Notice on the Issuance of Guiding Opinions on the Pilot Reform of Public Hospitals
People's Governments of Provinces, Autonomous Regions and Municipalities directly under the Central Government, and Xinjiang Production and Construction Corps:
The Guiding Opinions on the Pilot Reform of Public Hospitals formulated by the Ministry of Health, the Central Editorial Office, the National Development and Reform Commission, the Ministry of Finance and the Ministry of Human Resources and Social Security have been agreed by the State Council, and are hereby issued to you, please Please carefully implement the implementation of local practice. Please report to the Ministry of Health and relevant departments in a timely manner on important situations and problems in the pilot process.
Ministry of Health
Central Codification Office
National Development and Reform Commission
Ministry of Finance
Ministry of Human Resources and Social Security
February 11, 2010
(Form of Disclosure: Active Disclosure)
Guidance on Pilot Reforms of Public Hospitals
In order to implement the "Central Committee of the State Council of China", the State Council has issued the Guidance on Pilot Reform of Public Hospitals. Opinions of the Central Government of the State Council on Deepening the Reform of the Medical and Health Care System" (Zhongfa [2009] No. 6) and the State Council's "Medical and Health Care System Reform Immediate Key Implementation Program (2009-2011)" (Guofa [2009] No. 12), and to guide localities in effectively carrying out the pilot reform of public hospitals, the formulation of the guiding opinions.
I, the guiding ideology and basic principles
(a) Guiding ideology.
Public hospitals adhere to the nature of the public interest, the maintenance of people's health rights and interests in the first place, the implementation of the separation of government affairs, management and management, medicine, profit and non-profit separation, and promote innovation in the system and mechanism, mobilize the enthusiasm of medical staff, improve the operational efficiency of public hospitals, and strive to let the masses to see the disease. In accordance with the requirements of "moderate scale, optimize structure, rational layout, improve quality, sustainable development", adhere to the principle of equal emphasis on traditional Chinese and Western medicine, the overall allocation of medical resources between urban and rural areas and regions, and promote the healthy development of public hospitals, to meet the people's demand for basic medical services, and to effectively alleviate the problem of the masses of expensive and difficult to see a doctor.
(II) basic principles.
Adhering to the unity of fairness and efficiency, the combination of government-led and the play of market mechanisms; adhering to the dominant position of public hospitals, encouraging the diversification of medical care, and promoting the coordinated development of hospitals of different ownership and operating qualities; adhering to the combination of development, reform and management, improving the service system, innovating the institutional mechanism, and strengthening internal management; adhering to the overall design, advancing in an orderly fashion, making breakthroughs in key areas, and summarizing the system; adhering to the The central government to determine the direction and principles of reform, based on China's national conditions, and encourage local emancipation of thought, according to local conditions, bold exploration and innovation.
Second, the overall goal of the pilot, the main tasks and implementation steps
(C) the overall goal.
Constructing a public hospital service system with clear public welfare objectives, reasonable layout, appropriate scale, optimized structure, distinct levels, perfect function and efficiency, exploring the establishment of a division of labor and collaboration mechanism with the primary health care system, accelerating the formation of a diversified pattern of medical care, the formation of a more scientific and standardized management system of public hospitals, compensation mechanisms, operational mechanisms and regulatory mechanisms, and to strengthen the internal management of public hospitals, prompting the public hospitals to effectively fulfill their responsibilities. Internal management of public hospitals has been strengthened, and public hospitals have been prompted to effectively fulfill their public ****service functions and provide the public with safe, effective, convenient and inexpensive medical and health services. Formation of the general idea of public hospital reform and the main policy measures, to lay the foundation for the comprehensive promotion of public hospital reform.
(iv) Main tasks.
--Strengthen regional health planning. Reasonably determine the function, number and scale of public hospitals, optimize the structure and layout, and improve the service system.
