A few days ago, the General Office of the Provincial Party Committee, the General Office of the Provincial Government issued a "further deepening of grass-roots medicine and health system comprehensive reform of the opinions (for trial implementation)" notice, including "on the strengthening of the integrated management of rural health services implementation program", "on the city to carry out the pilot program of contracting services for chronic disease family doctors" two annexes.
This combination of documents to deepen the grassroots health care reform, in Fujian Province for the first time. December 15, the Provincial Health Reform Office, the Provincial Health Planning Commission jointly held a press conference on the interpretation of the document.
Comprehensive reform of county-level public hospitals early next year
At the end of 2014, Fujian Province, the start of the county-level public hospital reform, currently represented by Sanming part of the comprehensive reform of county-level public hospitals, while most counties are still stuck in the completion of the zero-difference rate of drugs this single reform progress, comprehensive reform at the county level hospitals have not been pushed forward comprehensively.
"Opinions" requires that before the end of this year, the reform preparations around, early next year to fully promote the comprehensive reform of county-level public hospitals. To draw on the experience of the reform of Sanming four aspects of reform, namely, reform of the total wage approved approach, reform of the internal distribution system, reform of the personnel establishment system, reform of the financial management system:
Reform of the total wage approved approach
The total wage measurement is only linked to the medical income
The total income structure of hospitals will be the total income structure of hospitals is divided into three pieces, namely, drugs and consumables, Checking laboratory tests, clinic nursing beds surgical treatment income (the third block collectively referred to as medical income). The measurement of the total salary of hospital personnel is only linked to the medical income, fully reflecting the value of the labor of medical personnel.
Reform of the internal distribution system
Breaking the original model of wages linked to departmental revenue generation
The annual salary of the director of the full financial burden, the director on behalf of the government to manage the operation of the hospital. The implementation of the whole target annual salary system, the hospital staff annual salary by the basic work points, workload work points and rewards and punishments work points of three parts of the composition, breaking the staff salary and the department of revenue generation linked to the distribution model. Medical personnel annual salary distribution by the hospital within the approved total salary independently approved. In principle, the total wage distribution ratio is: doctors, nurses and administrative logistics team accounted for 50% of the total wage, 40% and 10% respectively.
Reform of the personnel establishment system
Implementation of the appointment system of the dean gradually implement equal pay for equal work
Implementation of the appointment system of the dean; innovative county-level public hospitals, county-level public hospitals can be in the establishment, clear filing management methods and processes, the implementation of county-level public hospitals, the use of the preparation of the filing system; and the gradual implementation of the system of equal pay for equal work.
Reform of the financial management system
The implementation of the chief accountant system; strengthen the hospital balance fund management, clear the scope and purpose of the funds corresponding to the payment; strengthen the financial management of hospitals, the implementation of comprehensive budgeting and full-cost accounting.
Reform of the personnel management system
Establishment of specialized agencies to undertake affairs and services
Establishment of grass-roots health care personnel management services in the county health care department to specifically undertake the recruitment, management, deployment of personnel affairs, services, etc., and to explore the health care technical personnel "county management of the townships with the" management mechanism. "
The specific measures to be taken are as follows.
Specific measures to see this side
Reform of the internal operation mechanism of primary health care institutions
The relevant person in charge of the Provincial Health Planning Commission explained that the reform of the internal operation mechanism of primary health care institutions, one is to make clear that the total amount of primary health care institutions performance payroll, including the financial allocation of the personnel of the basic payroll, the national unified allowances and subsidies, basic performance payroll (including), the basic performance payroll, and the basic performance payroll. "five insurance and one gold"), after deducting the cost of basic public **** health service income, medical income (after deducting drugs and consumables, inspection and laboratory tests) three parts of the total amount of wages approved by the county medical management committee; Second, it is clear that the basic public **** health service funds shall not offset the basic salary and basic performance pay (including the "five insurance and one gold"). "five insurance and one gold").
