Opinions on Promoting Comprehensive Reform of County-level Public Hospitals
Public hospital reform is a key task in deepening the reform of the medical and health system, and the reform of county-level public hospitals (including traditional Chinese medicine hospitals, hereinafter referred to as the same) is an important part of comprehensively promoting the reform of public hospitals, and is the key link in solving the problem of "difficult and expensive medical treatment" for the masses. The reform of county-level public hospitals (including Chinese medicine hospitals, hereinafter the same) is an important part of comprehensively promoting the reform of public hospitals, and is a key link in solving the problem of "difficult and expensive medical treatment". Since the General Office of the State Council issued the Opinions on Pilot Comprehensive Reform of County-level Public Hospitals (Guo Ban Fa [2012] No. 33), after more than one year of pilot projects, the reform has achieved initial results and accumulated useful experience, while some deep-rooted contradictions and problems have gradually come to the fore. In order to implement the overall deployment of the central government on comprehensively deepening the reform, further promote the reform of the medical and health system, guide the county public hospitals to accelerate the pace of reform, consolidate and expand the effectiveness of the reform, now on the promotion of comprehensive reform of county public hospitals to put forward the following views:
One of the general requirements
Implementation of the spirit of the 18th CPC National Congress and the 18th Plenum of the Third Plenary Session of the 18th CPC Central Committee, and promote the implementation of the "Chinese" in depth. *** Central State Council on deepening the reform of the medical and health system" (China Development [2009] No. 6) and "the State Council on the issuance of the "Twelfth Five-Year Plan" period to deepen the reform of the medical and health system planning and implementation of the program of the notice" (Guo Fa [2012] No. 11), in accordance with the separation of government, management and management, and separation of medicine, profit-making and non-profit-making, adhering to the basic principles of protecting the fundamentals, strengthening the grassroots, and building mechanisms, adhering to the public welfare nature of public hospitals, taking the elimination of the mechanism of compensating doctors with medicines as the key link, paying more attention to the systematic, holistic, and synergistic nature of the reforms, focusing more on the innovation of the system and mechanism as well as on the governance system and capacity building, and focusing more on the unity of treating the root causes and symptoms, and promoting the overall progress and breakthroughs in the key aspects, and deepening the management system, compensation mechanism, and compensation mechanism of the public hospitals in the counties. Public hospital management system, compensation mechanism, price mechanism, drug procurement, personnel, income distribution, health insurance system, regulatory mechanisms and other comprehensive reforms, the establishment of a new mechanism to maintain public welfare, mobilize enthusiasm, to ensure sustainable operation; adhere to the reform to promote the development, strengthen the core of the human resources capacity building, and continuously improve the level of health care services of public hospitals at the county level.
Two, the reform of the management system
(a) a clear functional positioning. County public hospitals are public welfare institutions, is the county health service centers, rural three-tier health service network of the leader and urban and rural health service system of the link, is the government to the county residents to provide basic health care services to an important carrier. It undertakes the diagnosis and treatment of common and frequent diseases for county residents, the rescue of critical illnesses and the referral of difficult diseases, the training and guidance of personnel in rural primary medical and health care institutions, as well as some of the public **** health services, natural disasters and public **** health emergencies and other emergency response work.
(ii) establish and improve the corporate governance structure. Accelerate the transformation of government functions, and actively explore effective forms of separation of management and operation. Reasonable definition of the government and public hospitals in personnel, assets, financial and other aspects of the relationship between responsibility and power, the establishment of decision-making, implementation, supervision of the division of labor, mutual checks and balances of power operation mechanism, the implementation of the county-level public hospitals independent legal person status and the right to independent operation and management. Promote county-level public hospitals to administrative, gradually abolish the administrative level of hospitals, county-level health planning administrative departments shall not be in charge of county-level public hospitals leadership positions.
(3) rational allocation of resources. by the end of 2014, the state and provinces (autonomous regions and municipalities) to formulate health service system planning and health resource allocation standards, each city (prefecture) to develop regional health planning and medical institutions set up planning, and to the community. Each county (city) should run 1-2 county-level public hospitals. In accordance with the principle of "filling in the gaps", the construction of county-level hospitals will continue to be promoted, and at least one hospital in counties (cities) with a population of more than 300,000 will reach the level of Grade 2A. Effective measures are being taken to encourage county-level public hospitals to use domestically produced equipment and instruments. It will study and improve policies to encourage the provision and use of traditional Chinese medicine services, strengthen the basic conditions and capacity building of traditional Chinese medicine departments in county Chinese medicine hospitals and county hospitals, and actively guide medical institutions to carry out relatively low-cost and effective traditional Chinese medicine diagnostic and therapeutic services. Strictly control the scale of beds and construction standards of county-level public hospitals, and strictly prohibit the construction of debt and the acquisition of large-scale medical equipment with debt. For places and institutions that exceed the scale, standards and construction debt, the government and the persons in charge of the medical institutions will be seriously held accountable for their relevant responsibilities. Study the formulation of reform policies and measures for hospitals run by state-owned enterprises.
