editing this section of the system analysis
I. The policy of township health center reform and the institutional history of health centers. It examines the evolution of China's township health center system and policies, and clarifies the current policy provisions for the reform of township health centers. Second, the relationship between policy and law in the institutional reform of township health centers. It analyzes the operation of the "soft law" formed by the policy of township health center reform, and designs an institutional framework for the all-round adjustment of policy and law in the reform of township health centers. Third, the reform of township health centers and the positioning of government responsibility. The function of township health centers is the starting point for understanding the reform of township health centers. On the basis of the historical review of the function of township health centers and the comparison of the reality, the objective inevitability of the government-led reform of township health centers is profoundly discussed, and the strategic conception of the government-organized management mechanism of township health centers is then made. Fourth, the reconstruction of the legal person mechanism of health centers under the legal perspective. We will township health center of the legal nature of the positioning of public welfare, non-profit consortium legal person, as the basis for the health center as an independent legal person of the internal and external governance institutions for legal theory analysis and construction. Fifth, the legal application of township health center reform. It analyzes the basic legal relationships related to health centers and the adjustments in their restructuring, briefly describes the policies and regulations applicable to the reorganization or restructuring of the resources of health centers, and the management of health centers to be transferred to the county-level health administrative departments, and designs the legal application and operational procedures for the restructuring of health centers. Sixth, the argument for the reform policy of township health centers to be perfected again. Township health centers belong to the unit of "one government", based on the economic analysis of the three functions of preventive health care, basic medical service and health administration entrusted to township health centers, combined with the analysis of contradictions and obstacles of the reform of township health centers of "one medicine and one defense", the reform of township health centers is based on the analysis of the government's policies and regulations applicable to the restructuring of township health centers, and the design of legal application and operation procedures. Reform of township health centers and new rural cooperative medical care. By analyzing the positioning of health centers in the traditional cooperative medical care and the new rural cooperative medical care system, it tries to explore and position the legal nature of the new rural cooperative medical care in the pilot; and conducts innovative research on the farmers' right to supervise and participate in the new rural cooperative medical care system, the nature of the legal relationship between the doctor and the patient and the legal regulation of the new rural cooperative medical care management institutions.
Editing this section of the existing problems
1. Township health center infrastructure construction and equipment level is not optimistic. Although vigorously carry out the township health center project construction, part of the township health center infrastructure, hospital appearance has been a big change, but due to long-term investment is insufficient, most of the health center self-development capacity is limited, itself does not have the ability to carry out the equipment renewal and housing renovation, relying only on project funds, built a house, can not afford to buy equipment, some counties (municipalities) and district-level supporting funds are not yet in place. Township health centers and dangerous houses, most of the health centers still lack of equipment, completely change the appearance of township health centers and equipment backwardness of the task is still very difficult. 2. Survival in the cracks: technical equipment is not as good as the higher level - above county hospitals, flexibility is not as good as village health centers, such as price, credit, familiarity and so on. 3. Ineffective mechanism and poor management. Some health centers are still following the employment mechanism and distribution method of the planned economy period, and the enthusiasm and initiative of the workers are not fully utilized. Some county-level health administrative departments are negligent in guiding the operation and management of township health centers, which to a certain extent affects the construction and development of township health centers. There is a surplus of personnel and a shortage of those who are truly capable. 4. Township health center personnel, business, funding and other upward management is not thorough and financial subsidy policy, to solve the retired staff funding and other aspects of the measures are not strong enough, the enthusiasm is not yet high. Some counties (cities) and districts of township health centers of rural health care budget not only did not increase but has declined, belonging to the financial ensure disease control, health supervision, maternal and child health care and health education and other social public **** health funding is still seriously inadequate. Financial inputs, standards vary from place to place, here is not a penny allocation, said to be upwardly mobile to the county management, not as good as the original township management it, get around, it can be said that the health center is not in charge of the unit. 5. Wages and benefits are small, and some graduates of formal colleges and universities have to cope with a variety of exams, forms, continuing education, and so on. 6. Non-prescription medicines are sold in pharmacies at random, without obtaining a physician's qualification, but can write prescriptions. Administration I do not know how many directors of health centers are now elected, most of them are appointed by the Health Bureau. 7. Township health centers are located in the "money-making and self-supporting" medical institutions, rather than rural primary health care, disease control and health supervision, as well as the management of village health clinics and rural doctors function of rural public **** health institutions. At the same time, some functional departments always set the construction of township health centers on "improving the capacity and level of medical services", putting forward unrealistic development goals and requirements, while losing the public **** health functions that township health centers should have. This misdirection has brought the wrong message that "township health centers make money, and the reason why they can't do it well is because they lack the ability to make money," thus further increasing the neglect of the public **** health functions of township health centers and making it more difficult for them to get out of their predicament.