--Reform the management system of public hospitals. Explore effective forms of separation of government affairs and management and operation, establish a coordinated, unified and efficient public hospital management system, scientifically define the responsibilities and powers of owners and managers of public hospitals, explore the establishment of a corporate governance structure for hospitals, and push forward the professionalization and specialization of hospital directors.
-Reform the compensation mechanism of public hospitals. Explore specific ways to realize the separation of medicine, change the situation in which medical institutions rely excessively on income from drug sales to maintain their operations, gradually abolish the policy of drug markups, reasonably adjust the price of medical services, improve the payment method of basic medical insurance, and implement the policy of financial subsidies. The implementation of Chinese medicine support policies.
-Reform the operation mechanism of public hospitals. Deepen the reform of the personnel system and income distribution system in public hospitals, and improve the economic operation and financial management system of public hospitals; strengthen the internal management of public hospitals, implement various hospital management systems, formulate disease diagnosis and treatment protocols and promote the implementation of accelerating the promotion of information technology, to ensure the quality of medical care, improve the efficiency of the service, control the cost of medical care, and to facilitate access to health care.
--Sound public hospital regulatory mechanism. Implement hospital information disclosure, improve the performance appraisal system of public hospitals, and strengthen the supervision of medical safety and quality and economic operation.
--To form a diversified pattern of medical operation. Encourage, support and guide social capital to enter the field of medical services, improve the policy system, create a fair competitive environment for the operation of non-public medical and health institutions, guide, encourage and support the development of non-public medical and health institutions, and promote mutual cooperation and orderly competition among medical and health institutions of different ownerships, so as to satisfy the public's demand for medical services at different levels.
(V) Implementation steps.
In 2009, according to the General Office of the State Council, "five key reforms of the medical and health system in 2009 work arrangements" (State Office of the letter [2009] No. 75), the provinces, autonomous regions and municipalities directly under the Central Government have been selected 1-2 cities (urban areas) as a pilot city of public hospital reform. The state has selected 16 representative cities within the scope of pilot cities around the country as pilot cities for public hospital reform under the guidance of the state contact.
The pilot work of public hospital reform began to be promoted in 2010. It will strengthen the research and supervision of the pilot cities, study and solve the existing problems in a timely manner, strengthen the exchange of information and guidance and training, and carry out the evaluation work in due course. Continuously summarize the experience of the pilot work of public hospital reform, improve the overall idea of public hospital reform and the main policy measures, and gradually promote the reform of public hospitals throughout the country.
Three, the main content of the pilot
(F) improve the public hospital service system.
Strengthening the planning and regulation of public hospitals. Provincial people's governments formulate standards for the allocation of health resources, and organize the preparation of regional health planning and regional medical institution setup planning. Reasonably determine the functional positioning of various types of public hospitals at all levels. Municipal health administration (including Chinese medicine management) departments above the municipal level in accordance with their respective responsibilities, in accordance with the requirements of regional health planning and regional medical institutions set up planning, study and formulate this level of government is responsible for organizing the setting up of public hospitals and development planning, on the basis of careful calculations, clearly defined categories of all types of public hospitals at all levels, the number of size, layout, structure and large-scale medical equipment configuration standards. Existing medical and health resources are fully utilized and optimally allocated, and new health resources must be in line with regional health planning. For some public hospitals, they may be relocated, integrated, transformed and restructured in a planned and step-by-step manner to promote the optimization and adjustment of the structure and layout of public hospitals.
Establishing a mechanism for division of labor and collaboration among public hospitals and between public hospitals and urban and rural primary health care institutions. First-class and some second-class hospitals in cities should be transformed into community health service organizations in accordance with regional health planning. Public hospitals drive the development of primary healthcare organizations through technical support, personnel training, management guidance and other means, so that public hospital reform and the sound primary healthcare system are closely coordinated and mutually reinforcing. The establishment of a mechanism for the division of labor and collaboration between public hospitals and primary medical and health care institutions, the implementation of graded medical care and two-way referrals, and the clarification of the functional positioning of public hospitals above the second level and efforts to improve the service capacity and level of primary medical and health care institutions, while at the same time giving full play to the guiding and regulating roles of prices, basic medical insurance payment policies and other factors to guide the sinking of general medical treatment to the grassroots level. Where conditions exist, hospitals can promote the rational allocation of medical resources through cooperation, trusteeship and reorganization. The development of elderly care, rehabilitation and other extended services, and gradually realize the separation of acute and chronic diseases.