Three, the establishment of a scientific compensation mechanism
(a) to break the medicine for medicine, improve the compensation mechanism. County-level public hospitals compensation from service charges, drug markup income and government subsidies three channels to service charges and government subsidies two channels, abolish the drug markup policy. The reasonable income of hospitals thus reduced will be borne by many parties*** through adjusting the prices of medical technology services and increasing government investment, as well as strengthening accounting and economizing on operating costs in hospitals. Provinces (autonomous regions and municipalities) have formulated specific compensation methods and clarified sharing ratios. The central financial subsidies, local financial to adjust the expenditure structure, and effectively increase investment, increased government investment should be included in the financial budget. Give full play to the role of medical insurance compensation, medical insurance fund through the purchase of services to hospitals to provide basic medical services to be timely compensation, reduce the medical insurance fund policy within the reimbursement ratio and the actual reimbursement ratio gap.
(ii) rationalize the price of medical services. In accordance with the principle of "total control, structural adjustment, rise and fall, and gradually in place", reflecting the value of the technical services of medical personnel, taking into account the abolition of the drug markup, the ability to pay for health insurance, the public's burden of medical care and the level of local economic and social development and other factors to reasonably adjust prices, and gradually rationalize the relationship between the ratio of prices of medical services. Increase the prices of items such as diagnosis and treatment, surgery, nursing care, beds and Chinese medicine services. Reduce the prices of medicines and high-value medical consumables, and reduce the prices of large-scale medical equipment for examination and treatment. Encourage hospitals to earn a reasonable income by providing quality services. Has been loaned or pooled funds to buy large-scale equipment in principle by the government to buy back, buy back the difficulties of the deadline before 2015 to reduce prices. Price adjustment policy and health insurance payment policy are interlinked.
(C) the implementation of government investment responsibility. County-level people's governments are the main body of the county-level public hospitals, to strictly control the scale of construction of public hospitals, standards, on the basis of the full implementation of the government's county-level public hospitals in line with the planning of the capital and large-scale equipment purchases, key disciplines of the development of human resources training, in line with the national provisions of the cost of retirees, policy losses, undertake public **** health tasks and emergency treatment, support border, support agricultural public **** Services and other government input policies. Appropriate subsidies will be provided by the central and provincial governments. The implementation of the investment in Chinese medicine tilted policy.
Four, improve the drug supply guarantee system
(a) Reform of centralized drug procurement methods. County-level public hospitals use drugs, relying on the provincial centralized drug procurement platform, the province (district, city) as a unit, in accordance with the principle of quality first, reasonable price, take the recruitment and procurement of one, quantity and price linkage, double-envelope system to carry out centralized bidding and purchasing, while allowing the localities in accordance with the reality of the different ways to explore. The participation of medical institutions in the bidding and purchasing of medicines will be further enhanced; cross-provincial joint bidding and purchasing will be encouraged to ensure the quality and safety of medicines, effectively reduce the prices of medicines, and effectively curb corrupt practices and unethical practices in the field of drug purchasing and selling. For medicines that are clinically necessary but in small quantities and are in short supply in the market, supply can be ensured by means of bidding and adopting fixed-point production. A mechanism for linking the procurement of essential and non-essential drugs is gradually being established. County-level public hospitals should prioritize the use of basic drugs in accordance with regulations. Insisting on openness, transparency and fair competition, promoting online sunshine procurement of high-value medical consumables, county-level public hospitals and high-value medical consumables production and operation enterprises must carry out online transactions through the provincial centralized procurement platform. On the premise of quality assurance, the procurement of domestically produced high-value medical consumables is encouraged. Capacity-building of provincial centralized drug procurement platforms has been strengthened to safeguard the practical needs of drug procurement. Improve the transparency of procurement, and implement departmental and regional ****sharing of procurement data for drugs and high-value medical consumables.
