The Ministry of Finance responded to reporters’ questions on the "Opinions on Establishing and Improving the Compensation Mechanism for Primary Medical and Health Institutions"
Xinhua News Agency, Beijing, December 16 (Reporter Han Jie Xu Rui) Since last year Since the implementation of the national essential drug system in primary medical and health institutions, the average medical expenses per time in primary medical and health institutions have dropped to varying degrees, and the number of outpatient and emergency visits has increased, with initial results showing. However, as the reform gradually advances, some new situations and problems have emerged. One of the problems is insufficient compensation after the elimination of drug markups, which affects the normal operation of primary medical and health institutions.
In order to accelerate the advancement of the national essential medicine system and ensure the smooth operation and development of primary medical and health institutions, the General Office of the State Council recently issued the "Opinions on Establishing and Improving the Compensation Mechanism for Primary Medical and Health Institutions." The relevant person in charge of the Social Security Department of the Ministry of Finance stated on the 16th that financial departments at all levels will vigorously promote the comprehensive reform of primary medical and health institutions in accordance with the requirements of the "Opinions", implement multi-channel compensation, and promote the sustainable and healthy development of primary medical and health institutions.
To improve the compensation mechanism, we must first promote the comprehensive reform of primary medical and health institutions
The situation of township health centers in my country is very complex. Some of them have reached the level of county hospitals, some have specialist characteristics, and some have special characteristics. It is located in the suburbs of the city and is very close to a large hospital. The unclear functional positioning makes it difficult to implement the approved tasks, and it is also impossible to determine the required funds and staffing based on the workload. In addition, the expenditure structure of primary medical and health institutions is also unreasonable, highlighted by the widespread phenomenon of personnel being "on duty but not on duty" and "on duty but not on duty". As a result, personnel funds approved in accordance with regulations are often unable to meet the expenditure needs of primary medical and health institutions.
In this regard, the relevant person in charge of the Social Security Department of the Ministry of Finance pointed out that in accordance with the requirements of the medical reform opinions and implementation plans, primary medical and health institutions implement financial management methods of "assessment of tasks, assessment of revenue and expenditure, and performance appraisal subsidies" , determined that to improve the compensation mechanism, we must first promote comprehensive reforms of systems and mechanisms, and standardize the operating mechanisms and development paths of primary medical and health institutions.
The person in charge emphasized that coordinating and promoting the comprehensive reform of primary medical and health institutions, including functional positioning, regional planning, staffing and approval, personnel systems, income distribution systems, management systems, etc., is the key to improving the compensation mechanism. Important content. In the past year since Anhui Province implemented comprehensive reform, it has achieved a good situation in which grassroots medical and health institutions are operating effectively and the people's medical expense burden has been reduced with less investment. Practice has proved that comprehensive reform is an effective way to solve the current problem of promoting the essential medicine system. Preliminary statistics show that 18 provinces (autonomous regions and municipalities) have issued comprehensive reform documents. To this end, the "Opinions", based on summarizing Anhui's experience, clearly proposes to simultaneously promote the comprehensive reform of primary medical and health institutions and establish and improve a multi-channel compensation mechanism.
The merger of general diagnosis and treatment fees and inclusion in the scope of medical insurance payment is a highlight
Tianjin, Zhenjiang, Jiangsu and Yangzhou and other places provide appropriate compensation to primary medical and health institutions through medical insurance funds, and explore the establishment of The multi-channel compensation mechanism ensures the smooth implementation of the essential medicine system. Subsequently, 26 provinces across the country also successively issued documents establishing multi-channel compensation mechanisms. To this end, the "Opinions" clearly propose the establishment of a sound, stable, and long-term multi-channel compensation mechanism based on summarizing the experience of various regions.
