Yingcheng City is a county-level public hospital comprehensive reform pilot counties and cities, the city people's hospital, the city hospital has been listed as a pilot hospital. According to? Basic, strong grassroots, building mechanisms? The requirements, centered on the separation of government affairs, management separation, separation of medicine, profit and non-profit separation of the reform requirements, to eliminate? The mechanism of "medicine for medicine" is the key link, insisting that medical care should be based on the principle of "medicine for medicine. mechanism as the key link, insisting on medical treatment, medical insurance and medicine. The three medical institutions have been linked together to ensure the smooth reform of public hospitals.
First, the basic situation of the pilot hospital
Yingcheng City People's Hospital, the existing on-the-job staff of 953 people, health professionals and technicians 822 people, of which 107 senior titles, intermediate titles 314 people. Open beds 800, with 39 clinical medical departments, a community outpatient clinic, with 11 filial piety city-level key specialties. It is the first batch of county-level public hospital reform pilot units. 2014 completed 543,300 outpatient emergency room visits, 37,400 hospitalizations, business flow of 303 million yuan.
Yingcheng City Hospital of Traditional Chinese Medicine has 451 on-the-job employees, 355 health professionals and technicians, including 29 senior titles, 123 intermediate titles. Open beds 293, with 16 clinical departments, 9 medical technology departments, there are two provincial key construction specialties of traditional Chinese medicine, municipal key specialties of traditional Chinese medicine 2. It is the second batch of county-level public hospital reform pilot units. 2014 completed 163,800 outpatient emergency room visits, hospitalization of 11,500 people, business flow of 0.7 billion yuan.
Second, the main practices and progress
(a) to strengthen the three responsibilities, to provide a strong guarantee of reform
First, to strengthen the responsibility of government leadership. The high-specification set up a public hospital reform work leading group, the mayor as the leader, the executive vice mayor and the mayor in charge of the vice mayor, the development and reform, finance, human resources, health planning, editorial office, price, drug supervision and other seven units as members. The municipal party committee and the municipal government organize and convene special meetings on public hospital reform several times a year to make clear the key work arrangements and roadmap, and formulate and issue the "Comprehensive Reform of Public Hospitals in Yingcheng City, Implementation Plan". Municipal medical reform leading group to establish and improve the work of the target responsibility system and performance appraisal system, regularly convene joint working meetings, study and solve related problems, inform the progress of the reform work, the implementation of the accountability system, to ensure the smooth progress of the public hospital reform. In order to learn from the mature experience of foreign countries, at the beginning of the year, the municipal party committee and the municipal government also organized a visit to Sanming City, Fujian Province? Sanming medical reform? Model, to broaden the idea. At the end of last year, the provincial health care reform inspection team to inspect and supervise the city's public hospital reform, fully affirmed.
The second is to strengthen the responsibility of departmental contact. The establishment of a comprehensive reform of public hospitals contact system, regularly grasp the progress of work and dynamics. In accordance with the second batch of public hospital reform program and time nodes, the Municipal Health Bureau of the joint price, financial sector, seriously completed the city's public hospital reform baseline survey. The relevant departments worked closely together, and successively issued the "Yingcheng City Public Hospital Payment Mode Reform Implementation Measures", "Yingcheng City Public Hospital Comprehensive Reform Medical Service Price Adjustment Program", "Yingcheng City Medical Institutions Hierarchical Diagnostic and Treatment Implementation Program", and "Yingcheng City Public Hospital Performance Assessment Implementation Measures", "Yingcheng City Public Hospital Financial Management Implementation Rules", "Yingcheng City Strengthening the Construction of Health Professionals and Technical Talent Teams Implementation Plan", "Yingcheng City public hospital corporate governance structure implementation plan", "Yingcheng City public hospital comprehensive reform of the preparation of the record management implementation measures", "Yingcheng City public hospital job setting and income distribution system reform implementation plan" and other supporting documents to improve the centralized bidding and purchasing of medicines, regional health planning and health care institutions set up is being further improved, recently introduced.