(ii) Guaranteeing the supply of medicines. In principle, the distribution of drugs is entrusted by the winning enterprises themselves to the distribution of drug business enterprises or direct distribution, reducing the circulation links and standardizing the order of circulation. Strict procurement and payment system, the development of specific payment processes and methods. If payment is not made on time without justifiable reasons, the purchasing organization shall pay liquidated damages to the enterprise. Provincial health planning and financial departments are responsible for supervising the payment of goods and severely investigating and dealing with delayed payment. A unified national drug procurement and supply information system has been established, and the supply guarantee mechanism for low-priced and shortage drugs has been gradually improved.
(3) Establishing a strict integrity record and market clearance system. Strengthen the supervision and management of centralized procurement and distribution of medicines, and establish bad records. Provide false documents in the procurement, deliberately raise the price or maliciously lower the price, refused to sign the contract after winning the bid, the supply of drugs of substandard quality, not in accordance with the provisions of the contract for timely delivery and supply, to the procurement agency, county-level public hospitals and individuals to bribe or disguised as a bribe, are recorded and dealt with, by the provincial health and family planning administrative departments of the offending enterprises, the list of legal representatives and violations of the law The names of the violating enterprises, legal representatives and the violations will be announced by the provincial health and family planning administrative departments to the public and reported to the National Health and Family Planning Commission within one month after the announcement, which will be reproduced on the government website, and all provinces (autonomous regions and municipalities) shall not allow the enterprises and their legal representatives to participate in the bidding for the purchase or distribution of medicines within a certain period of time. Violation of relevant laws and regulations shall be punished according to law.
V. Reform of the health insurance payment system
(1) Deepen the reform of the payment method. While carrying out the total control of medical insurance payment, accelerate the reform of the payment method based on the type of disease, capitation and other major payment methods. Strict clinical path management will ensure the quality of medical services. Payment standards are scientifically and reasonably determined, and negotiation and consultation mechanisms and risk-sharing mechanisms are established between medical insurance operators and designated medical institutions. The medical insurance management organization should settle the bill in full and on time and disburse the funds according to the agreement.
(2) Strengthening the supervision and constraints of medical insurance on medical services. Give full play to all kinds of medical insurance on medical service behavior and costs of regulation and guidance and supervision and control. The use of information technology means, and gradually improve the medical insurance on medical personnel medication, inspection and other medical services behavior supervision. It has strengthened the monitoring of such indicators as the utilization rate of medicines outside the basic medical insurance catalog, the proportion of medicines in the total, the per capita cost, the level of burden on the insured, the hospitalization rate, the average hospitalization day, the follow-up rate, the headcount ratio, the referral and transfer rate, and the rate of surgical operations and elective surgeries.
VI. Deepening the reform of personnel and distribution system
(1) Reasonable authorized establishment. Localities can take into account the actual research and development of county-level public hospital staffing standards, rationally approved the total staffing of county-level public hospitals, and dynamic adjustment, and gradually implement the establishment of the filing system.
(ii) reform of the personnel system. The implementation of county-level public hospitals employing autonomy, the implementation of open recruitment of new personnel. Optimize the personnel structure, according to the standard reasonable allocation of physicians, nurses, pharmacists and technicians, managers and the necessary logistical support staff. Comprehensively implement the employment system and job management system, adhere to the need to set up posts, competitive recruitment, employment by post, contract management, the implementation of the fixed number of fixed posts not fixed personnel, change the status management to job management, the establishment of the flexible employment mechanism can be in and out, can be up and down. Combined with the actual and proper placement of non-recruited personnel. Improve the county-level public hospital medical staff to participate in the social insurance system, to promote the reasonable flow of talent to create conditions.
(3) the establishment of payroll system adapted to the characteristics of the industry. Combined with the characteristics of the medical industry, the establishment of public hospitals pay system, improve income distribution incentives and restraint mechanisms. According to the results of performance appraisal, to do more work more pay, merit pay, equal pay for equal work, focusing on the clinical front line, key positions, the backbone of the business and make outstanding contributions to the personnel tilted, and reasonably open the income gap. It is strictly prohibited to set income-generating targets for medical staff, or to link the income of medical staff to the income of hospitals from medicines, examinations and treatments. Doctors in public hospitals are permitted to obtain compliant remuneration through multi-location practice.
(4) Establishing a scientific performance evaluation mechanism. Develop performance evaluation methods for county-level public hospitals, taking the public welfare nature of hospitals, operational efficiency, and public satisfaction as important indicators for evaluation, and linking the results of the evaluation to health insurance payments, financial subsidies, and salary levels, and making them public. The quantity, quality, technical difficulty and patient satisfaction of the services provided by medical personnel as an important indicator, and the establishment of a personnel performance appraisal system centered on social benefits and work efficiency.