Edit this section of the mechanism of reform
The reform of the township health center involves a very wide range of interest groups, and is concentrated in the rural areas of a specific range, with the deepening of the market economy, the disintegration of the original collective economic model of the rural areas, the reform of the financial system, the implementation of the policy of townships and townships merger, the farmers of the medical problems, preventive health care issues, etc., a number of important and complex social issues All of these important and complex social problems need to be solved by the reform of health centers as an entry point. This "transition" period of the background, undoubtedly increased the difficulty of the township health center reform. In the author's opinion, the reform of township health centers is essentially a reform of the traditional system of township health centers. The system is made up of policies and regulations, which the township health centers cannot choose on their own. The reform of health centers is also a redistribution of social resources and economic benefits, which will inevitably affect established interest groups; at the same time, the effects of health center reform are uncertain due to the intricate backgrounds and rapidly changing situations. Under these circumstances, due to the risk and loss of benefits, the reform of township health centers in many areas has taken a wait-and-see, delaying attitude, and the reform of health centers in some places has been stagnated in a beautiful program that cannot be implemented. Thus, how to promote the smooth implementation of the reform of township health centers. The reform of township health centers is the top priority of the reform of the rural health service system and one of the basic elements of building a new socialist countryside. Governments at all levels are required to increase investment and strengthen the construction of rural health infrastructures focusing on township health centers; thus, township health centers have become an important carrier of the country's new rural health policy to benefit farmers. It can be said that the current reform of township health centers is related to the overall situation of rural health reform. The reform is always multi-dimensional, and requires sociologists, political scientists, economists and jurists to join hands to solve the problem.
Editing the direction of reform
The fact that each township retains at least one public health center requires governments at all levels to pay attention to the construction of township health centers. This attention is reflected in all aspects, both the leadership of the health center to assess, but also to do everything possible to improve the quality of doctors; both the construction of the system, but also to strengthen the ideological and political work, improve the medical service system; not only from the political concern, but also from the financial aspects of the increase in investment and so on. In fact, to retain at least one public health centers, is to run the township health centers as farmers own health centers, so that farmers can be assured that the sick into the health center treatment, so that the health center to become the farmers "sick for medical treatment" of the place. With the reform of township institutions to deepen the development of township health centers also naturally enter the scope of the reform. How to reform the township health center has become the attention of all. Around the township health center reform, many places are keen to refer to the township small enterprise restructuring approach, posing a "liberalization" posture. How to "save" means to implement the "transfer of assets", from universal ownership into private. The "privatization" of township health centres involves selling them to private individuals. From an economic point of view, this kind of "selling it off" is in line with the economic laws and is less troublesome. Obviously, this kind of saving is only from the point of view of restructuring, but the reform of township health centers should not only focus on economic benefits and saving, but more importantly, it is necessary to see that the restructured health centers will be able to provide convenient health care services for the peasant masses in the townships. If the latter cannot be guaranteed, then the restructuring of township health centers cannot be said to be a success. It has been seen that in some of the so-called "restructured" township health centers, although they are more concerned about economic accounting than in the past, they are very deficient in providing convenient medical services to the farmers. Some have raised prices arbitrarily, while others are managed in a chaotic manner, and farmers have many opinions. The State Council reiterated that every township should retain a public health center, which means that people should not deviate from the direction of serving farmers in the restructuring. The decision to retain at least one public health center in every township is y popular. This leads to other associations. In fact, restructuring reform is not equal to auction; restructuring is not equal to private ownership. Some well run health centers, parks and tourism venues, water plants and other public welfare projects, through the absorption of technology, strengthen the system to improve the grade, but also to "revitalize" the road a, do not have to go to the auction transfer of that "Huashan Road". To do this, the key is the local decision-makers have a clear concept of reform, adhere to the "people-oriented", adhere to the "people-oriented", adhere to the "people-oriented", adhere to the principle of seeking truth from facts.
