In order to further promote the construction of the public **** health system and the development of community health undertakings in our district, to alleviate and solve the current problems encountered in the work of health, such as the difficulty of the masses to see a doctor, expensive, etc., in the district party committee, the district government's support and guidance, in the district of the CPPCC's unified organization and coordination of the CPPCC, the district CPPCC Grammar Committee and the district government's Bureau of Health to form the research team, on the The development of health services in our region for more than three months of thematic research activities. The research group in-depth visits to the relevant health service institutions, the organization of some CPPCC members on the construction and use of public **** health hardware in our region to carry out thematic inspections, were held CPPCC members, experts and scholars, heads of community health service institutions, health services management and institutions in charge of the symposium, and to Chongqing, Chengdu and other friendly urban areas for learning and study visits, a wide range of collection of the relevant aspects of the opinions and suggestions. The basic situation of the research is reported as follows.
I, the basic situation
In the mapping survey, we focus on our region's health resources, demographic structure, insurance participation, the number of slow patients, the ratio of doctors and patients, etc., the preliminary mapping of some of the basic situation related to the work of our region's health services services.
1, the basic situation of health service resources. As of the first quarter of this year, the area **** there are 18 hospitals, divided by ownership, public hospitals 13, accounting for 94.3% of the total number of beds; non-public hospitals 5, accounting for 5.7% of the total number of beds. According to the division of affiliation, the province belongs to 1, the city belongs to 3, the district belongs to 1, the army belongs to 2, enterprises and institutions belong to 6, individual belongs to 5. In addition to hospitals, the district has a maternal and child health clinic, 11 community health service centers and 3 community health service stations. Among the community health service centers, there are 4 publicly-owned and 7 socially-associated ones. In addition, there are 139 outpatient clinics and clinics in the district, all of which are non-public medical institutions. The relatively dense configuration of medical institutions has kept the number of beds and doctors per 1,000 population at a high level. Now our district per 1,000 population with the number of beds and the number of practicing physicians were 12.9 and 5.97, both indicators are higher than other urban areas and the city's overall level of 4.46, 2.48, but also greatly exceeded the "Liaoning Province, the implementation of the regulations on the management of health care institutions," the provisions of the "in principle, the city should be controlled in every 1,000 population of 6.5 beds, 3.0 physicians," the standard. The standard of "6.5 beds and 3.0 physicians per 1,000 population in principle in urban areas" has been exceeded.
2, the residents enjoy medical insurance. Participation in the insurance situation is to measure the level of basic medical protection of the residents, the important indicators of the interests of the masses. Xigang District, the existing household population of 336,700 people, including 70,000 people over 60 years old, accounting for 20.8% of the total household population. There are 213,600 people participating in basic medical insurance, accounting for 63.4% of the total household population; 49,000 people participating in commercial medical insurance, accounting for 14.6% of the total household population; and 74,000 people paying for medical treatment at their own expense, accounting for 22% of the total household population. There were 0.84 million low-income insured persons, of whom 0.63 million participated in medical insurance, accounting for 75% of the total number of low-income insured persons; 0.18 million did not participate in medical insurance, accounting for 21.5% of the total number of low-income insured persons. There were 19,000 permanent foreign residents, of whom 0.18 million participated in medical insurance, accounting for 9.5% of the total permanent foreign residents; 17,200 did not participate in medical insurance, accounting for 90.5% of the total permanent foreign residents. There are 28,000 people suffering from nine common chronic diseases, of which 22,900, or 81.4%, are covered by medical insurance; and 0.52 million, or 18.6%, are not covered by medical insurance.
3, community health services carried out. Community health services is to increase the supply of medical services, improve the quality of medical services, alleviate and crack the masses "difficult to see a doctor, expensive" an important way. In recent years, in this regard, the district party committee, the district government continues to strengthen leadership, increase investment, the relevant departments to innovate ideas, pay close attention to the implementation of a large number of fruitful work. First, efforts to build a "service network" system. According to the "scientific planning, rational layout, optimize the allocation, convenient for residents" principle, the medical institutions in our region for the withdrawal and transformation and layout adjustment, planning and construction of 11 community health service centers, set up a health prevention and treatment stations in the streets, community health services for the provision of resources to protect the service. 11 community health service center, The 11 community health service centers and 3 community health service stations have basically realized the goal of "easy access to medical care within 10 minutes" within their respective service radius. As of the first quarter of this year, community health service organizations in our region*** established 135 family beds and 78,000 family health records. Last year, the use of family hospital beds was 861 visits, outpatient and rounds services 336,000 visits, accounting for 14% of the total number of medical outpatient visits in the district. The average number of daily visits in each community has now reached 83.6. The second is to continuously increase the "standardization" management. Strengthen the connotation construction, improve the management mechanism, the implementation of integrated and standardized management. Strict supervision in accordance with the law, the implementation of quantitative management, to promote the community health service institutions in accordance with the law, standardize the practice of medicine. Strengthening quality management, improving service effectiveness, and promoting the improvement of the quality of community health medical services through a variety of means and forms. At the same time, focusing on the "introduction, training, management" three links, and actively promote the construction of community health service personnel. Now there are 343 community health service practitioners, with an average of 3.6 doctors and 4 nurses per 10,000 people. Thirdly, we