Second, the reform of the performance allocation system. Primary health care institutions to implement the dean's target annual salary system, the dean's annual salary by the county medical management committee in the primary health care institutions to determine the total amount of wages. The annual salary of the hospital medical staff by the hospital in the total salary within the scope of the independent distribution, the implementation of the "double assessment, double linkage", breaking the pot of rice. On the one hand, the county medical management committee of primary health care institutions to assess the director, the results of the assessment and the hospital's performance of the total amount of wages, the director of the appointment and dismissal, rewards and punishments, financial subsidies and so on; on the other hand, the hospital on the internal departments and staff assessment, the results of the assessment and the individual rewards and punishments, the performance of the wage allocation linked to the number of outstanding services, quality, control of medical costs, access to the referral rate, medical ethics and medical ethics, the public's satisfaction with the focus on
Third, the reform of the employment system. Primary health care institutions can be in the approved number of staffing, to take the two ways of employment and occupation of non-staffing. The two are the same, but they are not the same, so they are not the same, so they are not the same, so they are not the same, so they are not the same, so they are not the same, so they are not the same, so they are not the same. More than the total number of staff employed, subject to the county medical management committee approved the number of personnel and payroll standards.
Reform of the personnel management system
In the county health department to set up grass-roots health personnel management services and security centers, specifically to undertake the recruitment, management, deployment of personnel affairs, services, etc., and to explore the health professionals "county management and township with" management mechanism.
Relax the educational restrictions on new hires in primary health care institutions, the new hires into the primary health care institutions of clinical and public **** health positions of professional and technical personnel can be relaxed to college education, medical technology and nursing positions of professional and technical personnel can be relaxed to secondary school education. Qualified shortage of urgently needed talents through the guidance directory can take direct assessment or interviews and other more simple and effective way of public recruitment, improve the utilization rate of the establishment.
The organization of the department by the classification of adjustments to the approved staffing of primary health care institutions. Research and improve the community health center preparation approved method. The county medical management committee in the approved total staffing, can be reasonable deployment of the primary health care institutions personnel.
Liberalize the conditions for the evaluation of grass-roots titles. The grass-roots medical personnel to declare senior title, in the academic papers, title foreign language and computer application skills do not make rigid requirements. The control standard for the proportion of senior titles in township health centers and community health service organizations has been gradually raised to 15%, and to 20% at the county level.
Reform of primary health insurance, price and basic drug policy
In terms of price, the abolition of primary health care institutions (excluding village health centers) general consultation fee policy, set up diagnostic fees, injection fees, the synchronization of the implementation of health insurance reimbursement policy, not to increase the burden of personal costs of the masses.
In terms of health insurance, the existing grassroots health insurance policy is comprehensively sorted out, and the reimbursement gap between the grassroots and different levels of hospitals or hospitals within the county and outside the county is widened. The company is actively encouraging the promotion of the use of basic medicines in the grassroots general outpatient clinics to cancel the starting line, in the health care system within the referral to cancel the second starting line and other practices, to guide the public reasonable medical care.
In terms of the basic drug system, the procurement of drugs for primary health care institutions all implement the centralized bidding and purchasing policy for drugs in public hospitals, and online purchasing is implemented to ensure that the varieties of drugs used in primary health care institutions and public hospitals are connected.
Integrated management of the village health center set up to serve the population, service radius and transportation accessibility and other factors, in principle, each administrative village has an integrated management of the village health center, the resident population of more than 2,000 administrative villages can be set up in the center of the village health center, remote mountainous areas, the islands of the resident population of the administrative villages less (less than 500 people) by the periphery of the village health center service or by the township health center selected by the doctor regular rounds of the hospital. The village health center can provide services from the surrounding village health centers or from township health centers that select doctors to make regular visits to the village health centers. In principle, village health centers are equipped with one village doctor per 1,000 population, with a maximum of three.
The remuneration of village doctors is mainly derived from four components: the basic allowance of village doctors, subsidies for basic public **** health service programs, subsidies for zero-differential rate of basic medicines, and general consultation fees paid by the New Rural Cooperative Medical Insurance Fund. These village-level public **** health service-related funds and various policy subsidies are packaged and handed over to township health centers for unified management, and all of them are used for village doctors' personnel funds after assessment. Village health center village doctor salary and treatment in accordance with the current government purchased services related to the cost of no less than the standard, by the township health center on a monthly basis.
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