VII. Strengthening Hospital Management
(1) Implementing the presidential responsibility system. Improve the selection and appointment system of public hospital directors, strengthen the director's term of office target management, the establishment of accountability mechanisms. Improve the dean's incentive and constraint mechanism, strictly prohibit the dean's income is directly linked to the hospital's economic income. Strengthen the dean management ability training, explore the establishment of the dean qualification management system.
(2) optimize internal operation and management. Improve the internal decision-making and implementation mechanism of the hospital. Improve the management system centered on safety, quality and efficiency, strengthen cost accounting, establish a sound cost responsibility system, and strengthen the awareness of cost control. Strictly implement the financial accounting system of the hospital and explore the implementation of the chief accountant system. Improve the financial analysis and reporting system, implement accounting supervision of the hospital's economic operation and financial activities, and strengthen the analysis and monitoring of economic operation and management of state-owned assets. Improve the internal control system, establish and improve the financial audit of hospitals and the economic responsibility audit system of hospital directors. The implementation of open hospital affairs, play the role of staff congress, strengthen democratic decision-making, and promote democratic management.
(3) standardize the behavior of medical services. Improve the management of medication in public hospitals, prescription review system, strengthen the management of the clinical application of antibacterial drugs, promote the rational use of medication, to ensure that the clinical use of medication is safe, economical and effective. Encourage the exploration of various forms of separation of medicine. Patients are encouraged to independently choose to purchase medicines at hospital outpatient pharmacies or retail pharmacies with prescriptions. Strengthening the management of clinical paths and diagnostic and therapeutic norms, strictly controlling the unreasonable use of high-value medical consumables, and increasing the early warning and analysis of abnormal and high medical expenses. Strengthening the construction of medical practice, promoting the practice of law and the clean practice of medicine. Strengthen accountability, seriously investigate and deal with serious irresponsibility or dereliction of duty.
VIII. Enhancement of Service Capability
(1) Establishing a talent training system that adapts to the characteristics of the industry. The establishment of a sound system of standardized residency training, by 2020 new doctors entering county-level public hospitals must undergo standardized residency training. Strengthen the training of key physicians in county-level public hospitals, study the implementation of specialized ad hoc post program, the introduction of urgently needed high-level talent.
(2) Promoting the construction of information technology. Under the national unified planning, accelerate the integration of county-level medical and health information resources, and gradually realize the interconnection and information *** enjoyment of medical services, public *** health, family planning, medical insurance, drug supply guarantee and integrated management system. Accelerating the construction of county-level public hospital informatization, focusing on regulating hospital diagnosis and treatment behavior and improving the performance appraisal and management capabilities of medical personnel. Making full use of existing resources, pilot construction of telemedicine systems and promoting telemedicine services. Strengthen the security of information system operation and protect the privacy of the public.
(C) the implementation of policies to support and guide social capital to run medical services. Improvement of social running medical policies in land, investment and financing, finance and taxation, price, industrial policy and other aspects of encouragement, priority support for the organization of non-profit medical institutions, support for social capital investment in scarce resources and meet the diversified needs of the service sector. The scope of access to medical care run by social capital should be relaxed, unreasonable regulations should be cleaned up and abolished, and the implementation of the policy of equal treatment for non-public and public medical institutions in terms of market access, social insurance designation, construction of key specialties, title evaluation, academic status, hospital accreditation, and technological access should be accelerated. Medical institutions organized by social capital are supported in upgrading their service capacity. The prices of medical services in non-public medical institutions are regulated by the market. The study of public hospitals in resource-rich counties (cities) to promote the restructuring of public hospitals policy, and encourage places with the conditions to explore a variety of ways to introduce social capital.
Nine, strengthen the up and down linkage
(I) to promote the vertical flow of medical resources. In a variety of ways to establish a long-term stable county-level public hospitals and primary health care institutions, urban hospitals division of labor and cooperation mechanism. County-level public hospitals should strengthen the technical assistance and guidance to primary health care institutions and personnel training, and improve the system of rotating and sending key physicians to township health centers, and establish a long-term mechanism. It may take the form of recommending outstanding management personnel to participate in the selection and recruitment of township health centers, etc., to improve the management level of township health centers. Fully implement the system of counterpart support for county-level public hospitals by urban tertiary hospitals, and improve the technical and management level of county-level hospitals. Adopting measures such as policy support and awarding of honors, guiding in-service discipline leaders and medical backbones of large urban hospitals to work in county-level public hospitals on a full-time or part-time basis, and creating conditions for them to work in county-level public hospitals on a long-term basis. Encourage retired discipline leaders and business backbones to serve in county-level public hospitals.
