Research report on the reform of municipal public hospitals
In order to further promote the reform of the city's public hospitals, the previous stage, the Municipal Medical Reform Office organized XX, XX and other relevant departments to go to the pilot city of XX, Zhejiang Province, the comprehensive reform of public hospitals to carry out a study, is now on the study of the situation to form the following report for the reference of the leadership.
First, the basic situation of medical reform in XX city.
Jiaxing's existing household population of 3.4 million, 1.8 million temporary residents, under the jurisdiction of two districts, five cities (counties), the average number of doctors per 1,000 people 2.06 (and the city is roughly the same), per 1,000 people with a hospital bed 3.82 (4.66 in our city), the city's existing four municipal public hospitals, all for the third-class A. In 2009, as the provincial In 2009, as a provincial pilot city for comprehensive reform of public hospitals, has formulated the "XX comprehensive reform of public hospitals, the implementation of opinions", "2011 XX public hospital reform pilot work arrangements" to strengthen the public welfare, the creation of a new mechanism as the focus of the reform of the major institutional mechanisms, the construction of service systems, the implementation of measures to facilitate the people to benefit the people, to promote the construction of information technology, to carry out standardized training of residents in the public hospitals of the five areas of reform and overall arrangements for the pilot work of the reform. The overall arrangement and deployment of the pilot reform work, in the optimization of resource allocation, control of unreasonable growth in medical costs, reform of the hospital management system, to explore the financial compensation mechanism to strengthen the independent exploration, and made positive progress. 2011 completed five cities (counties) public hospital reform; December 3, 2012 launched the implementation of the implementation of zero-differential-rate sales of medicines, the abolition of the registration fee for general outpatient clinics, The city's public hospital reforms, such as adjusting the price of medical service charges, adjusting the policy of employee health insurance and urban and rural residents' cooperative medical insurance, have been completed in the city of Jiaxing, the task of reforming public hospitals.
The main practice of XX public hospital reform
(a) Innovative public hospital management service mechanism
First, the implementation of modern business system reform. Canceled the municipal public hospital leadership team of the administrative level, the full implementation of the hospital leading cadres appointment system. The establishment of hospital decision-making, implementation, supervision and other institutions. In the medical and health units of leading cadres, the implementation of open selection system, tenure system, exchange system, and effectively strengthen the health cadres of vitality and vigor.
The second is to deepen the reform of the internal management system. The implementation of full employment, evaluation and recruitment of separate employment system reform, and the gradual establishment of the matter of post, post selection, employment by post, a post, a salary of the post management system. At the same time, a diversified job distribution incentive system based on job management, the number of jobs and job performance, and appraisal and evaluation, has been established, so that pay is determined according to post, pay according to task, and pay according to performance. The establishment of a public hospital performance appraisal system centered on public welfare.
Third, explore the establishment of quality supervision system. The establishment of the XX City Medical Quality Management and Control Center with independent legal personality, the Municipal Health Bureau will be the medical quality supervision of the affairs of the functions entrusted to the center. The center has set up a system of regular monitoring and publicizing of medical costs, and has implemented a system of inquiring about medical costs. The role of public opinion supervision has been brought into play. The health administrative department announces the relevant average cost of each hospital to the society on a quarterly basis, and carries out regular inspections of the practice and quality control inspections.
(2) Effectively control the unreasonable growth of medical costs
First, strengthen the cost control policy measures. Clearly control the growth of medical costs as one of the main tasks of the reform, and put forward to carry out a limited payment by type of disease, encourage the use of cheap and Class A drugs and herbal medicines, and improve the internal cost control mechanism of hospitals and other reform initiatives. The Circular on Strengthening Medical Cost Control in the City's Medical Institutions was issued to ? Zero growth in average costs? As a goal, the hospital's outpatient average cost, cost per inpatient bed day, hospitalization average cost, the average number of days of hospitalization of discharged patients, drugs accounted for the proportion of business income and other control indicators included in the hospital's annual target assessment.