are carrying out in-depth "health in the community" activities. At the same time as actively improving consultation services, it has stepped up its efforts to publicize, guide and go out of the home and into the community to deliver health care and services to the public, and has carried out the following activities: health intervention, disease prevention, maternal and child health care, medical rehabilitation, and Red Cross services in the community, as well as the following activities: delivering doctors and medicines, making medical returns, providing care for the critically ill, providing end-of-life care, providing family hospital beds, providing health surveys, providing guidance on rehabilitation, providing immunization and vaccination services, providing postnatal visits and providing warmth and assistance to the family. The main content of the "five into the community, ten into the family" activities, so that the residents really feel the convenience of community health services. Fourth, we are constantly improving our "preferential service" measures. With the goal of lowering the cost of medical care for the masses, we have introduced the "four exemptions" measures. With the goal of improving the quality of medical services, we have introduced the "Ten Commitments" measures. With the goal of reducing the medical expenses of low-income people, "ten concessions" have been introduced. At the same time, we have implemented "one certificate, one card" and "medical assistance" services for special groups such as low-income households, disabled households, marginalized households, and rural migrant workers, so that problems such as "difficult and expensive access to medical care" have been solved to a certain extent. This has helped to alleviate to a certain extent the problems of "difficult and expensive access to medical care" for the general public. Fifthly, we continue to strengthen our "health management" measures. Adhering to the principle of "education first, disease prevention first", we give full play to the role of community health service organizations, and actively strengthen the health education and management of residents under our jurisdiction. Health records of residents in the district are established to provide the basis for health management. Strengthen the community health education and publicity, in the community, public **** place to carry out health knowledge and disease prevention and control knowledge lectures, improve the jurisdiction of the residents of the rate of knowledge of health and the formation of healthy behavior rate.
Two, there are problems
I area in the construction of public **** health service system and community health services, despite the great achievements, but due to the subjective and objective conditions, there are still some impact on the construction of the public **** health service system and the impact of the residents of the public health service system to see a doctor, treatment of the difficulties and problems. Mainly manifested in: First, the masses are difficult to see the doctor, the problem of expensive still exists. Jurisdiction of the medical resource allocation, although relatively saturated, common diseases, common illnesses, relatively convenient, but some large hospitals, specialist clinics, hospitalization and other aspects of the phenomenon of the number of places, long queues, some of the difficult to complete the diagnosis and treatment of difficult illnesses in the local area, the difficulty of access to health care to a certain extent, still plagued the masses of the jurisdiction. In order to alleviate the problem of the masses to see a doctor, although the city and district government to some people in need of medical assistance measures, but by the macro system, the slow development of medical insurance and other factors, the masses to see a doctor is expensive, especially some of the patients who do not participate in the medical insurance of chronic diseases, urban marginalized people can not afford to see the problem is still relatively prominent. In addition, the aging of the population in our region is relatively serious, the elderly over 60 years old accounted for 20.9%, higher than the average level of 15.6% in Dalian City, objectively leading to the jurisdiction of the higher rate of chronic diseases, the amount of medical expenditures, exacerbating the problem of the masses of our region to see the expensive problem of the doctor. Secondly, there are still weak links in community health services. Due to service facilities, medical equipment, technical force and other aspects of the limitations, coupled with medical insurance and other policies and systems are not perfect, "minor illnesses in the community, serious illnesses into the hospital," the habit of medical care and process has not been formed, community service organizations and large hospitals, two-way referral mechanism has not yet been really established, affecting the healthy development of community health services. The existing community health service institutions in our region is mainly private, with the liberalization of health insurance policy, the liberalization of the management of chronic diseases, the liberalization of access to collective individual medical institutions, liberalization of drug prices, the original enjoyment of the policy advantage gradually weakened, the pressure to survive increases year by year. Out of the pressure of survival and profit-oriented nature, community health service organizations have not been fully reflected in the public service, "medicine for medicine" situation is very prominent, should bear the public **** service functions are not fully in place. Third, the construction of the talent team is still insufficient. Health system career personnel age, low education, professional and technical personnel shortage phenomenon is relatively serious. The perfect hiring mechanism has not really been established, affecting the staff's enthusiasm and initiative. The lack of a reasonable talent mobility mechanism makes it difficult to bring in good talent and transfer out existing personnel, affecting the overall vitality of the health system team. Due to the narrower source channels of community health service personnel, coupled with high work intensity and relatively low treatment, resulting in a shortage of talent, personnel instability, affecting the quality and level of service. Fourth, the policy input mechanism is not perfect. Although our region has implemented a public **** service subsidy policy of 40,000 yuan per 10,000 people per year, but with the development of community health services compared to the demand for input is still insufficient, affecting the public welfare of community health services to play.
Three, the idea of countermeasures
For the above problems, we improve the public **** health service system, solve the masses "difficult to see a doctor, expensive" problem as the goal, drawing on the experience and practices of friendly urban areas, and the synthesis of all aspects of the views and suggestions on the construction of the public **** health service system in our region, Community health service service development and other aspects, put forward the following ideas and countermeasures.
