According to the district people's Congress Standing Committee XX annual work arrangements, in order to crack the people "difficult to see a doctor, expensive" problem, the district people's Congress Standing Committee of the region's public hospital reform policy implementation to consider. UNESCO Working Committee on Health developed a detailed research program, part of the district people's Congress on the reform of the situation of decentralized research.
September 1, the District People's Congress Standing Committee Deputy Director Xiong Jun led some of the Standing Committee members of the centralized research, the research team visited the District People's Hospital and the District Second People's Hospital, held a symposium, listened to the district public hospital reform member units and two hospitals work report, and individual issues were discussed. Now the research report is as follows:
I, the measures taken and the results achieved
(a) strengthen the organizational leadership, and formulated the implementation of the program. District government set up to the leaders in charge as the leader, development and reform, editorial office, finance, human resources, health and planning and other 12 departments of the unit's main person in charge as a member of the comprehensive reform of public hospitals leading group, comprehensive coordination of the forces of all parties to coordinate and promote the reform work. Developed a comprehensive reform of public hospitals in our district level implementation program.
Clearly defined the working objectives and main tasks of the reform, formulated the "Bazhou District District Public Hospital Comprehensive Reform Pilot Implementation Program" "Bazhou District Public Hospital Comprehensive Reform Government Compensation Implementation Measures" and a series of other supporting programs to promote the health care reform has laid a solid institutional foundation.
(2) Strengthen hospital management and improve service level. District government and relevant departments to standardize the procurement and supply of drugs and medical supplies, the strict implementation of drugs and high-value medical supplies network. On the centralized bidding procurement, unified distribution, reducing the purchase price of drugs and medical consumables. Through the reform of the hospital personnel allocation, management and incentive system, deepening the recruitment and management of personnel employment mechanism, optimizing the structure of the personnel team.
Since XX **** introduced 5 master's degree students, 62 full-time undergraduate graduates, and hired 30 nursing staff on merit. Performance appraisal has been strengthened, with service quality, quantity and patient satisfaction as the core, and the appraisal results as the basis for income distribution. The region's four hospitals above the second level have signed two-way referral agreements with 45 primary health care organizations, and have done some grassroots first diagnosis, two-way referral, and hierarchical diagnosis and treatment in accordance with the referral procedures and standards.
(C) orderly promotion of reform, achieved initial results. My district is currently *** involved in district-level medical institutions 2, of which, the district people's hospital is a third-class Z hospital of Chinese medicine, the establishment of 499 beds, on-the-job workers 485 people, the district's second people's hospital is a second-class B general hospital, the establishment of 400 beds, on-the-job workers 307 people.
This reform in our region was fully launched on October 1, XX, according to the "Sichuan Development and Reform Commission and other five departments on the issuance of county-level public hospitals in Sichuan Province, the abolition of drug markups on the funding of the compensation approach" (Sichuan Development and Reform Prices [XX] No. 937) requirements of the two public hospitals in our region (District People's Hospital and the Second People's Hospital) from the date of the launch of the official abolition of drug markups ( Excluding traditional Chinese medicine tablets).
And has been compensated through the implementation of financial subsidies, adjust the price of medical services and strengthen the cost management of public hospitals and other measures. According to the survey, after the implementation of zero-differential rate sales of medicines in our district-level public hospitals, the price of medicines has dropped by 15% on average. As required, the abolition of 2 public hospitals drug markup at the same time, increase 5 medical service price charges (i.e., outpatient and emergency room consultation fee up 6 yuan.
Inpatient consultation fees and i, ii, ii level of care fees were raised by 9 yuan), and included in the scope of payment of the health insurance integrated fund to compensate for the abolition of the drug markup reduced by 70% of the part. XX District Finance has been allocated subsidies of 10,011,600 yuan to pay compensation for the inputs into the abolition of the drug markup reduced by 20% of the part and the protection of retirees, in-service personnel, public **** Health Service funds and other special funds.
Medicare organizations have also signed Medical Service Agreements with 2 public hospitals to protect and promote healthcare reform. Through the initial implementation of various reform measures, medical reform work has achieved certain results. According to statistics, first, the patient's drug costs fell. xx year, the district people's hospital drug sales totaled 58.31 million yuan, accounting for 37.14% of the total medical costs, down 39% from the previous year.
The second district people's hospital drug sales totaled 18.99 million yuan, accounting for 34% of the total medical costs, down 25% from the previous year. Second, the hospital revenue structure has been improved. xx 2 hospitals total income of 233.76 million yuan, of which the patient paid 72.79 million yuan, accounting for 25% of the total income; in addition to traditional Chinese medicine tablets outside the sale of medicines 680.09 million yuan, accounting for 37.14% of the medical income; examination, inspection income of 66.77 million yuan, a decline of 2% over the previous year.