Third, strengthen the responsibility of financial input. Municipal finance on the two public hospitals to cancel the drug markup income for careful accounting, to take a diversified form of compensation, public hospitals compensation from the service charges, drug markup income and government subsidies for three channels to service charges and government subsidies for two channels. At the same time on the city people's hospital comprehensive inpatient building for special subsidies amounted to 5 million yuan, the city people's hospital, the city hospital of traditional Chinese medicine and other new projects to reduce or waive the fees nearly 8 million yuan. This year, the municipal finance to increase the new rural cooperative supporting funds 5.7 million yuan, to solve the village health room standardization construction project funds 500,000 yuan, to provide financial security for health care reform.
(2) sound three systems, improve the concept of top-level design
First, the strict implementation of the price system. According to the spirit of the provincial price documents, in accordance with the ? The total amount of control, structural adjustment, rise and fall, gradually in place? The principle of the full abolition of the hospital drug markup (except for traditional Chinese medicine tablets), the implementation of zero-differential rate sales of medicines, hospitals thus reducing the reasonable income, by adjusting the price of medical technology services and increase government subsidies, as well as hospitals to strengthen the accounting, savings in operating costs, and other parties **** bear. Among them, 1,173 items were adjusted by the Municipal People's Hospital, and 905 items were adjusted by the Municipal Hospital of Traditional Chinese Medicine. Since November 2014 to the end of April 2015, the 2 pilot hospitals drug concessions 10.74 million yuan, outpatient emergency room average cost increased by 2.25% year-on-year, hospitalization average cost decreased by 2.81% year-on-year.
Second, the reform of the health insurance payment system. The new rural cooperative fund total prepayment, promote the single-patient payment, total prepayment and other health insurance payment method reform, reasonable control of diagnosis and treatment costs. It has also strengthened the monitoring of indicators such as the utilization rate of medicines outside the basic medical insurance catalog, the ratio of medicines to hospitalization, the average hospitalization day, and the rate of referral and transfer to hospitals, so as to enhance the efficiency of the use of the basic medical insurance fund. The Municipal Cooperation and Management Office measured and negotiated with the 2 pilot hospitals, and selected 30 disease types for trial implementation in the first stage. At present, the city's People's Hospital has 13 types of diseases on a trial basis single disease quality management control, 68 types of diseases to implement clinical path management, since November 2014 to carry out the clinical path of nearly 3,000 cases, an increase of 20% compared with the previous year.
The third is to promote the medical hierarchical diagnosis and treatment system. Further improve the medical institutions disease diagnosis and treatment catalog and upward transfer, downward transfer standards, formulated the "Yingcheng City graded diagnosis and treatment implementation plan". The starting standard and proportion of the medical institutions, the effective implementation of the agricultural hospitalization patients starting line township health centers 200 yuan, reimbursement ratio of 85%; municipal secondary hospitals starting line 500 yuan, reimbursement of 65%. Strict implementation of non-normal referral reimbursement policy, through the policy leverage to guide patients to choose the medical institutions, the current rate of consultation within the city reached 93.25%
(C) innovation of the three mechanisms to strengthen the connotation of the hospital construction
First, the adjustment of public hospitals revenue and expenditure mechanism. To guide the public hospitals to change the concept of hospitals, increase the pace of change, adjust the structure, develop effective incentives and constraints mechanism and scientific performance evaluation methods, strictly prohibit large prescription, indiscriminate inspection, strengthen the expenditure budget management, effectively reduce the cost of expenditure, reduce the public hospitals accounted for the proportion of drugs.
Second, improve the drug supply guarantee mechanism. Reduce the cost of drugs and high-value medical supplies, take the recruitment and procurement of one, volume and price linkage, the second bargaining methods to carry out centralized bidding and procurement. Establish and improve the inspection and supervision system, strengthen the supervision and inspection of the implementation of drug prices, standardize the price behavior, strengthen the monitoring of the prescription behavior of medical personnel, the implementation of electronic prescriptions, in accordance with the norms of the establishment of a systematic, standardized and continuous improvement of the prescription review system, to promote the rational use of medicines, to protect the legitimate rights and interests of patients. The proportion of basic drugs used in the city's people's hospitals has reached 51.5%, and 45.6% in Chinese medicine hospitals.
