County to promote the comprehensive reform of public hospitals research report
County public hospitals are the leader of the rural three-tier health care service network, bear the burden of rural public **** health, basic medical services, play an important role in the rescue of the dead, preventing and treating diseases, responding to public **** health emergencies, the construction of a new socialist countryside, and other aspects. This paper analyzes the current situation and problems of public hospital reform in our county, and puts forward countermeasures and suggestions to promote public hospital reform.
First, the basic situation
The county's existing medical and health care institutions at all levels of 195, of which: government-organized medical and health care institutions 16 (3 county-level public health care institutions, health planning units 6, 6 township health centers and a community health service center), 103 village health clinics, 2 private hospitals, individual clinics 57 individual clinics, individual office neighborhood health station 10, enterprises and institutions to run 7 medical clinics. County health care institutions approved preparation of 1,221 beds (including 70 private medical institutions), the actual opening of 1,038 beds, the total number of health personnel 1,569 people; county per 1,000 people with 5.34 beds, per 1,000 people with a licensed (assistant) physician 2.23 people, per 1,000 people with registered nurses 2.58 people.
On October 30, 2014, the county people's hospital and the county hospital of traditional Chinese medicine officially launched the comprehensive reform of county-level public hospitals, all drugs (except traditional Chinese medicine drinks) to implement the zero-differential rate of sales, and timely adjustment of medical service prices as required. The county women's service center is not included in the reform of the pilot unit, is still the implementation of zero-differential rate sales of medicines. in April 2015, the county to the county public hospital comprehensive reform as the core, the full start of the implementation of health care institutions reform, county public hospital management system reform, cadres and personnel system reform, reform of the income distribution system reform and health care inputs reform of the county's five as the main content of the comprehensive reform of the county's health and health.
Second, the main practice
(a) the implementation of the reform initiatives, the masses to benefit. The first is to break the mechanism of medicine. County public hospitals to implement the drug (except for traditional Chinese medicine)? Zero differential rate? Since then, the cumulative burden of reducing the patient's medication 14.88 million yuan. Second, improve the drug supply guarantee system. Start the county's basic drugs (2014) and commonly used low-priced drugs unified online centralized procurement work, the county's primary health care institutions drug distribution rate stabilized at more than 90%; the county people's hospitals, county hospitals of traditional Chinese medicine through public bidding, including Chinese medicine, including the implementation of the centralized distribution management of all medicines, and effective protection of the county's masses of safe, inexpensive and convenient medication. Third, the establishment of a hierarchical diagnosis and treatment system. The establishment of county-level public hospitals and primary medical institutions to support the division of labor and collaboration mechanism, explore the medical model, the development and implementation of the county's New Rural Cooperative graded diagnosis and treatment implementation program, clear graded diagnosis and treatment standards, out-of-county clinic rate is controlled at less than 10%. In accordance with provincial and municipal work requirements, it is proposed to carry out in the county? Internet + hierarchical diagnosis and treatment? Beneficial medical services, the real establishment of grass-roots first diagnosis, two-way referral, emergency and slow treatment, up and down the linkage of the hierarchical diagnosis and treatment system, and effectively allow the masses to afford to see a disease, see a good disease, convenient to see a doctor.
(2) adhere to the government-led, hospitals have to develop. First, strengthen the reform organization and leadership. The establishment of the county governor as the head of the relevant departments as members of the 'comprehensive reform leading group, regular research and deployment of the work. Formulate the implementation program, clear reform scope, main tasks, implementation steps and work requirements. Clear division of responsibility, the overall arrangements for the deployment of work, the responsibilities and tasks and work progress time frame clear to the responsible departments and units. Through a variety of forms of publicity the spirit of health care reform, extensive publicity and education, to create a good atmosphere for reform, to guide the community to understand and support, and mobilize medical staff to actively participate in the reform. Second, optimize the allocation of medical resources. Preparation of county medical and health service system planning (2016-2020), clear functional positioning of medical institutions at all levels, the size of beds, construction standards and equipment configuration standards, etc., to promote the reasonable flow of medical resources. Supporting social operation of medical care, and liberalizing the conditions for approval of individual clinic settings in accordance with the law. Improve the grass-roots health and family planning service system construction, in the former Mingfeng Township Health Center on the basis of the formation of Mingfeng Township Community Health Service Center, August 30, 2015 officially listed in operation. Third, to enhance the service capacity of county-level public hospitals. Increase government investment, consolidate the results of existing clinical key specialties in public hospitals, planning to create ? Thirteenth Five-Year? Key specialties. The implementation of urban tertiary hospitals to support county-level hospitals. Actively promote the construction of health planning team, to ensure the stability of the industry team. Strengthen the talent research, the county to develop and introduce preferential policies for the introduction of high-end health and family planning personnel. Comprehensively complete the construction of hospital information technology, each system gradually realize interconnection and information **** enjoy. Fourth, to promote the construction of the county medical center. County medical center in accordance with ? Meet the function, first-class, ecological and practical, save beautiful, a planning, phased implementation, from strength to strength, do our best? The principle of construction scale according to 600 standard beds for the overall planning and design, the estimated total project investment of 178 million yuan, a building area of 53,336 square meters, is scheduled for May 2018 to be completed and put into use. After the completion of the hospital infrastructure to reach the first-class standards of similar counties and municipalities, will comprehensively improve the mass medical environment to meet the needs of the masses in the next 30 years.