The second is to control the cost of drugs and medical supplies. The implementation of all medical institutions, including township health centers, including the centralized bidding and purchasing system of drugs, and take the lead in drugs, medical supplies and other bidding and purchasing into the municipal bidding center. At the same time, the establishment of health accounting sub-centers, municipal hospitals, financial section chiefs and host accountants by the health accounting sub-centers assigned to the implementation of the hospital operating cost accounting system, and the full implementation of hospital affairs (affairs) open. For each medical institution? Reasonable medication and reasonable examination? The implementation of these measures is being examined in a focused manner. The effectiveness of cost control has gradually emerged,
(C) promote the vertical integration of urban and rural medical resources
issued the "opinions on strengthening the vertical integration of medical technology resources", two three A general hospitals as a leader, to the city level community health service organizations as a network, the formation of two major medical technology support consortium. Its main elements include: ① consortium of municipal hospitals selected backbone medical staff stationed in community health service organizations; ② explore the integration of medical technology resources in the direction of multi-disciplinary practice of medical practitioners; ③ consortium within the implementation of two-way referral, community health service organizations in a timely manner to the municipal hospitals referral of patients, the municipal hospitals to open a green channel for rapid access to diagnosis; ④ consortium of community health service organizations in the high-end laboratory examination The high-end laboratory tests of the community health service organizations in the consortium can be centralized by the municipal hospitals for unified testing and detection, and those in need of large-scale instrument and equipment tests can also make appointments with the . Municipal hospitals to make appointments. ⑤ Strengthening the standardized training of general practitioners, the standardized training of general practitioners in community health service institutions at the municipal level are all entered into the training base of the consortium hospitals, and the consortium hospitals will undertake the standardized training tasks of general practitioners; ⑥ Encouraging the retired medical personnel of municipal hospitals to serve in the community; ⑦ Municipal finance to give special subsidies for the vertical integration of medical and technical resources, and the municipal hospitals' personnel stationed in the grass-roots community health service institutions. By the municipal financial standard of 100 yuan per person per day to be a special subsidy, at the same time by the municipal finance to send the hospital per person per day 50 yuan of work subsidies, the support of the county-level medical institutions of the municipal health care institutions of the municipal financial subsidies for municipal hospitals according to the standard of 50,000 yuan per year per stationed physician to give subsidies.
(d) Explore the establishment of financial health compensation mechanism
First, explore the establishment of financial support? Prize, insurance, control? mechanism, the use of cheap drugs in public hospitals for special subsidies and incentives, by the end of 2011, the municipal public hospitals Class A drug utilization rate of 20%.
The second is to explore the reform of funding by budget. The city's budget for public hospitals has been earmarked at 100 million yuan from 2009 to 2011 to support the reform of public hospitals, and the city's budget has been earmarked at 100 million yuan from 2009 to 2011 to support the reform of public hospitals.
(E) Effectively improve the public's experience of medical treatment
One is to optimize the diagnostic and treatment environment and service flow. The full implementation of the year without holiday services and lunchtime clinic, the strict implementation of the expert outpatient stop, replacement system; the establishment of the test project automatic single machine, increase the test results of the site consulting; improve the inpatient examination process, staggered examination, flexible scheduling, effective solution to the inpatient b ultrasound, dynamic electrocardiography and other examination queuing problems.
The second is to promote quality nursing service demonstration project activities. The hospitals to rationalize the allocation of nurse manpower, the implementation of the responsible nurse system, to provide standardized hierarchical care as the three major core, to promote? Quality Nursing Demonstration Project?
The third is to actively promote the booking of diagnosis and treatment and two-way referral services. All public hospitals have made appointments for all outpatient clinics. Actively explore the establishment of two-way referral relationship with primary healthcare units, in accordance with the principles of patient voluntariness, hierarchical diagnosis and treatment, resource **** enjoyment, seamless management of the establishment of an effective, strict, practical, smooth up and down referral channels, to provide patients with holistic, continuous medical services.
Fourth, actively explore the medical social worker service model. In the municipal hospital set up medical social work department, through the organization of the recruitment of social volunteers, ward visits and psychological counseling, the formation of patient support groups, community health education and other forms, to further strengthen the hospital human services, harmonious doctor-patient relationship.
