Work recommendations: First, increase the grass-roots clinicians of the use of basic drugs training efforts, and gradually establish the adaptation of the basic drug system of medication habits. Carry out the standardized use of basic drugs supervision and inspection, promote the rational use of basic drugs, change the clinical habit of drug use. At the same time, it has increased publicity on basic medicines for the public, so that the public fully recognizes basic medicines and accepts them. Secondly, the supervision of the implementation of basic medicines is strengthened, and the township health centers and village health offices are regularly conducting basic medicine inventories and public announcements, and investigating and punishing medical prescriptions. Strict supervision of the implementation of basic medicines in village health rooms is carried out, and violations are found, in addition to the refund of overcharging and indiscriminate charging, confiscation of purchased medicines, and the imposition of a fine of 3-5 times the overcharged portion or the purchased amount, and the second time of further disciplinary action, it can be canceled to be engaged in the public *** health services and implementation of the basic medicines system, and the qualification of the New Rural Cooperative outpatient reporting, so that the formation of a The working mechanism of strict control and heavy punishment. Third, enterprises to strengthen the management of the distribution link, the establishment of distribution enterprise integrity file, once the supply of essential drugs incomplete or untimely and other problems, should be depending on the severity of the situation, according to the purchase and sale of essential drugs contract breach of contract to be the appropriate sanctions. Fourth, an appropriate increase in the variety of basic drugs specifications and winning drug manufacturers.
Two, township health center performance pay system problems and recommendations. First, the performance management assessment mechanism is not perfect. Township health centers "approved tasks, approved income and expenditure, performance appraisal subsidies". This mechanism shows that government departments are able to accurately and reasonably evaluate and approve the amount and completion of the tasks of township health centers. The appraisal mechanism has a high degree of compatibility with the characteristics of basic public *** health services and a low degree of compatibility with basic medical services, which makes the incentive obviously inefficient. Second, there is a lack of incentive mechanism for township health centers. According to the provisions of the "performance pay", the amount of services completed, township health centers are able to get 60% -70% of the total amount of performance pay, but can not get higher than the total amount of performance pay in addition to any other incentives for income, this kind of TO low limit the high policy shows that low incentives for the township health centers, but also the medical staff of the high professional and technical content, the high degree of risk is equivalent to the level of the other business unit industry. Third, the lack of incentives for health personnel in township health centers. Although the document requires "give full play to the incentive-oriented role of performance pay allocation, the allocation of internal performance pay, should be tilted to the public *** health services and clinical front line." But 30-40% cumulative effect salary is not enough to open the reward gap and mobilize the enthusiasm of the backbone of the business. Doctors do not have clear economic benefits and work tasks, their work pressure is small, work enthusiasm reduced, part of the primary health care institutions are reluctant to admit and treat patients, resulting in certain diseases originally can be treated in the local health hospitals, the people but spend more money to the next level of hospitals to seek treatment, resulting in overcrowding in large hospitals, which conflicts with the original policy of promoting the patients to sink to the grass-roots health care institutions to seek medical treatment, and the The level of service and capacity of primary health centers has also been weakened, to a certain extent, exacerbating the problem of "difficult and expensive to see a doctor".
Recommendations: Establish and improve the performance management assessment system for township health centers as soon as possible. To establish the number of services, service quality and public satisfaction as the core of the performance appraisal system, fully reflect the distribution according to work, the principle of more work more pay. At the same time, medical tasks should be reasonably determined, and a mechanism should be implemented to ensure basic salary under performance pay, with no cap on the upper limit. For clinical operations, the basic salary should be authorized to be paid under the condition of keeping the operation, and the performance salary should be overpaid for overfulfilling the tasks. For the basic public **** health services assessment aspects, to implement the public health issued funds linked to the assessment results, according to the assessment scores will be the assessment results of the primary health care units for the excellent, qualified, basically qualified, unqualified four grades, the funding subsidies were issued according to the approved standard subsidies + incentive funding, approved standard subsidies, approved standard subsidies × 90% and approved standard subsidies × 80%.
Three, public **** health services equalization work problems and recommendations. First, the service capacity of primary medical institutions is weak. Primary health care institutions due to service facilities, medical equipment, technical force and other aspects of the limitations of some primary health care institutions should assume the function of public **** services are not fully in place, affecting the effective development of services. Secondly, some medical institutions and medical personnel emphasize the clinical aspect of health care, but do not emphasize public health, resulting in a low level of attention being paid to public **** health work. At the same time, primary health care institutions have the phenomenon of public health earmarked for personnel expenditure and public expenditure, resulting in insufficient funding for public **** health services, affecting the work.
Work recommendations: First, improve the basic implementation and equipment of primary health care institutions, improve medical conditions, and enhance the ability of public **** health services. Further increase the training and introduction of talents to improve the overall quality of the public health talent team. The second is to establish and improve the public public **** health service evaluation system, to take the public's satisfaction with the public **** health service as the standard for assessing performance, satisfaction should be evaluated by the service users, to improve the efficiency and quality of the basic public **** health service, and to strictly prevent falsification. Third, strengthening supervision and regulation. Quarterly comprehensive supervision of the implementation of public **** health work in all units to strengthen work guidance. At the same time, increase the transparency of the use of public health funds policy, the implementation of public health funds earmarked, strictly prohibit the diversion of funds for other purposes.
