Since the reform and opening up, my country's medical and health services have developed rapidly, public health conditions have been continuously improved, medical and health resources have been gradually integrated, and the people's health level has been significantly improved. In particular, the new rural cooperative medical pilot project started in 2003 has truly benefited the rural people. However, due to various factors, the development of my country's health sector still lags behind the economy and other social undertakings. The development of rural health lags behind that of cities. The contradiction between the rural medical and health service system and farmers' growing health needs is still quite prominent. The effective use of health resources faces severe challenges.
1. Main existing problems
1. The structure of urban and rural health resources is not reasonable. Mainly manifested in the unbalanced distribution of urban and rural health resources. Because superior health resources are relatively concentrated in county-level medical institutions, rural and community-level medical institutions have insufficient health resources, poor diagnosis and treatment conditions, and a lack of excellent general practitioners. Farmers and urban communities Residents do not have access to nearby, convenient, and reasonably priced medical services.
2. Insufficient investment has led to an obvious profit-seeking tendency of medical institutions. From 1992 to 2003, most regions in my country gradually canceled differential subsidies for township health centers, reformed the personnel allocation system for county-level medical institutions, implemented a full-employment system and a performance-based salary system, and used market mechanisms to manage public welfare. The path to health care. Due to insufficient financial subsidies, county and township medical institutions, under the impact of the market economy, have resorted to "supporting medicine with medicine" and "supporting medicine with medicine" in order to support themselves, retain talents, purchase equipment, and improve the environment, and rely on independent income generation to survive. , pursue development, and excessively pursue economic benefits, resulting in increased medical expenses and an increase in the medical burden of the people.
3. Township health centers and village clinics are unable to meet the needs of the masses. In my country, township health centers are the hub of the three-level health care network, playing a connecting role and undertaking basic health services such as preventive care, basic medical care, health supervision, health education, rehabilitation, and family planning. Village health clinics are the "bottom of the network", providing villagers with safe and convenient diagnosis and treatment services for common diseases, and playing an important role in public health and preventive health care. However, after the 1980s, a large number of professional medical personnel returned to the city from rural areas, resulting in a large loss of talent in township health centers. Coupled with the limited financial strength of townships, most township health centers receive less and less subsidies. Their survival is at risk and it is difficult to provide the medical and health services that the people need. Quite a number of township health centers are in development difficulties. The health resource most frequently used by most rural residents is village health clinics. Due to factors such as insufficient financial investment in rural health reform, the construction of village health clinics and the basic treatment of village doctors are no longer guaranteed, and the "bottom" of the three-level preventive health care network is Gradually damaged, most village health centers are unable to meet the medical needs of villagers.
4. The overall quality of medical staff needs to be further improved. At present, urban and rural medical and health institutions generally lack high- and intermediate-level professional and technical talents and key clinical medical talents. The proportion of medical and technical nursing personnel is unreasonable and there is a lack of key clinical medical talents. The professional ability and professional level of employees in rural medical institutions are relatively low, and there are many self-employed people. There are common conditions such as poor wages, low security levels, and difficult working conditions, which have resulted in low enthusiasm for work among rural medical staff and an unstable team.
2. Suggestions
1. Coordinate urban and rural health resources and build an integrated service network. Led by the county (city) and district governments, the current relatively independent secondary medical institutions are integrated into one county (city) and district secondary hospital to manage several rural health centers, forming a county (city) ), a medical service network with closely linked businesses and interests under a unified name led by district secondary hospitals. A county (city) or district secondary hospital forms an independent medical service network, and multiple county (city) or district secondary hospitals form multiple independent medical service networks. Professional and technical personnel can provide medical services in their respective medical counties (cities). , flexibly mobilize the district service network according to needs, breaking the current abnormality of "it is extremely difficult for township health center personnel to enter second-level county (city) and district hospitals, and doctors in county (city) and district-level hospitals remain stable for life regardless of their abilities." status quo.
2. Unify planning and comprehensive management to improve the service level of health centers. On the basis of building an integrated service network, five unified managements are implemented.
That is, the ownership is unified: the property and property of county (city) and district secondary hospitals and township health centers are unified under the management of county (city) and district secondary hospitals, and all properties of county (city) and district secondary hospitals belong to the county (city) and district secondary hospitals. City) and district governments. Unified personnel management: County (city) and district secondary hospitals have established human resources departments to implement unified deployment of all staff, and implement a mechanism for all staff to be assigned posts and compete for positions. The basic salary standards for staff in county (city) and district secondary hospitals and township health centers are unified. Unified business management: County (city) and district secondary hospitals conduct unified management of the relevant business of each township health center, and conduct regular supervision, inspections and guidance training. Unified drug distribution: County (city) and district secondary hospitals set up drug distribution centers to conduct unified bidding, procurement and unified distribution of drugs, disposable materials, reagents, etc. required by each health center. Unified financial logistics: County (city) and district secondary hospitals set up financial management centers to uniformly manage the finances of each township health center; all funds are uniformly allocated and used by county (city) and district secondary hospitals; logistics services for each health center It is provided by the logistics service center of the county (city) and district secondary hospitals.
3. Develop a talent flow mechanism to resolve the problem of talent shortage in health centers. Incorporate the personnel relations of township health center staff into the unified management of county (city) and district secondary hospitals, and establish a talent flow platform for county (city), district secondary hospitals and township health centers to attract, cultivate, and retain talents. Provide guarantee for the continuous supply of talents to township health centers, solve the problem of township medical institutions being unable to retain talents and attract talents, and improve the overall quality of grassroots health technical personnel.
4. Government-led, giving priority to public welfare, and meeting the medical and health service needs of farmers. To promote the integrated management of health resources in counties (districts) and townships, government leadership is the foundation, institutional innovation is the key, and benefiting the masses is the goal. Health care is a social welfare undertaking, and the degree of government support for public welfare undertakings directly determines the realization of its public welfare. To a certain extent, governments at all levels should establish a sound and stable investment mechanism and responsibility assessment mechanism for township health centers, focus on building a grassroots rural health service network, effectively control the growth of medical expenses, truly realize the coordinated development of urban and rural health, and ensure that rural residents enjoy safe, effective and convenient services. , affordable public health and basic medical services.