(F) actively promote talent training and information construction
Promote the pilot work of standardized residency training in a regional unit, the city's 17 municipal and county hospitals have passed the provincial review of the standardized residency training base. The city's 17 municipal and county hospitals have passed the provincial review of residency standardized training bases. Pilot project, research and development of "XX City, the national health reform health information construction pilot project implementation program", and combined with the provincial government? Smart city? construction to carry out a single pilot project? Intelligent health? Work. At present, the construction of health network has been completed, the city and county health information platform is under construction, and two databases are being improved. 4 municipal hospitals have carried out the pilot work of wireless room checking, the use of digital means, so that the doctor has more time to come to the patient's bedside, and to become a real ? Clinicians? ; outpatient appointment registration, electronic queuing and calling system, outpatient post-payment and other digital information platform based on the transformation of the service process is being implemented.
Three, the city to deepen the public hospital reform of a few points of inspiration
(a) the establishment of efficient leadership decision-making mechanism .XX city public hospital reform, is in the municipal party committee and municipal government of the main leaders personally over the issue of the early stage of doing a lot of research before the start. In the current situation, it is recommended that the city set up a leading group of public hospital reform work, the main responsible comrades in person, the responsible comrades in charge of the specific responsible for the development of the work plan, the implementation of the responsibility of the layers, to strengthen the supervision and inspection, to ensure that the reform of the pilot work to steadily progress.
(ii) Deepen? Management and operation separation? reform . We are in? The separation of management and organization? We are one step ahead of the rest of the country, but in recent years there have been few breakthroughs in the system and mechanism. An important change in the reform of Jiaxing public hospitals is the abolition of the administrative level of hospitals, and the comprehensive reform of the hospital management system, operation mechanism, compensation mechanism and supervision system. And also the appointment and removal of hospital directors to the municipal medical group. At the same time, the establishment of a third party with independent legal personality XX City Medical Quality Management and Control Center, the medical quality supervision of the transactional functions entrusted to the center. It is recommended that the city further deepen the medical and health care field? Separation of management and operation? The city's healthcare system has been reformed, and the functions of the healthcare bureau and the healthcare center have been rationally defined to accelerate the construction of the healthcare center's corporate governance structure.
(3) Control of unreasonable medical costs. To solve the masses? Difficult and expensive to see a doctor? is the primary goal of public hospital reform. Jiaxing public hospital reform clearly control the growth of medical costs as one of the main tasks of the reform to ? Zero growth in average cost? For the goal, and put forward to carry out the limit of payment by disease, drugs, medical supplies centralized bidding procurement system, the formation of medical technical support consortium and other initiatives to control the cost of results gradually appeared. Innovative public hospital performance appraisal mechanism.
(d) Increase financial input. Increase investment in public hospitals. Control new projects in public hospitals, steadily dissolve public hospital debt, and accelerate the construction of information technology in public hospitals. Determine the dominant position of the government in the provision of public **** health and basic medical services investment. The government is responsible for the capital construction of public hospitals and the purchase of large-scale equipment, the development of key specialties, and the subsidization of policy deficits; it provides special subsidies to hospitals for the public **** health tasks they undertake; and it guarantees funding for public **** services, such as emergency treatment, disaster relief, and support for the grassroots. Strive for public hospitals to make substantial progress in infrastructure construction, large-scale equipment allocation, the introduction of talent training, medical technology and information technology construction.
(V) create a favorable public opinion environment. Do a good job of publicity and training and policy interpretation, strengthen the publicity of the importance of the pilot reform of public hospitals, the main tasks and policies and measures, mobilize the majority of medical staff to participate in the reform of the enthusiasm and initiative, and strive for the understanding and support of the general public and all walks of life, in order to promote the comprehensive reform of the pilot public hospitals to create good conditions.
