(1) Define the responsibilities of rural doctors.
Rural doctors (including practicing physicians and practicing assistant physicians practicing in village clinics, the same below) mainly provide public health and basic medical services to rural residents, including in township health centers and professional hospitals. Under the guidance of public health institutions, carry out basic public health services in accordance with service standards and specifications; assist professional public health institutions in implementing major public health service projects, and promptly report infectious disease epidemics and poisonings in accordance with regulations incidents, handle public health emergencies, etc.; use appropriate drugs, appropriate technologies and traditional Chinese medicine methods to provide rural residents with general diagnosis and treatment of common and frequently-occurring diseases and emergency outpatient services, and promptly refer patients who exceed the diagnosis and treatment capacity to Township health centers and county-level medical institutions; entrusted by the health administration department to fill in statistical reports, keep relevant information, carry out publicity and education, and assist in the financing of the New Rural Cooperative Medical System.
(2) Clarify the establishment of village clinics and the allocation tasks of rural doctors.
1. Scientifically plan and set up village clinics. The county-level health administrative department shall formulate a plan for the establishment of village clinics based on regional health plans and medical institution establishment plans, taking into account factors such as service population, residents' needs, and geographical conditions. In principle, one village clinic is set up in each administrative village. Administrative villages with larger populations or dispersed residents can add additional clinics based on the principle that residents can reach the clinic within 30 minutes on foot; in principle, administrative villages where township health centers are located do not have village clinics. room.
Village clinics are mainly organized by the government, collectives or units. They can also be jointly organized by rural doctors or individually, and are set up with the approval of the county-level health administration department. The buildings and basic equipment of village clinics are equipped in accordance with national standards. Organized by the government, the construction land will be determined by the local township government and village committee, and will be provided free of charge to the village clinic for permanent use. Various localities should adopt various forms such as government subsidies, public construction and private operation to support the construction of village clinics and the purchase of basic equipment.
2. Properly deploy rural doctors. Rural doctors practicing in village clinics are allocated according to the ratio of 1.2‰ of the village's agricultural population (for villages with less than 1,000 people, one rural doctor is allocated), and are determined by the county-level health administration department in conjunction with relevant departments. Female rural doctors should be provided where conditions permit. Each village clinic has at least one rural doctor practicing. In principle, rural doctors should practice in village clinics.
For administrative villages that currently do not have village clinics and rural doctors, the local government must adopt various methods and measures before the end of 2011 to encourage qualified personnel to set up village clinics, or the government must build village health clinics. The health administration department recruits practicing (assistant) physicians, the township health center sends people to the site, or allocates rural doctors from neighboring villages to arrange for qualified doctors to practice in village clinics to ensure that every doctor who should practice by the end of 2011 Administrative villages with village clinics have one village clinic, and each village clinic has a rural doctor.
(3) Strengthen the management of rural doctors and village clinics.
1. Strengthen access management of rural doctors. Rural doctors must have a rural doctor practicing certificate or a practicing (assistant) physician certificate, be registered with the health administration department and obtain relevant practice licenses. Personnel engaged in nursing and other services in village clinics should also have corresponding legal qualifications. County-level health administrative departments must strictly follow relevant laws and regulations such as the Law on Practicing Physicians and the "Regulations on the Management of the Practice of Rural Doctors" to strengthen access management. In principle, new personnel entering the village clinic to engage in prevention, health care and medical services should have the qualifications of a practicing assistant physician or above. Strictly prohibit and resolutely crack down on the illegal practice of medicine by unqualified personnel.
2. Strengthen village-level health service management. County-level health administrative departments should strengthen supervision over the service behavior of rural doctors and village clinics, the use of drugs and equipment, and the coordination of new rural cooperative medical outpatient services. It is necessary to establish and improve rules, regulations and business technical processes that are in line with the functional positioning of village clinics, and organize training for rural doctors. It is necessary to scientifically divide the functions of township health centers and village clinics, reasonably allocate basic public health service tasks, and strengthen performance appraisal.
