Fujian Provincial People's Government Office health township integration management measures

The health bureau, finance bureau, human resources bureau, civil service bureau of each district city, social affairs bureau of the administrative committee of Pingtan Comprehensive Experimental Zone, finance and financial bureau, party and group work department:

Hereby, the "Guidelines for Pilot Work on the Integration Management of County and Township Medical and Health Care Services in Fujian Province" is issued to you, please organize and implement it conscientiously. Each district city pilot county (city) list please report to the Provincial Health and Family Planning Commission on September 10 for the record.

Fujian Provincial Health and Family Planning Commission Fujian Provincial Department of Finance Fujian Provincial Department of Human Resources and Social Affairs

August 25, 2014

Fujian Province, county and township medical and health services integration management pilot guidance

In order to accelerate the development of medical and health care in the county area of the province, promote the comprehensive reform of county and township medical and health care institutions, integration of medical and health care resources, to achieve the resources **** enjoyment, and further enhance the rural health care service capacity, to meet the masses of people to visit the health care system. Service capacity to meet the needs of the masses to see a doctor, according to the "General Office of the People's Government of Fujian Province forwarded to the Provincial Department of Health and other departments on the establishment of public hospitals and grass-roots medical and health institutions division of labor and collaboration mechanism for the implementation of the views of the notice" (Minzhengban 〔2010〕 No. 52), and other documents, after study, decided to carry out the pilot integration of county and township health care services management work, the following views.

First, the work objectives

In accordance with the "basic, strong grassroots, build mechanisms" requirements to establish and county economic and social development in line with the health care system as the goal, in accordance with the government-led, people benefit, highlight the key points, according to the principle of local conditions, through the county, township medical and health care services integrated management pilot, to explore the establishment of public hospitals and primary medical and health care services, and the establishment of a public hospitals and primary medical and health care services, and the establishment of a public hospitals and primary medical and health care services. Explore the establishment of public hospitals and primary health care institutions division of labor and collaboration mechanism to further improve the utilization rate of health care resources and comprehensive service capacity, and strive to reach 90% of patients within the county in 2015, to explore the establishment of graded diagnosis and treatment and two-way referral system.

Second, the scope of the pilot

each district city (except Xiamen) can combine the local reality, choose 1-2 counties (cities), to carry out county-level public hospitals and 1-2 C hospitals to implement the integration of county and township medical and health services management pilot.

Third, the main tasks

(a) clear functional positioning

County public hospitals (including Chinese medicine hospitals) is the county health care centers and rural three-tier health care network "leader", mainly responsible for the county residents of basic medical services, common diseases, diagnosis and treatment of common illnesses, patients with acute and serious illnesses, the rescue of the major difficult diseases, initial diagnosis, disposal and referral. It is mainly responsible for basic medical services for county residents, diagnosis and treatment of common and frequent diseases, rescue and treatment of critically ill patients, initial diagnosis, treatment and referral of major and difficult diseases, popularization and application of appropriate medical technology, emergency response to natural disasters and public health emergencies, as well as teaching, training and technical guidance for grassroots health personnel in township health centers. Township health center to maintain the health of local residents as the center, integrated to provide basic medical care, basic public **** health and family planning technology and other integrated services, and commissioned by the county-level health planning administrative departments, responsible for the jurisdiction of the village health room business management and technical guidance.

(B) the establishment of a new management system

In accordance with the requirements of the "four unified, three unchanged, a push", the pilot counties (cities) focus on the selection of 1-2 technically weak C township health centers and county-level public hospitals (including traditional Chinese medicine hospitals) to implement the integrated management of the county and township levels of health care services as a whole. To establish a synergistic relationship of mutual dependence and complementary advantages, to achieve resource ***sharing, unified management, optimization of structure, rational division of labor, mutual promotion, ***same development, and to gradually realize grass-roots first diagnosis, two-way referral, and hierarchical diagnosis and treatment, so that the public can enjoy "safe, effective, convenient, and inexpensive" basic medical services. Specific requirements:

1. personnel unified management. The implementation of county and township medical and health services integrated management of the pilot counties, can be technically weak, fewer medical personnel township health center personnel management authority into the county hospital unified management; can also be more township health centers, obtaining a licensed (assistant) physician qualification and registered in the post of the doctor into the county hospital unified management. County hospitals in accordance with the principle of "relatively fixed positions, personnel flow according to need", coordinated deployment and use of personnel. Township health center personnel and county hospital personnel in the remuneration, selection and use of equal rights, title assessment in accordance with the original assessment conditions. Localities should give township health centers more convenient recruitment policy, more favorable job setting policy, and appropriately increase the proportion of senior job structure.

2. Medical business unified management. Township health center medical business by the county hospital unified management, to achieve uniform rules and regulations, technical specifications, personnel training, business guidance and work assessment, in accordance with the functional positioning and technical requirements for medical services.