According to the annual work of the Standing Committee of the District People's Congress arrangements, in late September, we in the District People's Congress Standing Committee Ruan Miao-Juan, deputy director of the leadership of the region's key government investment projects to investigate the situation of the construction, respectively, held six symposiums, listened to five departmental reports, the field to see the 12 key government investment projects. Now the research report is as follows:
First, the basic situation and characteristics
Since this year, the district government and the district departments concerned in the face of the severe macroeconomic situation, in accordance with? The key to protect, protect people's livelihoods, protect the development? The tone of the work, strengthen leadership, increase investment, overcome difficulties, pay close attention to the implementation of the key government investment project construction is progressing smoothly, and has achieved certain results. The region this year, plans to arrange government investment projects 197, with a total investment of 20.606 billion yuan; of which 30 key government projects, with a total investment of 11.992 billion yuan, the year's planned investment of 3.534 billion yuan, as of the end of September, has begun 28, the start rate of 93.33%, the completion of the investment of 2.141 billion yuan, accounting for the annual investment plan of 60.58 %. Completion of the actual performance is better, and vigorously promote the rapid economic and social development of our region. In the work to promote, mainly reflects the following characteristics:
(a) the leadership of the importance of the full promotion . District government in this year's work, highlighting the protection of people's livelihood improvement and economic and social development, adhere to the scientific and rational arrangement of construction projects, and further strengthen the leadership, the establishment of a sound project promotion mechanism, to fully guarantee the promotion of key government investment projects. First, the establishment of key projects leadership contact system. District four sets of class and township department leaders to implement major projects contact system, timely understanding of the project construction, increase the project progress, project quality, financial security, environmental security and other aspects of supervision and coordination. Second, clear project construction responsibility unit. Before the start of the project, the district government to implement the project construction unit of responsibility, a clear project investment plan and project progress requirements, establish and improve ? Monthly report, quarterly check, year-end examination? The working mechanism, the construction of key projects into the annual post target responsibility system assessment. Third, strengthen the coordination of difficult issues. The district government to establish a key project bi-monthly reporting system, timely understanding of the project construction process, coordinated to solve the project to promote the difficult problems, to ensure that the project smoothly.
(2) to overcome difficulties, crack elements . This year, due to the macroeconomic impact, land, capital, environmental protection of the elements of the problem is more prominent, to the promotion of key projects has increased the new difficulty, the district government and the relevant departments to find ways to try to crack the elements of the bottleneck. First, increase the key project land security. Through? Upwardly competitive indicators, tapping the potential production indicators, inventory disk indicators? 30 government key projects *** for 4390 acres of land use indicators, of which 3252.5 acres for the Yu North Plain Remediation Project? with cap? Construction land use indicators. Second, increase the financing of construction projects. Actively broaden financing channels, adhere to? Open source and reduce expenditure? and take action, build a good investment and financing platform, and actively strive for low-interest rate special loans, and strive for higher-level financial support 200 million yuan, the successful issuance of the fifth issue of urban construction company corporate bonds 1.8 billion yuan, a powerful crack the problem of financial security. Third, strengthen the land acquisition, demolition and relocation policy processing. The functional departments to actively implement the cadres down, the power to sink, bite the target, in accordance with the time nodes, pay attention to the ways and means, do a detailed and practical work, properly solve the problem of land acquisition, demolition and relocation, to ensure the smooth implementation of key projects.
(3) Innovative mechanisms to strengthen management. This year, the district government has paid much attention to the innovation of the management mechanism, the development and introduction of the "2014 Shangyu District to promote the construction of major projects to comprehensively expand the effective investment in the work of the assessment methods", focusing on standardizing the management and strengthening the investment performance. First, the scientific preparation of the annual plan. Adhere to? The principle of plan preparation, scientific and reasonable arrangements for the construction of major projects, and optimize the structure. The principle of planning, scientific and rational arrangement of projects, optimize the investment structure, this year, the number of key government investment projects to adjust the number of significant reductions. Second, standardize the management of innovative mechanisms. Establishment? Double-checking and double-reporting? System, performance evaluation system, intermediary supervision system, cumulative savings of more than 20 million yuan of financial funds, the number of project design changes fell by 40% year-on-year. Third, strengthen project quality and safety. District government and relevant departments always adhere to the government investment projects? Quality, progress, safety? Concurrently, the strict implementation of a good quality and safety management system, the progress is not fast, poor work, poor safety, service is not in place of the responsible unit timely notification of criticism and treatment, strengthen the standardization of management, to ensure that the project safety.
The second problem and difficulties
One is that the progress of the project is not balanced enough. Part of the new project failed to start according to the node plan, such as the three ring road east of the expressway and tail water upgrading project failed to start according to the requirements of the plan, the second half of the new project started the task is still heavy. Part of the continuation of the project progress is slow, failed to complete on time, some projects supporting the construction is slow, such as North Jiangdong Road and the northern extension of the project supporting the construction needs to be grasped.