Focusing on strengthening the capacity building of county-level hospitals, and implementing peer-to-peer support for urban and rural hospitals. Promoting the standardized construction of county-level hospitals, and improving the operational rooms and equipment conditions of county-level hospitals. Improve the system of counterpart support for urban and rural hospitals, strengthen the construction of talent teams in multiple forms and through multiple channels, and gradually improve the quality of personnel and the level of competence of county-level hospitals.
(7) Reform of the public hospital management system.
Clearly define the responsibilities of governments at all levels in organizing public hospitals. Central and provincial people's governments are responsible for organizing the national or provincial medical centers that undertake the comprehensive functions of diagnosis and treatment of difficult and critical diseases, medical research and teaching; county (city, district) level people's governments are mainly responsible for organizing county-level public hospitals; other public hospitals are organized by the people's governments of municipalities that have set up districts.
Actively exploring effective forms of separation of management and operation. In accordance with the principle of separating the functions of medical service supervision and the functions of medical institutions, to promote the government health and other departments, state-owned enterprises and institutions belonging to the localized management of hospitals, and gradually realize the unified management of public hospitals. Areas with the necessary conditions can set up specialized agencies responsible for asset management, financial supervision and the appointment of key hospital officials, and establish a coordinated, unified and efficient public hospital management system. Relevant government departments, in accordance with their responsibilities, formulate and implement policies and measures for the development and construction of public hospitals set up according to the plan, staffing, government investment, medicine prices, income distribution and other policies and measures, so as to provide safeguards for public hospitals to fulfill their functions as public **** services. Health, education and other administrative departments to actively study and explore the university hospital management system reform.
(viii) Reform of public hospitals corporate governance mechanism.
Clearly define the main body of the government-run hospitals, scientifically define the responsibilities and powers of the owners and managers; explore the establishment of various forms of public hospitals with the Council as the core of the legal person governance structure, clearly defined in the major matters of responsibility, the formation of decision-making, implementation, supervision and mutual checks and balances of the power to operate the mechanism. The implementation of the independent legal person status of public hospitals, strengthen the specific management functions and responsibilities, and enhance the vitality of public hospitals.
Developing a management system for the qualification, selection and appointment of public hospital directors, and promoting professionalization and specialization. To establish a public hospital performance appraisal management system centered on public welfare, and to explore the establishment of incentive and constraint mechanisms for hospital directors.
(ix) Reform the internal operation mechanism of public hospitals.
Improve the internal decision-making and implementation mechanism of hospitals. Improve the dean's responsibility system. In accordance with the provisions of the corporate governance structure to carry out management responsibilities, major decisions, important cadres, major projects, investment, the use of large sums of money and other matters must be discussed collectively by the leadership team of the hospital and in accordance with the management authority and the provisions of the procedure for approval and implementation. Implement openness of hospital affairs and promote democratic management. Improve the organizational structure of the hospital, rules and regulations and job responsibilities, and promote the institutionalization, standardization and modernization of hospital management.
Improve the financial and accounting management system of the hospital. Strict budget management and revenue and expenditure management, strengthen cost accounting and control. Actively promote the reform of the hospital financial system and accounting system, strict centralized and unified financial management, strengthen asset management, establish and improve internal control, the implementation of internal and external audit system. In large public hospitals to explore the implementation of the chief accountant system.
