Since 20 12, our city took the lead in launching the pilot project of comprehensive reform of urban public hospitals, various reform measures have been implemented one after another, which has achieved phased results and accumulated valuable experience, laying a solid foundation for further reform. However, the reform of public hospitals is a long-term, arduous and complicated systematic project. At present, there are still some outstanding contradictions and problems, which urgently need to be solved step by step through institutional mechanism reform. In order to thoroughly implement the requirements of Guiding Opinions of General Office of the State Council on Comprehensive Reform of Urban Public Hospitals (Guo Ban Fa [2015] No.38) and Several Opinions of Beijing Municipal People's Government on Continuing to Deepen the Reform of Medical and Health System (Fa [2014] No.30), and further promote the comprehensive reform of public hospitals, this implementation plan is formulated in combination with the actual situation of this Municipality.
I. Reform ideas, principles and objectives
(A) the overall thinking
Thoroughly implement the spirit of the 18th National Congress of the Communist Party of China and the 2nd, 3rd, 4th and 5th Plenary Sessions of the 18th National Congress, take deepening the reform of medical and health system as an important measure to safeguard and improve people's livelihood in accordance with the decision-making arrangements of the CPC Central Committee and the State Council, give full play to the public welfare nature and main role of public hospitals, and earnestly implement the government's responsibility of running medical services; Deepen the reform of payment methods and play its key role, and establish a scientific and reasonable compensation mechanism; Adjust and optimize the pattern of medical service system, take the lead in establishing a basic medical and health system covering urban and rural areas and a modern hospital management system, and promote the reform of the city's medical and health system to develop in depth. Focus on promoting the institutional reform of "two separation, three mechanisms, two systems and three supports", that is, continue to promote the separation of medicine and medicine, continue to deepen the separation of management and operation, make efforts to make breakthroughs in the reform of medical insurance regulation mechanism, price adjustment mechanism and financial input mechanism, continue to promote the reform of personnel remuneration system and the construction of graded diagnosis and treatment system, and give play to the supporting role of personnel training, discipline development and information construction.
(2) Basic principles
1. Adhere to policy linkage. Incorporate the comprehensive reform of public hospitals into the overall arrangement of the city's medical and health system reform, promote the linkage of medical care, medical insurance and medicine, promote the simultaneous reform of public hospitals within the administrative area of this city, make overall plans for the reform of large hospitals and primary medical and health institutions, make overall plans for the coordinated development of public hospitals and social medical services, make overall plans for disease prevention, control, treatment and rehabilitation, and enhance the systematicness, integrity and coordination of the reform.
2. Adhere to the classification reform. Clarify the functional orientation of urban public hospitals and give full play to their backbone role in providing basic medical services and emergency diagnosis and treatment. Starting from reality, we should implement differentiated reform policies in terms of medical insurance payment, price adjustment, financial investment and performance evaluation for public hospitals in different regions, levels and types.
3. Adhere to key breakthroughs. Under the reform direction and principle determined by the central government, we will boldly explore and innovate, strive to make breakthroughs in key reform areas such as medical insurance payment, separation of medicines, price reform, personnel compensation, and graded diagnosis and treatment, and establish an institutional mechanism that conforms to the actual situation of the capital.
All the tertiary, secondary and primary public hospitals within the administrative area of this Municipality are included in the scope of reform. Reform policies in planning access, industry supervision, price, medical insurance, separation of medicines, drug circulation procurement and third-party evaluation are applicable to all public hospitals. The reform policies in management system, financial input, personnel salary and performance appraisal are applicable to municipal and district public hospitals. National ministries and commissions, armed police forces, institutions and hospitals run by state-owned enterprises in Beijing can refer to them. The competent department will formulate specific rules according to the relevant requirements of the state and the army to ensure the implementation of the policy.