The relevant person in charge of the Social Security Department of the Ministry of Finance pointed out that in addition to implementing direct subsidies to providers in accordance with regulations, the "Opinions" clearly proposed the need to adjust and merge the general diagnosis and treatment fees, and the medical insurance fund will purchase services through provide reasonable compensation to grassroots medical and health institutions, and refine and clarify specific operating methods, changing the investment mechanism that focused on the supply side in the past, in line with increasing subsidies for medical insurance funds such as New Rural Cooperative Medical Care and Urban Resident Medical Insurance, and reasonably determining The reform direction of medical service prices is to enable grassroots medical and health institutions to receive reasonable compensation through the purchase of service mechanism.
Providing reasonable compensation through the medical insurance fund not only solves the problem of unaffordable and unsustainable financial resources for a single financial institution, but also solves the problem that the price of medical services cannot fully reflect the service costs and technical labor value of medical personnel. It further enhances the stability and sustainability of the compensation mechanism for primary medical and health institutions, helps mobilize the enthusiasm of primary medical institutions and medical staff, ensures the smooth advancement of the national essential medicine system, and also accumulates experience for public hospital reform pilots.
In addition, through medical insurance fund compensation, it can not only effectively promote the reform of outpatient co-ordination and medical insurance payment methods such as capitation payment, disease payment, and total prepayment, but also effectively guide urban and rural residents to actively participate in insurance as soon as possible. Achieve the goal set by the medical reform plan of more than 90% of urban and rural residents being insured, thereby promoting the further improvement of the medical insurance system, expanding the scope of benefits to the masses, and giving full play to the role of medical insurance funds in service compensation, cost control, and service supervision.
Increase government investment in implementing various subsidy policies
The relevant person in charge of the Social Security Department of the Ministry of Finance said that in order to implement the spirit of the "Opinions", the next step will be for financial departments at all levels to increase The government invests in implementing various subsidy policies. In accordance with the requirements of the "Opinions", the financial department will strive to adjust the expenditure structure and further increase support for grassroots medical and health institutions in accordance with the requirements of ensuring the basics, strengthening the grassroots, and building mechanisms.
On the one hand, the funds for capital construction, equipment purchase, personnel training and retired personnel approved in accordance with national regulations are implemented as required. Gradually increase basic public health service funding. In 2010, the per capita basic public health funding standard at all levels of finance will be no less than 15 yuan. This will be further increased in 2011. Most of this subsidy fund will flow to primary care. health facilities. Subsidies for the balance of current revenue and expenditure approved in accordance with regulations will be included in the government's annual budget for full arrangements.
On the other hand, investment in medical insurance funds has been increased. In 2010, the government subsidy standard for New Rural Cooperative Medical Insurance and urban medical insurance at all levels of finance was increased from 80 yuan to 120 yuan per person per year, and further improvements will be made in the future. With the improvement, the ability of primary medical and health institutions to obtain compensation for providing medical services will also be further improved.
Financial departments at all levels must also strengthen performance appraisal and improve incentive and restraint mechanisms. It is necessary to scientifically design an evaluation index system and link the performance appraisal results with public health subsidy funds and the subsidy results for the current balance of revenue and expenditure, so as to promote grassroots medical and health institutions to improve service quality and efficiency. At the same time, we will improve appropriation methods and speed up budget implementation.
In addition, the financial department must actively cooperate with relevant departments to adjust the charging items, charging standards and medical insurance payment policies of primary medical and health institutions, and give full play to the compensation role of medical insurance funds for primary medical and health institutions; at the same time, vigorously promote comprehensive Reform, effectively promote the transformation of systems and mechanisms, and lay a solid foundation for the implementation of "assessment of tasks, assessment of revenue and expenditure, and performance appraisal subsidies".
In order to alleviate the pressure on local fiscal expenditures, especially at the city and county levels, in the future, in addition to continuing to implement various special subsidy funds in accordance with existing policies, the central government will further increase funding through "rewards instead of subsidies". Special support for the implementation of essential medicine systems in difficult areas. At the same time, we will further improve the fiscal system below the provincial level and enhance the ability of grassroots governments to provide public services. Provincial finance should effectively implement the investment responsibilities that the finance at this level should bear in accordance with the requirements, and increase support for areas in difficulty.