Deepen the reform of the personnel system of public hospitals, improve the distribution of incentives. Scientific and reasonable approval of public hospital staffing. Establish and improve the personnel management system with the employment system and job management system as the main content. To professional and technical ability, work performance and medical ethics as the main evaluation criteria, improve the health professionals and technicians title appraisal system. Reasonably determine the level of treatment for medical personnel, improve the personnel performance appraisal system, and implement a job performance pay system that reflects the work characteristics of medical personnel and fully mobilizes their motivation. Explore ways to implement and standardize the practice of registered physicians in multiple locations, and guide the reasonable mobility of medical personnel.
(j) Reform the compensation mechanism of public hospitals.
Promoting the separation of medicines, reforming the mechanism of compensating doctors with medicines, and gradually changing the compensation of public hospitals from three channels of fees for services, income from drug markups and government subsidies to two channels of fees for services and government subsidies. Charges for services and government subsidies are reasonably determined by each region in accordance with the relevant provisions of the state, taking into account the hospital's functional positioning, the affordability of the medical insurance fund, local financial capacity, the income level of urban and rural residents, and the affordability of price adjustments and other factors.
Reasonable adjustment of pharmaceutical prices, and gradually abolish the policy of drug mark-up. On the basis of cost accounting, rationalize the price of medical technology services, reduce the price of drugs and large medical equipment inspection and treatment, and strengthen the price management of medical consumables. The gradual abolition of the drug markup policy has led to a reduction in the reasonable incomes of public hospitals, which has been compensated for by measures such as the establishment of additional fees for pharmaceutical services and the adjustment of some technical service charges, as well as by means of payments from the medical insurance fund and increased government investment. Pharmaceutical service fees are, in principle, reasonably determined in accordance with the cost of pharmaceutical services, taking into account such factors as social affordability, and are included in the scope of reimbursement under basic medical insurance. Can also be carried out on the hospital sales of drugs differential markup pilot, to guide hospitals to rationalize the use of drugs.
Improving the reform of the medical insurance payment system. Improve the payment of basic medical insurance expenses, actively explore the implementation of payment by type of disease, capitation, total prepayment, etc., timely and full payment of the costs in line with the medical insurance policy and the provisions of the agreement; the implementation of medical assistance, public welfare and charitable works of the project management and payment system; improve the payment methods of supplemental insurance, commercial health insurance and road traffic insurance, and effectively reduce the burden of the people's medical expenses. On the premise of strengthening government guidance, reasonably determining the guiding price of medical services, and reasonably controlling the total cost of medicine and the sub-average cost of hospitals, explore the negotiation of the scope of services, payment methods, payment standards, and quality of service requirements by hospitals (hospital representatives) and medical insurance agencies.
Increase government investment. The government is responsible for the public hospital capital construction and large-scale equipment purchases, the development of key disciplines, in line with national provisions of the retired personnel costs and policy loss subsidies, etc., public hospitals to undertake public **** health tasks to give special subsidies to ensure that the government designated emergency medical treatment, disaster relief, foreign aid, support for agriculture, support for the border and support for the community, such as public **** service funds, the Chinese medicine hospitals (ethnomedicine hospitals), infectious disease hospitals , occupational disease prevention and treatment hospitals, psychiatric hospitals, maternity hospitals and children's hospitals, etc. in the input policy to be tilted.
(k) to strengthen the management of public hospitals.
Strengthening the quality management of medical services. Improvement and implementation of hospital management rules and regulations and personnel responsibility system, improve medical quality management organization, the implementation of disease diagnosis and treatment norms and clinical application of drugs guide, standardize the clinical examination, diagnosis, treatment, the use of drugs and implants (intermediary) into the class of medical equipment behavior, and continue to improve the quality of medical care, to protect the safety of patients. Strengthen the key disciplines and talent team construction, improve medical service capacity and level. It is necessary to standardize the proportion of public hospitals of all levels and types that are equipped with and use national essential medicines, establish and improve the management system for the procurement and supply of national essential medicines, and promote the preferential equipping of public hospitals with and the rational use of essential medicines. The application of appropriate technologies and basic medicines should be promoted, and mutual recognition of examination results in medical institutions at the same level should be gradually implemented on the basis of strengthened standardization and quality assurance, so as to reduce the cost of medical services. It is studying the formulation of disease diagnosis and treatment protocols and promoting their implementation, as well as standardizing the treatment of disease types.
