Further Strengthening of Rural Doctors' Team Construction of the Implementation Opinions
Municipal and county people's governments, provincial government departments, and directly subordinate institutions:
In order to implement the "State Council General Office of the State Council on the Further Strengthening of Rural Doctors' Team Construction of the implementation of the Opinions" (State Council 〔2015〕 No. 13) and the "Anhui Province People's Government on the issuance of Anhui Province to deepen the comprehensive reform of the medical and health system of the pilot program notice" (Anhui government [2015] No. 16), to further strengthen the construction of the rural doctor team, agreed by the provincial government, is now put forward the following implementation of the views:
One, the overall requirements and main objectives
(a) the overall requirements. In accordance with the overall deployment of the deepening of the comprehensive reform of the medical and health system pilot, adhere to the basic, strong grass-roots, build mechanisms, reform the rural doctor service model and incentives and constraints mechanism, improve and perfect the rural doctor compensation, pension and training policies, stabilize the rural doctor team, improve the overall quality of the rural doctors, strengthen the supervision of medical and health services, and comprehensively improve the level of village-level medical and health services.
(2) Main goals. By 2025, to ensure that the province's rural doctors generally have medicine and health secondary school education, more than 50% of rural doctors to obtain the qualification of practicing assistant doctor or above, rural doctors age, education, practice qualification structure is more reasonable, the practice environment is further optimized, reasonable treatment to be effectively safeguarded, and basically build a higher quality, adapt to the needs of rural grass-roots rural doctors team to promote grass-roots first diagnosis, The establishment of a hierarchical diagnosis and treatment system to better ensure that rural residents enjoy equalized basic public **** health services and safe, effective, convenient and inexpensive basic medical services.
II. Improving the management system for rural doctors
(3) Defining the duties and tasks of rural doctors. Rural doctors (including practicing physicians and physician assistants practicing in village health centers, hereinafter the same) are mainly responsible for providing rural residents with public **** health and basic medical services, as well as undertaking other medical and health services commissioned by the health and family planning department related work.
(D) rational allocation of rural doctors human resources. Each district shall take into account the service population, the current situation and expected demand for services under its jurisdiction, as well as geographic conditions and other factors, and reasonably allocate rural doctors, in principle, in accordance with the standard of 1 per 1,000 of the service population to be equipped with rural doctors, and at least 1 rural doctor shall be practicing in each village health office. In village health offices where there are no rural doctors, the primary health care institutions to which they belong will send doctors to provide services, or will bring in persons qualified as practicing (assistant) physicians to work in the village health offices. In principle, no new personnel may be brought into a village health office if its actual staff exceeds the prescribed staffing standards.
(E) strict access to rural doctors. County health departments should strictly follow the "Chinese People's **** and State Practicing Physicians Law" and "Regulations on the Administration of the Practice of Rural Doctors" and other relevant laws and regulations, strict qualification examination of rural doctors, and strengthen the management of access. Medical and nursing personnel practicing in village health offices must have the appropriate qualifications and be registered in accordance with the regulations. New entrants to the village health office to engage in prevention, health care and medical services, must obtain a licensed physician or licensed physician assistant qualification; engaged in nursing, pharmacy and medical technology, must obtain the appropriate licensing qualifications.
(F) standardize the assessment of rural doctors. County health departments should be in accordance with the principle of basic public **** health and basic medical care and improve the village health office and rural doctors performance assessment methods, unified organization to carry out the assessment. The content of the assessment includes the quantity, quality and public satisfaction of the basic medical and basic public **** health services provided by rural doctors, the implementation of the basic drug system, compliance with the provisions of the basic medical insurance, learning and training, as well as medical ethics and medical style. The results of the assessment serve as the main basis for the registration of rural doctors' practice and financial subsidies. Specific assessment work is mainly undertaken by township health centers, in principle no less than once a year. In the village health office within the establishment of assessment and income distribution mechanism, income distribution to the business backbone tilt.
(VII) strengthen the supervision of practice services. County health departments should effectively strengthen the practice management and quality of service supervision of rural doctors, to promote the rational use of drugs, improve the safety and effectiveness of health services. Gradually incorporate rural doctors into the medical personnel practice supervision information system. The integrated management of counties and villages is being pushed forward, and township health centers are being promoted to run village health offices. The government is cracking down on the illegal practice of medicine by rural doctors, the illegal purchase and sale of medicines, the inducement of services and excessive medical treatment, and the illegal referral of patients.