(3) reform objectives
By the end of 20 17, the hospital management system, operation mechanism and medical service system that meet the characteristics of the capital will be established, so as to benefit the people, motivate medical staff, add vitality to the development of hospitals and ensure the sustainability of funds. Specific objectives:
1. A scientific and reasonable compensation mechanism was initially established. The mechanism of supplementing medical care with medicine was completely broken, the price of medical services was gradually straightened out, the reform of medical insurance payment method made a breakthrough, and the differentiated financial investment policy was further improved. The unreasonable growth of medical expenses has been effectively controlled, and the growth of total health expenses is coordinated with the growth of GDP in this region.
2. The graded diagnosis and treatment system has been solidly promoted. In the medical service system, the functional orientation of different levels and types of public hospitals has become clearer, the order of medical treatment has been improved, and the proportion of general outpatient visits in urban tertiary hospitals to the total number of medical and health institutions has gradually decreased, and a graded diagnosis and treatment model of primary consultation, two-way referral, fast and slow division of labor and up-and-down linkage has been initially established.
3. The personnel compensation system in line with the characteristics of the industry has initially taken shape. The personnel system is more reasonable, the employment mechanism is more flexible, the incentive effect of the income distribution mechanism is more active and effective, and the value of medical personnel's technical services is reasonably reflected.
4. Modern hospital management system was initially established. The localization of the capital, the medical management system of the whole industry is more perfect, the assessment and supervision system of public hospitals is more perfect, and the cooperation between the government and social forces is standardized and orderly.
5. The satisfaction of doctors and patients has been effectively improved. Medical behavior is more standardized, basic medical services are more fair and accessible, and the medical environment is safer and more orderly; The burden of medical expenses is maintained at a reasonable level, and the proportion of personal health expenditure to total health expenditure is maintained at around 20%; The satisfaction of patients and medical staff with public hospitals has gradually improved.
Second, establish a new governance system for public hospitals.
(four) the implementation of government medical responsibility.
Implement the government's leadership responsibilities in the planning and layout, functional orientation, objectives and tasks, team selection, etc. of public hospitals, and guarantee responsibilities in the establishment of public hospitals, financial investment, prices, wages, capital construction, purchase and maintenance of equipment and facilities, development of key specialties, public health investment, emergency support for emergencies, and establishment and improvement of public welfare operation mechanisms. Management responsibilities in major decision-making aspects such as personnel, finance, materials, foreign investment cooperation, cost control, and efficiency improvement in public welfare in public hospitals, and supervision responsibilities in promoting the legal and compliant practice of hospitals and medical personnel, improving the quality of medical services, and ensuring safety.
From 20 16 to 20 17, efforts were made to promote the two levels of government in urban areas to implement the responsibility of running a doctor, and to promote the main body of running a doctor in public hospitals to implement the responsibility.
(5) Deepen the reform of separating management from office.
Strengthen the unified planning, unified access and unified supervision functions of health and family planning administrative departments at all levels on the medical and health industry, improve the overall coordination mechanism of the Capital Medical and Health Coordination Committee (hereinafter referred to as the First Medical Committee) and give full play to its role, strengthen territorial coordination and regional linkage, and establish and improve the management mechanism of the whole industry. Further clarify the management responsibilities of relevant departments for different types of public hospitals, clarify the responsibilities of hospital management departments as representatives of government investors, and clarify the relationship between hospital management departments and hospitals. Strengthen standardized hospital management, promote the construction of modern hospital management system, and optimize the allocation and structural adjustment of medical resources. Explore the management mechanism of Beijing Central Hospital, and the two levels of government in urban areas provide support in planning access, land security, construction approval and government purchase of services.
20 16-20 17 focuses on deepening the reform plan of separation of management and operation, vigorously promotes the whole industry management of medical and health institutions, optimizes the government-run medical system, and strengthens the territorial management and overall planning of medical and health institutions.
(6) Improve the corporate structure and governance mechanism of public hospitals.