Improving hospital services. Efforts are being made to shorten patients' waiting time through measures such as the provision of booking of consultation services, unimpeded access to emergency green channels, optimization of the service flow, and classification of consultation and treatment according to the condition of the patient. Establishment of patient complaint management mechanism, timely and effective handling of patient complaints and medical disputes, to build a harmonious doctor-patient relationship.
Improve the level of hospital informationization. Focusing on hospital management and electronic medical records, public hospitals are promoting the construction of informatization to improve management and service levels. It will study and formulate regulations and standards for the internal information management of medical institutions, make full use of existing resources to gradually establish interconnection mechanisms between hospitals, between higher-level hospitals and primary medical and healthcare service organizations, and between hospitals and public ****health institutions and health insurance agencies, and build a convenient and efficient hospital information platform.
(xii) Reform of the regulatory mechanism for public hospitals.
Implementation of industry-wide supervision. Strengthen the health administration (including the management of traditional Chinese medicine) department of medical services regulatory functions, establish and improve the medical services regulatory mechanism. All medical and health institutions, regardless of ownership, investment, affiliation and business nature, by the health administrative (including Chinese medicine management) departments to implement unified planning, unified access, unified supervision. Improvement of institutions, personnel, technology, equipment, access and exit mechanism, the implementation of industry-wide supervision in accordance with the law.
Strengthen the public hospital medical service safety and quality supervision. Fully relying on the existing public hospitals with high diagnosis and treatment technology level and quality management level, establish and improve the national, provincial, municipal (local) three-level medical quality and safety control and evaluation system and all levels of professional medical quality control and evaluation organizations, strengthen medical quality and safety evaluation and control work, and continuously improve the quality of medical services. Improvement of all levels and types of hospital management evaluation system, continue to do a good job of hospital management assessment and evaluation work.
Strengthening the supervision of the operation of public hospitals. Health administrative departments should strengthen the supervision of the functional positioning and development planning of public hospitals. Strictly control the scale of construction of public hospitals, standards and lending behavior, and strengthen the allocation of large medical equipment management. Control the scale of special needs services in public hospitals, with the proportion of public hospitals providing special needs services not exceeding 10% of all medical services. Improve the financial analysis and reporting system, and strengthen the financial supervision of public hospitals. To establish and improve the financial audit of public hospitals and the economic responsibility audit system of hospital directors.
Establishing a system of supervision with the participation of multiple parties in society, and giving full play to the role of supervision of public hospitals by all parties in society. Comprehensively promote the hospital information disclosure system, accept social supervision. Strengthening the role of medical insurance agencies in monitoring and controlling medical services, monitoring the services provided by medical institutions in accordance with the agreement, and incorporating them into the assessment and evaluation of public hospitals. Give full play to the auditing and supervisory role of accounting firms, and strengthen the role of medical industry associations (societies) in the self-regulatory management and supervision of public hospitals. The establishment of third-party mediation mechanisms for doctor-patient disputes, the active development of medical accidental injury insurance and medical liability insurance, improve the mediation mechanism for medical disputes, and crack down on "medical malpractice".
(xiii) The establishment of a system of standardized training of resident physicians.
Gradually explore the establishment of a system of standardized training for resident doctors that conforms to the laws of growth of medical talents and adapts to China's national conditions, and make the training of resident doctors a mandatory part of the training of general practitioners and specialists. Through the pilot, explore and improve the system model, norms and standards, institutional mechanism and supporting policies for the standardized training of resident doctors, establish the financial guarantee mechanism for the standardized training of resident doctors, improve the personnel guarantee mechanism for the establishment management, job setting, personnel recruitment and salary guarantee and other related policies. During the pilot period, the focus will be on training specialty-oriented residents for county-level hospitals and generalist-oriented clinicians for urban and rural primary healthcare institutions.
(xiv) Accelerating the pattern of diversified medical management.