Third, improve the service performance assessment mechanism. The establishment of the quality of service, job work objectives as the core of the performance appraisal and performance pay incentive system, the assessment and evaluation system according to the quality of medical care, medical safety, medical level of five primary indicators, 19 secondary indicators, 37 tertiary indicators detailed decomposition to the department, to the person. Highlighting social benefits and work efficiency, the company has implemented the policy that medical staff's income is not linked to medicines, inspections and treatments. At the same time, it vigorously carries out? Further improve medical service action? , increase convenience measures, additional service windows, the implementation of flexible scheduling, window departments to work early and extended service, optimize the service process, shorten the waiting time for patients. Municipal People's Hospital opened 114 appointment platform, to carry out appointment booking, volunteer services and other projects. since November 2014, appointment booking more than 200 times.
(D) Coordination of three major projects to promote the coordinated development of the industry
First, the implementation of the village health room construction project. Actively strive for the province's village health room construction projects, the implementation of unified planning, unified design, unified bidding, unified construction, unified acceptance of the ...? Five unified? Mode, this year, the construction of 50 standardized village health room, Sanhe Town, Hua Li Village, Tian Dian Town, such as milking Chen Village 12 villages have begun construction, plans to be completed by the end of July. Strengthen the training of village doctors, held three training courses, nearly 200 people, to improve the ability of grass-roots primary care. Strengthen the village health room performance assessment, monthly audit, promote the equalization of basic public **** health services, the implementation of zero-differential rate sales of essential drugs.
Second, the implementation of the residents' health card program. Actively signed a letter of responsibility with the Yingcheng City Rural Credit Union, has completed the townships (towns) HIS system unified deployment, health network construction and the residents of the health card personnel identity information verification, to ensure that the end of August to achieve the city's residents of the first health card, November 1 before the completion of the participation of the population of 50% of the card issued by the workload, December 31 before the completion of the participation of the population of more than 80% issued by the card next year to achieve the full coverage of urban and rural residents in the city. The city's urban and rural residents full coverage.
Third, the implementation of social medical policy projects. The introduction of social capital, the establishment of modern hospitals and benevolent hospitals. The successful transformation of the city health school, plus the addition of the city health school nursing home, the implementation of? The first time I saw this, it was a very good idea for me to go to the hospital to see the doctor.
These are the first time I've ever seen a patient in a hospital in the United States.
Third, there are difficulties and problems
First, personnel autonomy to be further improved. The reform of public hospitals clearly stipulates that under the control of the total amount of preparation, the hospital enjoys personnel autonomy. However, the city at present, all personnel introduction, subject to the unified examination by the human resources department, coupled with the introduction of personnel subjects are different, a single examination content, can not highlight the urgent need for professionals characteristics, and recruitment, can not handle staffing, only the implementation of personnel agency. According to regulations, the city people's hospitals by the number of beds and staffing 1:0.9 ~ 1.1 programmed, Chinese medicine hospitals by 1:1 ~ 1.2 programmed, the city's people's hospitals programmed beds 1,000, the city's Chinese medicine hospitals 500, while the actual city's people's hospitals staffed 640, the city's traditional Chinese medicine 270, a large number of staff without the establishment. The problem is more prominent in the township health centers, the city's 18 township health centers are programmed 922 people, the actual on-the-job in the staff of only 408 people, at present, there are six township health center director has no preparation, belonging to the personnel agency personnel. On the one hand, the establishment is vacant, on the one hand, a large number of use of non-staff personnel, has affected the healthy development of the health and family planning cause. At the same time, the new staff establishment has not been implemented, resulting in follow-up professional and technical promotion, pension insurance, household registration and a series of problems are difficult to solve.