(2) Improving the rational hierarchical diagnosis and treatment model. Developing standards and methods for graded diagnosis and treatment, and comprehensively utilizing medical, health insurance, price and other means to gradually establish a system of primary first aid, graded medical care, and two-way referral for medical treatment. Convenient referral channels between county-level public hospitals and primary medical and healthcare institutions should be established, and county-level public hospitals should provide patients referred from the grassroots level with such conveniences as priority consultation, priority examination, and priority hospitalization. Giving full play to the leverage of medical insurance, payment policies are further tilted towards the grassroots, and differences in reimbursement ratios between designated medical institutions at different levels have been widened. Improve the system of out-of-county referral and filing, and strive to achieve the goal of about 90% of intra-county consultation rate by the end of 2015.
X. Strengthening Service Supervision
(1) Strict industry management. Health planning administrative departments should improve the entry and exit mechanism of institutions, personnel, technology and equipment. Strengthen the county-level public hospital medical quality and safety, cost control, financial operation and other supervision, strict control of unreasonable and rapid growth in medical costs. Do a good job of monitoring and controlling the growth of medical costs, strengthen the high medical costs, antibacterial drugs, expensive drugs and high-value medical supplies used in retrospective inspection efforts, and timely investigation and handling of the pursuit of economic interests of unreasonable use of medicines, materials and inspection and testing behavior.
(ii) play the role of social supervision and industry self-regulation. Promote hospital information disclosure, regular disclosure of financial status, performance appraisal, quality and safety information. Strengthen the role of medical industry associations (societies) in the county-level public hospitals in self-regulatory management supervision. Establishing and improving the management information system and assessment files for medical personnel, recording all basic information, annual assessment results, and violations of the law by medical personnel. Establishing a social supervision and evaluation system, and fully listening to the opinions of all aspects of society. Reform and improve the system for evaluating and certifying medical quality, technology, safety and services. Explore the establishment of a third-party evaluation mechanism to comprehensively and objectively evaluate the quality of medical care, service attitudes, and the construction of ethical practices.
(3) Promoting harmonious doctor-patient relations. Strengthen the humanistic quality education of medical personnel, and further strengthen the construction of medical ethics. Strengthen public opinion propaganda and guidance, and create a good atmosphere of respect for doctors and health care in the whole society. Strengthen the mediation of medical disputes, improve the third-party mediation mechanism, and protect the legitimate rights and interests of doctors and patients. Maintaining the normal order of medical services in accordance with the law, and cracking down on illegal and criminal behaviors such as harming medical personnel and "medical trouble". Actively develop medical liability insurance and medical accident insurance, and explore the establishment of medical risk **** sharing mechanism.
Eleven, strengthen the organization and implementation
(a) Preparation of the action plan. 2014 comprehensive reform of county-level public hospitals pilot covering more than 50% of the counties (municipalities), and in 2015 a comprehensive push. Develop a specific division of tasks for comprehensive reform of county-level public hospitals, further refine and decompose the reform tasks, implement the lead department and schedule, a clear timetable and roadmap, and effectively carry out the organization and implementation.
(ii) the implementation of the relevant responsibilities. All localities and relevant departments should establish a work promotion mechanism and strictly implement the responsibility system. County-level people's governments are the main body of reform implementation, to implement the responsibility, improve the system, and effectively do a good job of implementation. The leading group for deepening medical reform in each province (region and city) shall establish a mechanism for supervision, inspection, assessment and accountability to ensure that the initiatives of comprehensive reform are put into practice. The Office of the Leading Group for Deepening Medical Reform of the State Council should work with relevant departments to develop an evaluation index system for the effect of comprehensive reform of county-level public hospitals, strengthen tracking and assessment, and carry out special supervision of the progress of the action plan for reform of county-level public hospitals, with regular assessment and timely notification. The assessment results are linked to the central financial subsidies.
(3) Do a good job of publicity and training. Carry out policy training for leading cadres at all levels of government and relevant departments, and strengthen policy interpretation. In-depth and detailed publicity and mobilization of medical personnel, giving full play to their role as the main force of the reform. Publicize the effectiveness of the reform progress and typical experience, carry out public opinion monitoring, timely answer and respond to the hot issues of concern to all sectors of society, and reasonably guide social expectations.