Four, rural doctors team building problems and recommendations. First, the overall quality of rural doctors need to be improved. Rural doctors working ability and technical level is uneven, a considerable part of the qualification, but still is the teacher from the army, lack of formalized learning or training. Although the county health bureau each year to arrange for the organization of rural doctors for business training, but part of the rural doctors are not highly motivated, can not be well combined with practice. Even fewer rural doctors can take the initiative to go to higher hospitals for further training. At the same time, because the rural doctors have been full, in and out of the mechanism is not smooth, coupled with the rural doctors practice environment is fixed and other factors, this team is basically difficult to adjust, the new can not come in, the old can not retreat, and even more reluctant to withdraw, resulting in the overall quality of the rural doctors is difficult to improve. Second, the village health center infrastructure is backward. In our county, there are still more than 70% of the village health room does not meet the standard requirements, the vast majority of rural doctors in their own homes or rented houses to open a village health room, some of the houses are simple, three separate rooms are not in place, the lack of medical equipment, difficult to meet the requirements of basic health care. Although the central financial year by year to increase the investment in rural health room infrastructure construction, at present our county new for standard village health room only 29, only 8% of the village health room, far from meeting the actual demand. Third, rural doctors management difficulties. After the implementation of the basic drug system, although the implementation of a number of measures to strengthen the management, but because of the long line, the management of the implementation of the phenomenon is not in place. Public **** health basic services in the village level implementation of the project also has a certain gap, some village doctors work in the phenomenon of formality, the actual effect is poor, on the people's health protection does not play a due role. Fourth, the compensation mechanism is difficult to mobilize the enthusiasm of rural doctors. At present, the compensation standard of rural doctors is low, the compensation method is single, it is difficult to reflect the more work more pay, clinical business volume, on the contrary, the hidden loss is big.
Work suggestions: First, promote the construction of village health center project. Increase the strength of the village health center project, not given the project construction of the village health center to give support to help improve the conditions of the village health center, but also to avoid the phenomenon of village health center village-run private. At the same time, it is recommended to increase the support for the capacity building of Chinese medicine in village health centers, and to promote the capacity of Chinese medicine services in village health centers. Secondly, we should explore the establishment of medical liability insurance and medical risk funds for village health centers, so as to reduce the risks of rural doctors' practice and alleviate the burden of medical risks on village health centers and rural doctors. Explore the establishment of a pension protection system for rural doctors, and introduce relevant policies to clarify the participation standards for rural doctors. Third, increase investment and raise compensation standards. Further implementation of rural doctors engaged in public **** health services, financial subsidy policy, taking into account the county financial difficulties, and gradually increase the level of subsidies at the national, provincial and municipal levels. At the same time, it is recommended that reference to the "college student village officials", "three support one" incentive policy to encourage college education, have a practicing physician assistant certificate to the village health office practice, improve the overall quality of rural doctors. Fourth, the village health office into the integrated rural management. Work layout, unified arrangements for the assessment, the requirements of standardization and unification of efforts to increase, enhance the township health hospitals on the management of rural doctors, to encourage the conditions of the township health hospitals and village health offices to implement financial management.
Fifth, the new rural cooperative hospitalized patients flow unreasonable and recommendations. Due to the lack of incentives for primary care doctors, hospitalization drugs to reduce the risk of avoiding surgery and limitations on the scope of practice and other reasons, the new rural cooperative patients flow in an orderly manner to the provincial and municipal hospitals, so that should be "basic" of the new rural cooperative funds to be "robbing the poor to help the rich", some of the "minor illnesses are treated in a big way". Some of the "minor illnesses treated" phenomenon caused by the waste of health resources, but also to the new rural cooperative funds to use the pressure. According to statistics, in 2007, our county new rural cooperative hospitalized patients in the province, city, county, township proportion were 2.37%, 17.08%, 49.54%, 31.01%; average cost of 17,200.00 yuan, 6,343.00 yuan, 2,281.00 yuan, 995.00 yuan; the total hospitalization costs were 5,779,500 yuan, 15,346,000 yuan, 16.00 million yuan, 4.367 million yuan.In 2012, the proportion of the county's new rural cooperative hospitalized patients in the province, city, county and township were 3.61%, 18.13%, 48.74% and 29.53% respectively; the average cost per visit was 11,429.00 yuan, 6,524.00 yuan, 2,437.00 yuan, and 935.00 yuan; and the total hospitalization costs were 30,608,500 yuan, 87,860,000 yuan, 88,241,000 yuan, and 20,515,000 yuan. In addition, the hierarchical medical system has not been formed, also resulting in an unreasonable flow of patients, affecting the efficiency of the use of funds of the New Rural Cooperative.
Work recommendations: First, through the policy guidance, increase the policy comparison publicity, the reimbursement policy of each fixed-point medical institutions, the average cost of cases, the compensation ratio is announced to the village level, to guide the participating public to reasonably choose the fixed-point medical institutions. Second, the compensation program has been adjusted to implement two-way technical referrals to guide the reasonable flow of patients in order to reduce fund risks. Third, strengthening the supervision of medical institutions above the county level to control medical costs. (