Secondly, the financial investment to be further increased. In recent years, the city's various health care reform and health investment has increased year by year, but due to the city's limited financial resources, public hospitals, capital and equipment purchases, key disciplines, talent training, in line with the national provisions of the cost of retirees, the key talent swing room construction, policy losses, as well as to undertake the public **** health tasks and emergency treatment, etc., have not been guaranteed, the financial input is clearly insufficient.
Third, the government policy compensation to be further implemented. After the operation of recent months, 2 pilot hospitals by adjusting the price of medical services government compensation for 20% of the funding is not included in the financial budget, the funding gap is very large. Xiaogan City Price Bureau, Xiaogan City Health Bureau of medical services price adjustment program operation of the survey reported data for review, the city's medical price adjustment compensation is only 49.5%, the city's Chinese medicine hospitals accounted for only 15.6% of the reduced part. Based on this projection, the annual shortfall of more than 13 million yuan, (of which nearly 9 million yuan of the People's Hospital, the City Hospital of Traditional Chinese Medicine nearly 4 million yuan), the normal operation of the hospital and sustainable development has had an impact.
Fourth, the next step in the work of the intention
We will be in accordance with the national and provincial public hospitals comprehensive reform requirements, highlighting the key points, overcome the difficulties, reform and innovation, and continue to promote the city's public hospitals comprehensive reform.
First, clear departmental responsibilities, in the government's main responsibility has been strengthened. As the main responsibility of the public hospital reform, the city government will conduct in-depth research, timely solution to the difficulties and problems in the reform of public hospitals, supervise the relevant departments to improve the reform program and supporting measures, actively and steadily promote the comprehensive reform of public hospitals.
The second is to strengthen the construction of the team, a breakthrough in the standardization of the preparation and management. According to the principle of classification guidance, the pilot hospitals to take the preparation of a nuclear program, step by step in place, the dynamic management approach, the fixed number of people not fixed, the implementation of the preparation of the filing system management; township health centers and public **** health units, according to the academic qualifications, positions, years of service and other conditions, in the existing staff through the examination and verification, step by step approach to the recruitment of staff, in about three years to solve the legacy of the problem, the implementation of the new staff into the test must be examined. The new staff to implement all must be examined.
Third, increase the financial security, a breakthrough in the financial input compensation mechanism. Further increase the national and provincial transfer payments, and gradually increase the cost of capital construction and large-scale equipment purchases, especially to increase the hospital's historical debt clearance of the special subsidies, to promote the healthy development of public hospitals.
Fourth, the implementation of the reform responsibility, in the reform of the management system have a breakthrough. Improve the corporate governance structure, the city is filial piety city to establish a corporate governance structure of the pilot, will be in the county-level public hospitals to establish a council as the core of the corporate governance structure, the implementation of the dean's responsibility system, the establishment of a modern hospital management system. Promote hierarchical diagnosis and treatment, and make efforts in the urban and rural grouping of medical institutions and rural integration to form the characteristics of Yingcheng. Implement single-disease payment, gradually expand single-disease payment categories in accordance with the principle of implementation, improvement and enhancement at the same time, and by 2017, comprehensively implement the composite payment method mainly based on disease payment, capitation payment, and payment per bed day. Improve hospital performance assessment, optimize the allocation of health care resources, the implementation of job performance management, the implementation of people-friendly measures to improve the satisfaction of the masses to see a doctor, and strive to achieve ? Small diseases do not go out of the village, common diseases do not go out of the township, big diseases do not go out of the county (city)? The rate of consultation within the county has reached more than 90%.
Director, deputy directors, members, comprehensive reform of public hospitals is an important initiative to protect and improve people's livelihood, has become a hot spot of concern to society as a whole, we will be in the municipal party committee and the correct leadership of the municipal government under the supervision and guidance of the Municipal People's Congress, with a more full of spirit, a more solid style, a more forceful initiative, and strive to promote the city's public hospitals comprehensive reforms to build a healthy Yingcheng Make a new and greater contribution.
Report on the progress of public hospital reform work2In November 2016, the thirty-fourth meeting of the Standing Committee of the twelfth session of the provincial People's Congress listened to the provincial people's government "on the province's report on the work of the reform of public hospitals" and put forward deliberations to the provincial government to study and deal with. The provincial government attached great importance to the deliberations of the Standing Committee of the Provincial People's Congress, and carefully studied and handled the report. Now the summary of the report on the handling of the situation is published below.