3. Medical equipment unified management. Strengthen the integration of elements and functions of county and township medical and health resources, through the formation of clinical testing centers, imaging consultation centers, disinfection supply centers and other resources **** enjoyment platform, the implementation of the examination and test results of mutual recognition, improve the quality of medical resources scale, intensive use. Encouragement through service outsourcing and other forms of qualified medical testing, sterilization supply and other social professional services institutions to purchase services to enhance the grass-roots diagnostic and treatment capacity and management level.

4. Performance evaluation and unified management. County and township integrated management of health care institutions to implement a unified performance assessment, financial independent accounting. County hospitals according to the results of the performance appraisal of the independent distribution, to do more work more pay, merit pay, equal pay for equal work, income distribution focus on the clinical front line, key positions, the backbone of the business and make outstanding contributions to the personnel tilted to the township positions and appropriate tilted to the reasonably open the income gap. County-level health planning and administrative departments should improve the performance appraisal system for county and township-level medical institutions, develop assessment indicators for the reasonable diversion of patients, and strengthen the supervision and guidance on the implementation of the financial accounting system for county hospitals and township health centers. Disposal of assets in accordance with the unified provisions of the county-level state-owned assets management department.

5. Institutional settings and administrative structures remain unchanged. County hospitals and township health centers to retain their original institutional settings and administrative structure, township health centers can be added to the county hospital branch of the brand.

6. Organizational functions and tasks remain unchanged. County hospitals bear the county health care services, primary health care institutions, technical guidance and staff training and other tasks remain unchanged. Township health centers are still responsible for the administrative area of the residents' health records, health education, immunization, prevention and control of infectious diseases, child health care, maternal health care, health care for the elderly, chronic disease management, management of patients with severe mental illness, health supervision and management, health management of traditional Chinese medicine and other 11 types of basic public **** health services and family planning technical services, as well as their functions appropriate to the basic medical services.

7. Financial input guarantee mechanism remains unchanged. County and township medical institutions of the current financial input policies and channels remain unchanged. C township health center capital construction, equipment purchases and other development and construction funds and basic public **** health services funded by the government in a timely manner and full payment, staff salaries in accordance with the current policy of full payment.

8. Promote the construction of hierarchical diagnosis and treatment system. County hospitals as the center, to the county and township integrated management as a carrier, the comprehensive use of health care, medical insurance, price, personnel training and innovation of new models of primary health care services and other measures to improve the county hospitals and primary health care institutions of the division of labor and coordination mechanism to promote the construction of hierarchical diagnosis and treatment system. Pilot counties should formulate clinical standards for two-way referral of outpatients and inpatients at the county and township levels, referral procedures and management norms, and abolish the two-way referral of patients to medical insurance and the New Agricultural Cooperative Medical Insurance Scheme (NACMS) at the county and township levels of healthcare institutions under integrated management, so as to promote the implementation of the two-way referral policy. In principle, outpatients should be given priority in primary healthcare institutions. Medical institutions at the county and township levels should clarify the conditions for admission and treatment of inpatient diseases; patients who meet the conditions for admission and treatment of inpatient diseases at the primary level should be given priority for treatment at the primary level; patients who meet the conditions for referral should be given priority for treatment and inpatient services at the county hospitals, so as to gradually realize the seamless referral of patients. Primary healthcare organizations can also provide patients with appointment services for tests and examinations carried out in county-level hospitals, and provide timely feedback on test and examination results. By strengthening referral services, smooth referral channels, guide patients to the grass-roots level of medical care, and gradually realize the grass-roots first, two-way referral, hierarchical diagnosis and treatment.

Fourth, the work requirements

(a) strengthen the organizational leadership

The pilot counties (cities) health administrative departments to strengthen the organizational leadership, combined with the local reality, the development of county and township medical and health services integrated management pilot work program, clear responsibility for the main body, the work task and time schedule. In addition to the implementation of close integrated management, you can also carry out medical services hosting type, technical cooperation, counterpart support type and other loose integrated management, through effective management, effectively improve the level of integrated management, and promote the improvement of county medical service capacity. Preparation, finance, personnel and other departments in accordance with their respective responsibilities to actively cooperate with the formation of synergies to promote the smooth implementation of the pilot work.

(B) a clear division of responsibilities

county hospitals in accordance with the requirements of the rational deployment of human resources, township health centers for the demand for medical services, the development of practical work plan, take effective measures to improve the township health center's service capacity. Township health centers to do a good job in the medical and health services at the same time, to do a good job in basic public **** health services and family planning technical services, to fulfill the jurisdiction of the village health center supervision responsibilities.

Each place should pay attention to the process of strengthening the pilot management, strengthen communication and coordination, found that the problem of timely improvement, and constantly improve the policy measures. Focus on the pilot counties (cities) of initiative, enthusiasm, creativity, and summarize the work experience in a timely manner, to promote the integration of county and township medical and health services management pilot work to achieve results.