(viii) Improving the exit system for rural doctors. To establish and improve the village doctor assessment and exit, to the age of exit, illegal and disciplinary exit mechanism. The village health office and rural doctor's assessment results, as an important basis for the registration of rural doctors practice, the assessment failed rural doctors, shall not continue to practice in the village health office. Serious violations of the law or serious medical ethics problems of rural doctors, revocation or suspension of their practicing qualifications, and ordered to withdraw from the village health office. Counties (cities, districts) government to develop rural doctors to the age of exit methods, and actively explore the village health office surplus personnel exit mechanism.
Three, strengthen the training of rural doctors
(ix) strengthen academic education. Health and family planning departments at all levels should formulate training plans for rural doctors in accordance with the requirements of the National Rural Doctor Education Plan (2011-2020). Encourage eligible on-the-job rural doctors to enter higher medical (health) colleges and universities (including Chinese medicine colleges and universities) to receive medical academic education and improve the overall academic level. For on-the-job rural doctors who attend academic education in accordance with the regulations and obtain the appropriate medical qualifications, the government may provide appropriate subsidies for their tuition fees.
(J) the implementation of order-oriented training. Strengthen the rural order-oriented medical students free training work, focusing on the implementation of the village health office for the three-year college free medical student training. Free medical students are mainly recruited from rural areas. Completion of general practitioner standardized training of free medical students can be arranged to work in the village health office, the village health office work time counts towards the agreement stipulates the period of service, the county-level health planning department and the township health hospitals should be in further training, title evaluation and other aspects to be tilted.
(xi) standardize job training. Localities should rely on county-level medical and health institutions or the conditions of the central township health centers to carry out post training for rural doctors. Rural doctors receive free training no less than two times a year, with a cumulative training time of no less than two weeks. Each region is encouraged to utilize information technology to conduct online training for rural doctors. Each region may select and send outstanding rural doctors with the qualifications of practicing physicians or practicing assistant physicians to receive free training at provincial and municipal hospitals. Every 3-5 years, rural doctors shall go to county-level medical and health institutions or central township health centers with conditions for free off-the-job training, and the training time shall be no less than one month in principle. Rural doctors should learn the knowledge of traditional Chinese medicine, the use of traditional Chinese medicine skills to prevent and treat diseases.
(xii) Strengthening the construction of a reserve force of rural doctors. The establishment of a reserve pool of rural doctors. Localities should formulate preferential policies to attract retired urban doctors, practicing (assistant) physicians and graduates of medical (health) colleges and universities who have obtained practicing qualifications to work in village health offices. Through the "Three Supports and One Support" program and other channels, graduates of higher medical (health) colleges and universities are openly recruited to supplement the ranks of village doctors, and are uniformly managed by township health centers, enjoying the relevant policies and treatments of the "Three Supports and One Support" program. "Three support a support" after the expiration of the assessment, township health centers can be in accordance with the provisions of the recruitment procedures within the establishment, continue to be used for rural doctor positions, the implementation of the "hospital sent hospital management".
Four, innovative rural doctor service mode
(xiii) to carry out contractual services. Localities should combine the actual, explore the rural doctors and rural residents of the contract service. Rural doctors or by the township health center business backbone (including general practitioners) and rural doctors to form a team and rural residents to sign a certain period of service agreement, the establishment of a relatively stable contractual service relationship, to provide the agreed basic medical and health services, and in accordance with the provisions of the service fee. The service fee is shared by the medical insurance fund, basic public **** health service funds and contracted residents, with the specific standards and coverage to be determined by each region in accordance with the level of local medical and health services, the structure of the contracted population, and the affordability of the medical insurance fund and basic public **** health service funds, among other factors. Rural doctors providing contracted services shall not charge other fees in addition to the service fee in accordance with the regulations. In places where contracted services for rural doctors and rural residents have not been carried out, the cost of basic medical services provided by rural doctors shall be shared by the medical insurance fund and individuals through measures such as charging general consultation fees. Each county (city) will select at least one township to carry out a pilot project in 2015, and gradually expand the coverage after summarizing the experience. Increase the promotion of appropriate technology and encourage rural doctors to provide personalized health services and charge fees in accordance with relevant regulations.
(xiv) Establishing a system of rural general practice assistant physicians. In the existing licensed physician assistant qualification examination in rural general practice assistant qualification examination. Rural general practice assistant physician qualification examination in accordance with the relevant provisions of the National Medical Qualification Examination, the examination issued by the qualified rural general practice assistant physician qualification certificate, limited to the township health center or village health office practice. Qualified rural general practice assistant physician can participate in the physician qualification examination in accordance with the provisions.