The assessment results are publicized in the administrative village where they are located and serve as the basis for calculating financial subsidies and dynamically adjusting rural doctors practicing in village clinics. County-level health, finance, price and other departments should strengthen supervision over the use of subsidy funds for rural doctors and village clinics, urge them to standardize accounting and financial management, disclose medical service and drug charging items and prices, and ensure that there are receipts and accounts for charging There are records and vouchers for expenditures.
3. Strengthen business guidance and integrated management. County-level health administrative departments entrust township health centers to provide technical guidance, business and drug and equipment supply management, and performance appraisal to rural doctors and village clinics. All localities should actively promote the integrated management of township health centers and village clinics without changing the identity of rural doctors and the legal person and property relationships of village clinics. The staff of village clinics that implement integrated management can be recruited through open competition by township health centers and deployed uniformly within the township. Township health centers should strengthen business guidance for rural doctors through business lectures, monthly meetings and other methods, and conduct daily supervision of rural doctors and village clinics on appropriate technology, supply and use of drugs and equipment, and new rural cooperative medical outpatient coordination and financial management. Under the unified organization of the county-level health administration department, rural doctors and village clinics will be assessed on the service quality and quantity, medical ethics and practice, and the implementation of the New Rural Cooperative Medical System policy.
4. Realize information management of village clinics. Incorporate village clinics into the scope of information construction and management of primary medical and health institutions. Before the end of June 2012, each administrative village must have a clinic equipped with computers, printers, card readers and electronic resident health record software, and make full use of information technology to coordinate its service activities, supply and use of medicines and equipment, and coordinate new rural cooperative medical outpatient services. etc. Strengthen management and implement performance appraisal, and improve the service capabilities and management level of rural doctors and village clinics. Before the end of June 2012, village clinic information management software based on residents’ electronic health records will be equipped, unified and standardized residents’ electronic health records will be established, unified electronic bills and prescriptions will be implemented in township hospitals and village clinics, and residents’ medical treatment will be gradually realized "All-in-one card".
(4) Implement the essential drug system and coordinate the new rural cooperative medical care outpatient service.
1. Implement the national essential medicine system in village clinics. Before the end of 2011, each administrative village must select one village clinic to implement the national essential medicine system, implement various policies of the national essential medicine system, and implement centralized procurement, equipment, use and zero-margin sales of essential medicines. Rural doctors practicing in village clinics must all use essential drugs, which are supplied by township health centers. The plan for the implementation of the national essential medicine system in village clinics will be issued separately.
2. Village clinics implement new rural cooperative medical outpatient services as a whole. Before the end of 2011, all qualified village clinics will be included in the management of designated medical institutions under the New Rural Cooperative Medical System, and the general diagnosis and treatment fees collected by the village clinics and the basic drugs used will be included in the payment scope of the New Rural Cooperative Medical System, and the payment ratio will not be lower than that in towns and villages. Payment ratio for medical treatment in health centers. The health administrative department and the New Rural Cooperative Medical System management agency must strengthen the supervision of rural doctors and village clinics’ medical expenses and service practices. While actively promoting the overall planning of New Rural Cooperative Medical Care outpatient services, they must accelerate the reform of the New Rural Cooperative Medical Care System payment method and implement the new rural cooperative medical care system according to the payment method. Various payment methods such as capitation payment and total prepayment guide and promote rural doctors and village clinics to change their service behavior and improve service quality. It is necessary to strengthen the supervision of the diagnosis and treatment and drug fees paid by the new rural cooperative medical care in village clinics, and seriously investigate and resolutely crack down on disciplinary and illegal activities such as forging medical records, decomposing prescriptions, double charging, false issuance of documents, etc. to defraud and obtain new rural cooperative medical funds.
(5) Effectively guarantee the reasonable income of rural doctors.