Third, the structure of the medical team is gradually optimized. At present, two public hospitals*** have 211 practicing (assistant) physicians, including 10 with postgraduate education and above, 39 senior titles, respectively, compared with the previous year, an increase of 8% and 6%.
Fourth, the number of people seeking medical treatment has gradually increased, in XX, the 2 hospitals hospitalized patients amounted to 26,502, an increase of 5.42% over the previous year.
Two, the main problems
(a) hospitals operating pressure increases year by year. First, the establishment of pressure. With the gradual implementation of health care reform policies, health insurance coverage continues to expand and gradually increase the service population, according to the beds set up, according to the requirements of the editorial staff has been unable to meet the reality of the community's need for medical care, resulting in a lot of management system can not be promoted at a deeper level: Second, the pressure of labor.
Public hospitals in our region to recruit some of the agreement to use laborers, although the appropriate qualifications, but by the establishment of restrictions, hospitals . Economic burden, management pressure; Third, economic pressure. Due to the hospital to expand the scale of operation and infrastructure construction, more indebtedness (district people's hospital debt of 121,280,600 yuan, the second people's hospital debt of 24.3 million yuan).
(ii) financial compensation pressure increases year by year. After the abolition of the drug markup policy, the district hospitals compensation from service charges, drug markup income and government subsidies three channels, to service charges and government subsidies two channels, and through the adjustment of the price of medical technology services and increase government investment and other ways to compensate.
Through the research, although the two public hospitals in our region to lock the debt, but due to the special reasons of the local economy, debt repayment is still beyond our reach. Financial subsidies to public hospitals, although increasing year by year, but still can not meet the needs of the two hospitals to expand the total amount of business, taking into account the natural growth of drug revenues, urban and rural health insurance and public **** health services and other factors, the financial pressure is even greater.
(3) social expectations of the reform brought about by the pressure to increase year by year. Public hospital reform is oriented to the public welfare, only in the institutional mechanism of the reform of a great deal, in order to let the masses feel the benefits of the reform, and public hospital reform needs top-level design, since... Top down the relevant comprehensive supporting reform has not been carried out in depth.
Management system, the establishment of management, health insurance payment system, distribution system and drug procurement and other related ancillary reforms have not been substantially advanced, the establishment of a unified and efficient, consistent powers and responsibilities of the "management of the Office of the separation of government affairs open" public hospital management system needs to be explored and practiced in depth. The total amount of public hospital resources in our region is relatively small, and the distribution is not balanced.
Quality resources are even less, the district people's hospital back to the wind hospital area has not been put into operation, coupled with most of the masses are accustomed to flocking to urban hospitals for medical treatment, difficult to see a doctor, expensive to see a doctor problem has not yet been effectively resolved.
Three, a few suggestions
(a) further improve and perfect the financial input mechanism. The government should play a leading role, and effectively implement the government's responsibility to invest in public hospital capital construction, equipment investment, personnel training, public **** health tasks and other public **** services.
(ii) further increase the supervision of medical insurance fund. Further explore the reform of health insurance payment methods and develop relevant supporting systems, strengthen the supervision of designated medical institutions, and strictly investigate and deal with health insurance violations. District-level public hospitals should adhere to reasonable inspection, reasonable treatment, reasonable medication and reasonable fees, and standardize the behavior of medical services.
(3) to further strengthen the management of district-level public hospitals. District public hospital management committee to perform the function of supervision, hospital construction, operation, development and other all-round supervision; strengthen the target management assessment of hospitals, and further establish and optimize the term of office of the hospital director's target responsibility system and the hospital level assessment system, optimize the internal management of hospitals.
Deepening the reform of personnel system, and gradually establishing and implementing diversified incentive mechanism for performance pay distribution; actively exploring the establishment of record management system and dynamic adjustment mechanism to stimulate the vitality of public hospital reform.
Expanded:
The Office of the Leading Group for Performance Evaluation of Tertiary Public Hospitals of the National Healthcare Commission (NHSC) has recently commissioned the NHSC Doctor-Patient Experience Research Base at the Peking University People's Hospital (PUPRB) to initiate on-site verification of the results of the survey of satisfaction with nearly 200 tertiary public hospitals in 22 provinces and municipalities across China. Patient satisfaction is one of the key elements of the national performance assessment of tertiary public hospitals.
The main ways of obtaining data about patient satisfaction include posting WeChat QR codes in the public **** area of each hospital, with the NHMRC platform being responsible for collecting satisfaction ratings from patients and hospital staff scanning the codes for feedback. The advantage of this approach is that it can quickly collect a lot of information, but whether the data has "water", but also need to be further verified through the combination of online and offline.
People's health network - public hospital satisfaction survey on-site verification launched