Encourage, support and guide the development of social capital in medical and health care, and accelerate the formation of a diversified system of running medical institutions with diversified investment bodies and investment methods. Improve policies and measures to encourage social forces to organize non-profit hospitals. In the regional health planning and medical institutions set up planning, to leave enough space for non-public hospitals. Non-public hospitals will enjoy the same treatment as public hospitals in terms of medical insurance designation, scientific research projects, title evaluation, continuing education, etc., and will be treated equally in terms of access to services, supervision and management. The government may take the form of purchasing services from non-public hospitals to undertake public **** health services and public **** services. Implement preferential tax policies for non-profit hospitals and improve preferential tax policies for for-profit hospitals. Strengthen the supervision of non-public hospitals, and guide non-public hospitals to operate in accordance with the law, strengthen management, strict self-discipline, and healthy development. Provincial health administrative departments, in conjunction with relevant departments, will determine the scope, conditions, procedures and supporting policies and measures for the restructuring of public hospitals in accordance with regional health planning and the planning of the establishment of regional medical institutions, and will actively and steadily transform some public hospitals into non-public hospitals to ensure the preservation of the value of state-owned assets and the lawful rights and interests of employees. The public hospital restructuring program must fully solicit the opinions of employees. Allow commercial insurance institutions to participate in the restructuring of public hospitals.
Four, the pilot organization and leadership
(xv) pilot leadership mechanism.
The pilot public hospital reform is a heavy task and difficult, we must fully understand the importance, complexity and enormity of public hospital reform, and effectively strengthen the leadership of the pilot public hospital reform. Pilot work by the State Council to deepen the reform of the medical and health system leading group (hereinafter referred to as the State Council leading group of health care reform) unified leadership, the people's government of the pilot city and the location of the provincial people's government is responsible for the implementation of the Ministry of Health to organize and promote the pilot work, to strengthen the work of the pilot city of the guidance, training, assessment and supervision of the work of the other departments concerned to actively support and cooperate.
(16) the organization and implementation of the pilot.
The people's government of the pilot city shall establish a pilot work leading agency responsible for organizational coordination, guidance and supervision. According to the "Central *** State Council on deepening the reform of the medical and health system", the State Council "reform of the medical and health system in the near future focus on the implementation of the program (2009-2011)" and the "guidance" requirements, full research, multi-disciplinary argumentation, extensive consultation, the development of the pilot implementation program. The implementation plan should adhere to the directions and principles set by the central government, strive to refine, actualize and concretize the plan, highlight key aspects and key links, emphasize innovation in the system and mechanism, conduct in-depth explorations, make bold attempts, and strive to make breakthroughs and achieve practical results. The pilot implementation plan will be reviewed by the provincial medical reform leading group and then organized and implemented, and reported to the Ministry of Health and the State Council Medical Reform Leading Group Office for the record. Develop and implement supporting policies and measures for the pilot, coordinate and solve problems arising from the pilot work, and report major issues to the provincial people's government and relevant state departments in a timely manner.
(xvii) Guidance, assessment and supervision of the pilot.
Provincial people's governments shall strengthen the guidance and support for the pilot cities. The relevant departments of the State Council will take up their respective responsibilities, work closely together, strengthen the guidance and assessment of the pilot work, summarize the pilot situation in a timely manner, improve the relevant policies and measures, and promote the pilot work to be carried out in a positive and steady manner.
(xviii) Create a favorable pilot environment.
The pilot areas should do a good job of public opinion propaganda work, strengthen the publicity on the importance of the pilot work of public hospital reform, the guiding ideology, the basic principles, the main tasks and policies and measures, to mobilize the majority of medical personnel to participate in the reform of the enthusiasm and initiative, and to strive for the understanding and support of the masses of the people and all walks of life. Health departments and publicity departments should work closely together to strengthen the public hospital reform pilot public opinion monitoring and research and judgment, and actively guide public opinion, firm confidence in the reform, and reasonably guide social expectations.