1. Improve the compensation policy for basic public health services. Rural doctors will be compensated through multiple channels based on the quantity and quality of services they provide. The basic public health services provided by rural doctors will be reasonably compensated mainly through government purchase of services. County-level health administrative departments shall clarify the specific content of basic public health services that should be provided by rural doctors based on the responsibilities, service capabilities and population of rural doctors. In principle, 40% of the rural basic public health service tasks should be Leave it to rural doctors.
Based on the performance appraisal results, a corresponding proportion of the national basic public health service funds shall be allocated to rural doctors in a timely and full amount, and shall not be deducted, squeezed, withheld or misappropriated.
2. Establish a compensation policy for basic medical services. Basic medical services provided by rural doctors are mainly paid for by individual patients and the New Rural Cooperative Medical System Fund. After the implementation of the national essential medicine system, the original registration fees, examination fees, injection fees and pharmaceutical service costs in village clinics will be combined into general diagnosis and treatment fees. The general diagnosis and treatment fee standard is tentatively set at 6 yuan/person, and the patient will pay 1 yuan out of pocket. , and the remaining 5 yuan will be paid by the New Rural Cooperative Medical Care Outpatient Coordination Fund in which he participates. All localities must strictly implement the general diagnosis and treatment fee standards for village clinics and the new rural cooperative medical care payment standards and methods uniformly formulated by the government price department.
3. Implement a zero-margin drug sales subsidy policy. After the implementation of the national essential medicine system in village clinics, in order to ensure that the reasonable income of rural doctors practicing in village clinics is not reduced, the government, after comprehensively considering the compensation for basic medical and public health services, has set an annual per capita standard of 3,000 yuan. Rural doctors who are staffed at a ratio of 1.2‰ and practice in village clinics will be subsidized for zero-margin drug sales. The subsidy funds are shared proportionally by the provincial and county finances. The sharing ratio is: 8:2 between the provincial finance and the counties extended by the western policy; 6:4 between the provincial finance and the counties not extended by the western policy.
(6) Establish a pension security and living subsidy system for rural doctors.
All localities should actively guide rural doctors to participate in the new rural social pension insurance. The government provides rural doctors with pension and living subsidies. Specifically: As of December 31, 2011, for rural doctors who have been reviewed and registered by the health administrative department, starting from January 1, 2012, for those who are over 60 years old and have practiced medicine for 20 years, they will be eligible for treatment from the age of 60. Starting from the month following the first year of their birthday, the finance department will provide a monthly living allowance of 65 yuan in accordance with regulations, and this will apply in the future. The fiscal sharing ratio of living subsidy funds at all levels is: 8:2 between provincial finance and counties extended by western policy; 6:4 between provincial finance and non-western policy extended counties. Living allowances are specifically distributed by township finance offices and township health centers.
After the implementation of the pension subsidy policy for rural doctors, rural doctors who are over 60 years old, are in good physical condition and are still competent in basic public health services and other professional work, can continue to work in the village clinic of their own free will. practice.
(7) Improve the professional quality and service level of rural doctors.
1. Strengthen professional training for rural doctors. Health administrative departments at all levels should formulate reasonable training plans for rural doctors, adopt various methods such as clinical training, centralized training, and urban and rural counterpart support, and select rural doctors to receive training in county-level medical and health institutions or medical schools to improve the professional quality of rural doctors. . County-level health administrative departments can provide professional training to rural doctors practicing in village clinics through various forms such as centralized face-to-face teaching, remote video teaching, etc. The free training should not be less than twice a year, and the cumulative training time should not be less than two weeks.
2. Strengthen the reserve force of rural doctors. County-level health administrative departments must find out and dynamically grasp the practice situation of rural doctors in their own administrative regions, prepare a plan for building a team of rural doctors, establish a reserve talent pool for rural doctors, select local personnel for targeted training, and promptly replenish them to village clinics. Where conditions permit, preferential policies should be formulated to attract retired urban doctors, practicing (assistant) physicians and medical school graduates to work in village clinics. All localities should explore the establishment of general practitioner teams and promote the contract service model, and actively connect the construction of rural doctor teams and the construction of general practitioner teams.