Edit paragraph development proposals
(a) gradually strengthened with a full complement of health technicians to ensure that the people "in the sick not out of town". Every year through the community to recruit health professionals with licensing qualifications. Establish a sound talent attraction mechanism. The implementation of preferential policies to attract graduates with undergraduate degrees or above to work in township health centers. Create favorable conditions, so that highly educated medical and health professionals "to go, stay, use". (ii) gradually increase financial input, so that township health centers from self-supporting medication to government-supported health care. Implement the Party's health policy, implement the spirit of the 17th Party Congress "to adhere to the public **** health care public welfare nature", "adhere to the rural areas as the focus", "strengthen the government's responsibility and inputs "; implementation of the spirit of the provincial party committee [2007] No. 9, "from 2007 onwards, the province's township health centers according to the financial full allocation of public welfare medical and health institutions for reform and construction." "The business expenses of township health centers in economically underdeveloped areas are mainly the responsibility of county (city and district) level finances, with support from provincial and municipal level finances." (b) Gradually remodeling the business premises of township health centers, and gradually purchasing and updating equipment and facilities. (c) Gradually promoting the reform of the management system of township health centers. According to regional health planning, township health centers are clearly divided into central health centers and general health centers according to their functions. The management of the establishment of township health centers has been strengthened. In accordance with the principles of streamlining and efficiency, the establishment of township health centers has been reasonably approved on the basis of factors such as service population and work projects, and the establishment of departments and positions in township health centers has been standardized. Strict access conditions are in place, and non-health technicians are prohibited from entering health technology positions. For those who do not meet the licensing qualifications, they should be gradually streamed and retired.
Edit this paragraph policy support
[1]? In the future, township health centers in Heilongjiang Province, where the application of traditional Chinese medicine tablets or acupuncture, tuina, massage, cupping and other non-pharmacological therapies of traditional Chinese medicine, will be compensated by the government. This is the reporter recently learned from the provincial health department. Recently, the provincial government has developed a township health center reform pilot program, requiring the province's primary health care units to gradually expand the service surface, the implementation of zero-differential rate sales of essential drugs, the promotion of simple and inexpensive Chinese medicine appropriate technology and methods, so that the majority of farmers can enjoy the benefits of basic public health services and equalization of medical services and the benefits brought about by the benefits. Among them, the use of Chinese medicine tablets can be compensated at 20-30% of the amount of tablets used, and the use of non-pharmacological therapies can be compensated on a per-service basis, with each treatment being compensated at 20-30% of the cost of the patient's visit to the doctor. The program points out that township health centers organized by the government are an important part of the primary health care service system. As a public welfare unit, in principle, each township only set up a government-sponsored health center (according to the function can be divided into the center of the health center and the general health center) medical | education network collection, by the county (city, district) health administration unified management, shall not be taken to auction, lease, contract, decentralized business and other detrimental to the nature of public welfare and the loss of state-owned assets of the mode of operation. Program requirements, by the end of next year, the province, including all township health centers, including primary health care institutions must initially build the national basic drug system, the implementation of centralized drug purchasing and distribution policies, the full implementation of zero-differential rate sales of drugs. In addition, in the new rural cooperative medical system, the eligible Chinese medicine diagnostic and treatment items, Chinese medicine varieties and medical institutions Chinese medicine preparation into the scope of reimbursement, increase the reimbursement ratio of Chinese medicine items, reduce the starting line of reimbursement of Chinese medicine items.