(A) the infrastructure of rural tertiary health service institutions is backward
First, the business premises are outdated. According to the survey, the gap of business rooms in county hospitals and county Chinese medicine hospitals in poverty-stricken counties, border counties and minority counties at the provincial level is 40%, and the average proportion of dangerous houses is 20%; The average ratio of dangerous buildings in county-level maternal and child health care institutions in China is 13%, of which 80% are concentrated in the central and western regions. Most township hospitals basically do not have the conditions for isolation and transportation of infectious diseases, and water, electricity and heating facilities are not matched. The crisis rate of township hospitals in the central and western regions is 33.6%, and the proportion of township hospitals that need to be rebuilt is 70%. The situation in the village clinic is even worse.
Second, the lack of common equipment. About 60% county hospitals need to equip or update ECG monitors; 90% county maternal and child health care institutions need to equip or update neonatal ECG monitors. 80% township hospitals need to equip or update X-ray machines; Up to now, individual hospitals only rely on the "three-piece set" (sphygmomanometer, thermometer, stethoscope) to barely maintain a low level of medical services. There are no sphygmomanometers in 0/3.2% village clinics in the western region/Kloc, and 40.5% village clinics do not have disinfection pots, so it is impossible to carry out basic examination and diagnosis and ensure the cleanliness and disinfection of medical instruments.
The third is poor accessibility. In some rural areas, especially remote rural areas, health resources are insufficient, which makes it difficult for residents to seek medical treatment. According to the report of the third national health service survey in 2003, four types of rural areas (remote and poor) 18% families are more than 5 kilometers away from the nearest medical institution, and 25% families spend more than 30 minutes to get to the nearest medical institution.
(B) the lack of rural health technical personnel, low level of medical services.
According to the third national health service survey, among the health technicians in township hospitals, the proportion of intermediate or above titles is 1 1.5%, and the proportion of college degree or above is 19.3%. In poverty-stricken areas, only 15% township hospitals can perform appendectomy, and some hospitals can't even do the simplest debridement and suture, which not only brings inconvenience to farmers, but also increases the economic burden of patients, and even delays their illness and endangers their lives.
(C) the lack of medical security system for farmers
There are still 79. 1% of the rural population in China who have no medical security, and basically rely on their own expenses to see a doctor, with a heavy burden of medical expenses; 45.8% of rural residents should see a doctor instead of seeing a doctor, and 30.3% of rural residents were not hospitalized because of hospitalization, of which 38.6% and 75.5% were not hospitalized because of economic reasons.
(D) The reform of rural health management system lags behind, and the operating mechanism lacks vitality.
The rural health management system has not been straightened out, the pace of county management of township hospitals is slow, the pattern of running hospitals with diversified investment and orderly competition has not yet been formed, the internal management and operation mechanism of rural health institutions is also lacking in vitality, the reform of personnel system and distribution system is lagging behind, and the effective incentive and elimination mechanism has not yet been formed.
Two, the main task of building and improving the new rural health service system
Due to the duality of long-term economic structure, China has formed a medical security and medical service system that divides urban and rural areas. The rural population, which accounts for 7 1%, has only 20% medical resources. The medical facilities for urban residents are mainly provided by the state, and the rural areas are mainly solved by farmers themselves. The allocation of health resources "pays more attention to cities than rural areas", and the government's long-term investment in rural health is insufficient, resulting in imperfect rural health service system, incomplete functions and low service capacity, which makes it difficult to guarantee farmers' public health and basic medical needs, and the health level of urban and rural residents is quite different.
According to the requirements of building a new socialist countryside and building a harmonious society, we must take accelerating rural health development as an important way to solve the "three rural issues", coordinate urban and rural development and promote social equity. In terms of development goals, we should take the realization of basic public services and medical care for everyone as the direction of efforts as soon as possible. In the development policy, we should take the development of rural health as the top priority of the whole health development, adhere to the government's leadership, take public finance as the main support, and focus on accelerating the construction of rural health service system. At present, we should focus on three tasks:
First, strengthen the rural health service system and facilities construction. In view of the weak links such as outdated rural health houses and equipment shortage, in accordance with the principles of unified planning, graded responsibility, integrated resources, supplementary planning, overall planning and step-by-step implementation, the central and local governments will increase investment, transform and expand the dilapidated business houses of county, township and village medical and health institutions (with emphasis on township hospitals), and equip them with basic medical equipment, so that they can develop basic medical and public health services as soon as possible.
The construction of rural health service system and facilities should focus on township hospitals, strengthen the construction of county hospitals, county hospitals of traditional Chinese medicine (ethnic medicine), county maternal and child health centers and village clinics, and form a service network with county health institutions as the leader, township hospitals as the center and village clinics as the foundation. The central finance mainly supports the infrastructure construction of rural health institutions in the central and western regions, and at the same time arranges a small amount of guiding funds to take into account some difficult areas in the east. In terms of construction priorities, we should build facilities in key areas of AIDS, schistosomiasis and tuberculosis that are most harmful to farmers at present, and at the same time, according to the requirements of the coverage progress of the new rural cooperative medical system, promote infrastructure construction accordingly, and give priority to solving the most urgent and difficult problems in hospital construction. In terms of construction steps, we will first comprehensively promote the construction of township hospitals, and gradually start construction projects such as county hospitals, maternal and child health hospitals, and county Chinese medicine hospitals (ethnic hospitals), which will be promoted year by year. Strive to basically change the dilapidated houses and equipment shortage of the rural health service system in China by 20 10, comprehensively improve the infrastructure conditions and comprehensively improve the service capacity and level.
The second is to speed up the establishment and improvement of the new rural cooperative medical system. The establishment of a new rural cooperative medical system should be regarded as the basic system construction to provide basic medical services for farmers and ensure the operation of rural health institutions. On the basis of summarizing the pilot experience, we should further expand the pilot, accelerate the pace of construction, and strive to achieve the overall goal of basically covering rural residents by 20 10. At the same time, the standard and scope of central subsidies should be gradually expanded. It has been confirmed that from 2006, the central government will increase the annual subsidy for farmers participating in the new rural cooperative medical system in the central and western regions except cities and towns to 20 yuan, and the local finance will also increase accordingly 10 yuan. In the future, we should gradually raise the subsidy standard according to the financial situation. It is necessary to improve the management and operation mechanism and implement supporting policies. Establish a complete organizational management system, implement a scientific fund management model, adopt various forms of compensation and simple and reasonable reimbursement settlement methods, and thoroughly study and explore ways to solve the outstanding problems in the collection of farmers' personal expenses, review and reimbursement, medical assistance, medical service supervision, and handling capacity building.
The third is to promote the reform of rural health management system and operation mechanism. Accelerate the formulation and implementation of regional health planning, rationally plan layout, and integrate rural health resources. The government runs a public health center in each township, defines its functions and responsibilities, brings its personnel, business and funds into county-level management, and implements two lines of revenue and expenditure management. Actively promote the reform of the personnel distribution system, implement the appointment system for the directors of township hospitals, and other personnel should create jobs and compete for posts, implement the post salary system, and improve the overall service level and operational efficiency. At the same time, it is necessary to promote the classified management system of medical institutions, break the restrictions of departments and ownership, explore various forms of running medical institutions, and establish an effective incentive mechanism for social investment and donation to organize rural health. Accelerate the reform of the internal operation mechanism of county-level public medical institutions. Strengthen the government's regulation and supervision of rural medical and health fields, standardize the drug market and medical behavior, reasonably control drug prices, and establish a rural drug price management system and rural medical service standards that are compatible with farmers' income levels.