First, strengthen the government's responsibility to coordinate the promotion of ? The three doctors? The first step is to make sure that you have a good understanding of what is happening in the world. Deepen the medical reform work by the party and government at all levels is responsible for, medical, medical insurance, medicine? The three doctors? The three medical institutions are under the control of one leader. Planning for the establishment of provincial public hospital management committees, play the role of public hospital management committees at all levels, to fulfill the government-run medical functions; grasp the implementation of the medical and health service system planning (2016?2020), the development of the implementation of the views of the 2017; research and development of a comprehensive medical reform pilot assessment standard system, quarterly assessment of the implementation of the effect; research and development of the public hospitals input and debt resolution policies, government input and debt resolution as a systematic arrangement. Government input and debt resolution for institutional arrangements; carry out comprehensive medical reform pilot? Looking back? In the past, the government has been able to improve the top-level design of the input system, personnel remuneration and other key difficulties of the reform.
Second, the implementation of reform policies to accelerate the establishment of new mechanisms for the operation of public hospitals. The first step is to make sure that you are able to get the best out of your computer. The first is to make sure that you have a good understanding of what you are doing and how you are doing it. system; in accordance with? Allow medical and health institutions to break through the current salary control level of institutions, allowing medical service income after deducting costs and extracting the funds according to the provisions of the main staff incentives? Requirements, the implementation of medical personnel remuneration system reform; enhance the county medical service capacity and level, enhance the attraction, retention and training of talents; dynamic adjustment of medical service prices, promote the pilot reform of fee charging according to the type of disease, timely review of the new medical service projects; in the province's public hospitals above the second level of the establishment of performance appraisal reporting system and carry out monitoring and analysis.
Third, improve the mechanism of medicine, and effectively reduce the burden of medical costs on the masses. The implementation of drug procurement? The two-ticket system? The reform, to encourage the implementation of the? The first is to make sure that you have a good understanding of what you are doing and how you are doing it. Blacklist? system; explore the establishment of a drug price comparison regulatory system; carry out a rigorous purge of unethical practices in the purchase and sale of medicines and medical services; carry out prescription reviews, standardize the rational use of clinical medication; the overall increase in medical costs in 2017 to control the growth rate of 10% or less. Fourth, to deepen the comprehensive medical reform, enhance the public's sense of access to the results of the reform. On the basis of the unification of basic medical insurance policies for urban and rural residents, gradually promote urban and rural residents' and employees' medical insurance? Three guarantees in one? Establish a unified urban and rural basic medical insurance system, further improve the differentiated payment policy of medical insurance for different levels of medical institutions, and basically realize the direct settlement of medical insurance for hospitalization expenses for medical treatment in other places in accordance with the provisions of referral in 2017; further improve the level of medical insurance financing and protection treatment, and the proportion of payment for expenses within the scope of the policy reaches 75%; establish and improve a performance evaluation mechanism that combines the effect indicators of hospitalization rate of patients with chronic diseases with the quantity of work; and establish and improve a performance evaluation mechanism that Combination of performance assessment mechanism; improve the function of medical convenience service platform; fully implement the physician multi-practice system, improve the proportion of community hospital health insurance reimbursement; implementation of primary health care institutions to meet the standards of the project, the standard rate of 95% in 2017, for some of the more populous townships, the reconstruction and expansion of the central health center, so as to achieve the scale of the second level hospital; in 2017, the proportion of inpatient time-slot booking for examination reached 100%, outpatient patients appointment appointment consultation rate of not less than 50% of patients with appointment consultation; in 2017, 50% of discharged patients in tertiary hospitals and 70% of discharged patients in secondary hospitals were managed in accordance with the clinical pathway, and more than 50% of discharged patients were paid according to the type of disease; to strengthen the monitoring of patients' out-of-pocket expenses, and to enhance the sense of achievement of the masses' access to health care.