(C) optimize the operation mechanism, the government has the people's hearts. First, the establishment of a new mechanism for the operation of public hospitals. Improve the corporate governance structure of county-level public hospitals; improve the performance appraisal system, the development of county-level public hospital performance appraisal methods; improve the financial management system of hospitals, and actively carry out cost accounting, to further standardize the financial management of public hospitals; improve the medical management system, standardize the behavior of medical services, and optimize the service environment, to further enhance the efficiency of hospital management and operation. 2016 January-June, two public hospitals The number of outpatient and emergency consultations and discharges increased by 6.1% and 0.2% respectively compared to 2015 year-on-year. Second, the establishment of public hospital compensation mechanism. The county party committee and government clear county public hospital compensation program, public hospitals, capital construction, eligible personnel costs, etc. into the financial budget, to solve the hospital reform concerns. 2015 county budget county hospitals to abolish drug markups to reduce the income of 20% of the provision of 1,493,000 yuan, the 2016 budget of 1,330,000 yuan. Third, the implementation of medical service price adjustment policy. since November 2015, the county public hospitals to implement the province and city of the new round of medical service price adjustment policy, and combined with the actual adjustment of medical service project structure, the hospital loss situation has been reversed, the amount of the loss is compensated by the higher level of special funding, without increasing the burden on the public. Fourth, the implementation of personnel distribution system reform. New personnel are unified by the human resources and social services department to implement open recruitment, according to the standard reasonable allocation of medical technology, management and logistical support staff. Promote the employment system and job management system, complete the township health center president, vice president, middle-level cadres, staff competition. Approve performance pay for county-level public hospitals, and approve the total amount of performance pay in accordance with the number of people on duty in the previous year and 2.5 times the performance pay baseline of 23,000 yuan, to protect the treatment of employees. Fifth, reforming the health insurance payment system. County-level public hospitals have implemented a total control under the payment method reform by disease, capitation payment. 2 county-level public hospitals in the implementation of the New Agricultural Cooperative 85 kinds of single-patient payment, standardize the management, and reduce the cost of medical care. Sixth, strengthening industry supervision. Strengthen the medical service behavior supervision and target responsibility system assessment, a number of initiatives to control the unreasonable growth of medical costs, reduce the burden of medicine on the masses. Deepen the construction of medical ethics activities, strengthen the regular assessment of medical staff and medical institutions, in recent years, the satisfaction rate of the public satisfaction survey continued to remain at more than 95%.
Third, the main problems
(a) county-level public hospitals are not strong comprehensive service capacity. County medical resource advantage is not fully utilized and played, two county-level public medical institutions function positioning is not allowed, comprehensive medical and traditional Chinese medicine services leading role is not fully played, clinical focus on specialties featured advantages are not obvious, medical equipment resources utilization rate is not high, the public health care environment needs to be improved.
(ii) the establishment of personnel system reform is not enough to promote. Currently not according to the standard re-authorized county-level public hospitals total staffing, the preparation of the record system is difficult to implement, the public hospital personnel from the identity management to job management requirements can not be put in place, the hospital employment autonomy is not enough to implement. Hospital performance appraisal of equal pay for equal work, job management and the county non-staff management system does not match, etc., affecting the hospital staff motivation and team stability.
(C) health care talent problem is more prominent. Our county lacks medical high-level talents and excellent professional discipline leader, the total amount of clinical medical professional and technical personnel is insufficient; village doctors ageing, lack of successors, pension insurance system has not been established. Health care personnel team is weak, health care technical service capacity is insufficient, restricting the development of health care in our county.
Fourth, countermeasures and recommendations
First, increase the reform to promote efforts. Adhering to the government-led, clear departmental responsibilities, strengthen the departmental linkage synergy, conscientiously fulfill the government's responsibility to run the medical, overall promotion of comprehensive institutional reform.
The second is to fully implement the reform task. Effectively implement the government investment, personnel allocation system reform, hospital management and service capacity enhancement and other key supporting reform work, and actively explore solutions to the lack of comprehensive service capacity of county hospitals, the establishment of personnel system reform is not in place, the lack of health care personnel, to further accelerate the pace of construction of the county medical center, to ensure the completion of the comprehensive reform of the various tasks.
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