Improve the system of board of directors, dean responsibility system and board of supervisors in corporate governance pilot hospitals, standardize the internal decision-making and restraint mechanism of hospitals, and further implement the independent legal person status of pilot hospitals. Encourage public hospitals and medical complexes with diversified assets to explore the establishment of corporate governance structures and mechanisms through various forms. The president and vice president of the hospital shall be appointed and removed by the board of directors according to regulations, and open competition shall be explored. Promote professionalism, implement the target responsibility assessment and accountability system for the principal's term of office, and the assessment results will serve as an important basis for the principal's job evaluation, salary determination and post appointment and dismissal. Explore the abolition of the administrative level of public hospitals, and the heads of health and family planning administrative departments at all levels shall not concurrently hold leadership positions in public hospitals.
Focus on improving the operating mechanism of corporate governance in Beijing Friendship Hospital and Beijing Chaoyang Hospital. 20 17 Strive to explore a variety of corporate governance models in Beijing Children's Hospital, Tsinghua Chang Gung Hospital and other hospitals.
(seven) to strengthen the performance appraisal and industry evaluation of public hospitals.
Improve the performance evaluation system of public hospitals, highlight the evaluation indicators such as functional orientation, duty performance, cost control, operational performance, financial management, cost control and social satisfaction, and guide public hospitals to adhere to the public welfare direction; Regularly organize the performance appraisal of public hospitals and the annual and term target responsibility appraisal of the dean, and the assessment results are linked to the hospital financial subsidies, medical insurance payment, total wages, dean's salary, appointment and dismissal, rewards and punishments, etc. Formulate evaluation standards for public welfare industries, regularly organize industry evaluations, and disclose the evaluation results to the public.
, to carry out performance appraisal and industry evaluation of public hospitals at two levels in urban areas. From 20 16 to 20 17, the industry evaluation of public hospitals was continuously carried out and the evaluation results were announced to the public.
(8) Improve the multi-party supervision mechanism.
Strengthen the supervision function of health and family planning administrative departments (including Chinese medicine administrative departments) in medical services. Strengthen the disclosure of hospital information, standardize the contents of information disclosure, and establish a regular publicity system. Fully implement electronic supervision of drug production and circulation, promote the extension of electronic supervision of drugs to medical institutions, and realize closed-loop supervision from production to consumers. Give play to the role of medical industry associations and societies, strengthen industry self-discipline, supervision and professional ethics construction, and guide medical institutions to operate according to law and strictly self-discipline. Establish a social supervisor system, and give play to the supervisory role of the people's congress, CPPCC, supervisory and auditing organs and the social level. Promote the construction of credit system for medical institutions and doctors. Improve the third-party professional institutions to participate in the assessment and evaluation mechanism.
, to carry out the inspection of tertiary hospitals, and to publish the relevant information of secondary and above public hospitals. 20 16 to 20 17, improve the supervision and management measures of medical institutions in this city, and carry out hospital inspection activities in the city; Establish a monitoring system for medical expenses in public hospitals and an accountability mechanism for medical expenses control and assessment to control unreasonable growth of medical expenses.
(nine) to improve the management and service level of public hospitals.
Strengthen the management of hospital financial accounting and implement the chief accountant system of three-level public hospitals. Further strengthen the budget management of public hospitals and promote the cost accounting and cost control of public hospitals. Strengthen the management and control of medical quality, and standardize the clinical examination, diagnosis, treatment, medication and implantation (introduction) of medical devices. Promote the innovation of medical service model, continuously optimize medical service process, improve patients' medical environment and experience, and promote the harmony between doctors and patients. Considering the quality and safety of medical services, basic medical needs and other factors, we should formulate clinical pathways and strengthen management. High-quality nursing services were carried out in depth.
To study and formulate guiding opinions on strengthening the comprehensive budget management of public hospitals. 20 16 to 20 17, standardize the diagnosis and treatment behavior, and continuously innovate the medical service model. 1 2