V. Guaranteeing reasonable treatment for rural doctors
(XV) Effectively guaranteeing reasonable income for rural doctors. Through the government's purchase of services, the full implementation of the village health center zero-differential rate subsidies for drugs, general diagnosis and treatment fees, basic public **** health service funds, operating funds and other compensation policies. Dynamically adjusting the standard of subsidies for rural doctors from various channels, and gradually raising the level of treatment for rural doctors. On the basis of the additional 5 yuan per capita of basic public **** health service subsidy funds in rural areas being fully utilized for rural doctors in 2014 and 2015, new basic public **** health service subsidy funds will continue to be focused on tilting towards rural doctors in the future, and will be used to strengthen basic public **** health service work at the village level. For rural doctors serving in arduous and remote areas and contiguous and particularly difficult areas, localities should appropriately increase their subsidies. Each region shall include eligible village health offices and individual clinics in the management of designated medical institutions for medical insurance.
(xvi) Standardize the method of funding allocation and supervision. Standardize the village health room account opening and accounting operation, strengthen the financial subsidy funds and medical insurance compensation funds use supervision. Basic public **** health service funds, zero-differential rate subsidies for medicines, village health room operating subsidies to implement the "quarterly advance allocation, card issuance, assessment and settlement", by the county-level financial departments directly to the village health room account. The medical insurance reimbursement portion of the general diagnosis and treatment fee is allocated to the village health office account by the medical insurance agency on a quarterly basis, and is settled at the end of the year. Funding for basic public **** health services, zero-differential rate subsidies for medicines, and general diagnosis and treatment fees are allocated by the head of the village health office based on the actual work done by the village doctor, and the primary health care organization is responsible for supervision.
(xvii) Improvement of rural doctors' pension policy. Improve the livelihood security mechanism of the elderly rural doctors, on-the-job rural doctors pension insurance in accordance with the implementation of village cadres policy. Localities should support and guide eligible rural doctors to participate in the basic pension insurance for employees in accordance with the regulations. Qualified rural doctors, engaged in rural doctor work for more than 10 years, to the age of the village health office from the withdrawal of rural doctors, the implementation of no less than 300 yuan per month living subsidies, subsidies by the municipal, county (city, district) government to coordinate the solution. To engage in rural doctors work years or quit the age of less than the above conditions, can be based on the financial resources of each region, to develop specific measures to give appropriate subsidies, the level of subsidies shall not exceed the eligible to age out of rural doctors.
VI. Optimizing the practice environment for rural doctors
(XVIII) Improving the working conditions of rural doctors. Adopting public-private partnership, government subsidies and other means to support the construction of village health offices and equipment procurement. Accelerating the construction of information technology, using mobile Internet technology, establishing an information system centered on rural residents' health records and basic diagnosis and treatment and extending it to village health offices, supporting the management of instant settlement of the new rural cooperative medical care, the linkage of information on health records and basic diagnosis and treatment, performance evaluation, as well as remote training and telemedicine.
(xix) Expanding the career prospects of rural doctors. Under equal conditions, township health centers give priority to rural doctors who have obtained the qualifications of licensed physicians and licensed physician assistants, and further attract licensed physicians, licensed physician assistants and graduates of medical schools to work in village health centers.
(xx) Improvement of the practice risk resolution mechanism. To establish and improve the medical dispute prevention and disposal system covering village health centers. Improvement of rural doctors practice risk prevention mechanism, in accordance with the village health office business income of an appropriate proportion of the medical risk fund, the county-level financial may give appropriate subsidies.
VII, effectively strengthen the organization and leadership
(xxi) to develop the implementation of the program. All localities and relevant departments should strengthen the construction of rural doctor teams into the deepening of the comprehensive reform of the medical and health system for overall consideration. Municipalities should formulate and introduce specific implementation programs before the end of May 2015, and report to the Provincial Medical Reform Office, the Provincial Health and Family Planning Commission, the Provincial Department of Finance, the Provincial Department of Human Resources and Social Security for the record.
(xxii) Implementation of financial input. People's governments at the county level should incorporate funds related to the construction of rural doctor teams into their financial budgets. The province to support the construction of rural doctor teams, and further increase the subsidies to difficult areas. All levels of finance should be timely and full allocation of funds related to the construction of rural doctor teams, to ensure that funds are earmarked, shall not be retained, misappropriated, squandered.
(xxiii) Strengthening supervision and guidance. Localities should effectively safeguard the legitimate rights and interests of rural doctors, strictly prohibited in any name to the rural doctors to collect, assessed costs other than the state regulations. In rural preventive health care, medical services and emergency response to emergencies in rural doctors have made outstanding achievements, may be in accordance with the relevant provisions of the state and province to give recognition. All localities and relevant departments should establish supervision and notification mechanisms to ensure that the relevant policies for rural doctors are implemented.
Office of the People's Government of Anhui Province
March 31, 2015