The second is the project supervision needs to be strengthened . Individual project coordination mechanism is not smooth enough, the key project promotion and management still need to be strengthened, project quality, use of funds, safety production, investment performance and other regulatory efforts need to be further increased. Such as high speed rail XX area construction projects more, large engineering vehicles in and out of frequent, there is a certain safety hazards, need to further strengthen the department's collaboration and cooperation.
Third, factor constraints are more prominent. This year, I area construction projects, large-scale investment, subject to financing platform land mortgage clearance, part of the construction project financing is more difficult, the funding gap is larger; some projects land acquisition, demolition and relocation policy is not smooth enough to deal with the nail households, stranded households lack of effective means of construction of individual projects are blocked, affecting the project to promote.
Three, the next step countermeasures and recommendations
(a) clear objectives, strengthen the project attack . One is to further accelerate the implementation of planned projects. Grasp the time nodes, clear objectives, detailed responsibilities, scheduling plans, implement measures to promote the project to grasp the implementation. Especially on the project has not yet started and investment progress significantly lagging behind the implementation of tracking supervision, organization and attack, to ensure that the project is completed on schedule. Second, to further strengthen the promotion mechanism. This year, our government investment projects, involving a wide range of projects, some projects are complex and changing circumstances, the implementation of the difficulty, the departments should increase coordination efforts, the formation of promotional synergy, timely and effective solutions to the various difficulties encountered in the process of advancing the project to optimize the construction environment, and make every effort to speed up the progress of the project construction. Third, to further tighten the project supporting works. Strengthen the project coordination, synchronize the underground pipeline and other infrastructure construction, to ensure that the implementation of the project in an orderly and coordinated manner.
(2) multiple measures to strengthen the elements of protection . One is to resolve the contradiction of the project funding shortage. Actively absorb private capital, integration of financial funds, elaborate financing work, vigorously expand financing channels, pay attention to financing costs, strengthen investment, deepen the silver docking, multi-pronged approach to do a good job of financial security. Second, to resolve the contradiction of the project land shortage. Do a good job of land security, accelerate the turn but not for supply, supply but not for use, use but not exhausted land cleanup, and actively strive for indicators, do our best to solve the key project land and related resettlement land indicators. Third, to crack the project land acquisition, demolition and relocation problems. Grasp the land acquisition, demolition and relocation of the policy processing, to ensure that the project rapid progress.
(3) standardize management and strengthen investment performance. First, to strengthen the standardized management of the project, focusing on quality supervision, the implementation of key construction projects quality life-long responsibility system, to ensure the quality of the project. Second, to establish and improve the performance of government investment projects to monitor the system, strict project budgeting, strengthen the key projects to audit, carry out project performance assessment work, focusing on understanding the use of government investment project funding arrangements for the legitimacy of the situation, scientific and rational, promote savings, eliminate waste, and effectively improve the efficiency of investment. Third, we must strengthen the project bidding management, the implementation of government investment projects bidding the whole process of tracking and supervision, strengthen the special inspection and accountability, to ensure that the key projects bidding work standardized and transparent.
(4) full argumentation, strengthen the project stage. First, we must scientifically plan major construction projects, combined with the financial strength of Shangyu, prioritize key projects, rationally determine the construction schedule, scientific arrangements for construction projects, the establishment of a scientific decision-making mechanism. To seriously summarize the experience of various aspects of project construction over the years, such as land acquisition and relocation, financing, approval, etc., and take into account the policy, land, capital elements, etc., to fully demonstrate the necessity and feasibility of the project, and carefully determine the project. Secondly, we should do deep and detailed pre-project work, and strive for more projects with mature conditions to be included in the provincial key. To start work for the lack of adequate preparations for the start of construction does not start, etc., analyze the reasons, take measures to implement. At the same time, to be based on scientific evidence, integrated planning for 2015 to start projects and renewed projects. Thirdly, we should combine the government's function transformation and institutional reform, innovate the decision-making, construction and management system and mechanism of major projects, fully mobilize the enthusiasm of all parties, create a good construction environment, and strive to complete this year's key project investment tasks.
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