1, further improve the level of public **** health system construction. First, attention should be paid to the integration of the jurisdiction of the public **** health service resources. Fully summarize the "SARS" period of public **** health services, especially the experience of disease prevention and control system construction, and strengthen the cooperation with municipal preventive health institutions, adhere to the principle of not seeking all, but seek to use, relying on the jurisdiction of the municipal public **** health services focused on the advantages of the area, further increase the integration of health resources in the jurisdiction, and efforts to Form a good situation of "resource *** enjoyment, regional linkage" to provide resource support for the public *** health service system in our region. Secondly, the efficiency of the use of public **** health resources in the district should be fully improved. In recent years, our district has increased investment in public **** health hardware construction, and facilities such as the District CDC, Maternal and Child Health Center, and Health Supervision Institute have been reconstructed or renovated. To this end, the principle of building, managing and utilizing should be adhered to, to ensure that good hardware produces good results. At the same time, practices such as internal **** enjoyment and paid leasing can be adopted to improve the utilization rate of newly configured equipment, prevent idle and wasteful use of resources, and give full play to the proper role of these resources and facilities in public **** health services. Thirdly, the vitality of the institutions should be fully tapped and mobilized. Strengthen the work guidance, refine the work responsibilities, improve the work assessment, guide and prompt the health system institutions based on their respective functions, a good division of labor, assume the role of the main force in the construction of the public **** health service system. Explore the establishment of employment mechanism full of vitality and vigor. According to the principle of reform of institutions, in accordance with the requirements of leanness and efficiency, increase the reform of personnel management system, adopt two-way selection, competition, merit-based employment, contract management, etc., to stimulate the internal vitality of institutions, and establish an employment mechanism conducive to mobilizing the work of the enthusiasm of the employer. Strict performance appraisal, the appraisal results and income linked to the adoption of the assessment of unqualified personnel to wait for training or transfer out of the post and other practices, for the introduction of talent to make room, and gradually solve the problem of the orderly entry and exit of personnel and other issues, for the public **** health services to provide talent security.
2, to further deepen the work of community health services. First, should further improve and implement supporting policies conducive to the development of community health. Our region should learn from the practice of Chongqing and other places, seriously implement the Dalian City on the community health subsidies related regulations, the full arrangement of subsidies, and gradually establish a scientific policy compensation mechanism to reduce the pressure on the survival of community health institutions, so that they have the spare capacity to take into account the function of good public **** health services. Second, efforts should be made to establish and improve the collaboration system between community health organizations and other medical institutions. Continue to strengthen the publicity of community health service institutions, enhance public recognition and trust, and strive to guide the public to form the habit of seeking medical treatment for minor ailments in the community, so that community health service centers can play a good role as the basis for comprehensive health protection in the region. Strengthen guidance and coordination to promote community health institutions and large hospitals in the jurisdiction to establish a long-term stable two-way referral partnership, so that the two reasonable division of labor, staggered services, close collaboration, mutual support, and strive to form a hierarchical medical care, two-way referral mechanism and "minor illnesses" in the community, "major diseases" into the hospital pattern. The pattern of "minor illnesses" in the community and "major illnesses" in the hospital. In view of the actuality of the relative weakness of community health service talents, can coordinate and guide the community health institutions and large hospitals to cooperate in the establishment of talent training and exchange system, arrange for community hospitals to take turns to large hospitals for training and further training, but also can be arranged for large hospitals to the community health institutions of health personnel internships, to promote the overall quality of the health service team of the region to improve. Third, we should continue to strengthen the standardized management of community health service institutions. Continue to increase the hardware and software construction and the introduction of talent to further strengthen the standardization of community health services, optimize the medical environment, medical procedures, and strive to create convenient, friendly health services. On the basis of implementing the service standardization and consolidating the existing service achievements, we will innovate the service mode and adopt the forms of community rounds and follow-up services to further enhance the level of community services. Cultivating characteristics and building up advantages, supporting the development of a number of community health service organizations featuring Chinese medicine and rehabilitation services, so as to enhance their competitive advantages and raise the level of effectiveness. Improve supervision, inspection and business guidance, so as to encourage community health service organizations to improve their service functions and raise their service levels. The establishment of the government to purchase services system, around the community health institutions six functions, the development of community health service institutions target responsibility system management assessment program, quantitative assessment indicators, especially the rate of public satisfaction as an important basis for the assessment of the completion of the public **** service functions and government investment combined. The establishment of assessment and reward system, from the community health service institutions of health funds to extract a certain percentage as the assessment and reward funds, according to the results of the assessment, to take the way of awards, to mobilize the community health service institutions to carry out the public **** health services, and to promote its by favoring the profit-oriented to the public welfare and profit-oriented and heavy transformation.
3, within the ability to solve the problem of the masses to see a doctor. First, attention should be paid to solving the problem of access to medical care for key populations. Focusing on women, children, the elderly, the chronically ill, the disabled, and poor residents, in-depth medical treatment, prevention, health care, rehabilitation, health education, and diagnostic and treatment services for common and frequent diseases in general. Second, it should continue to carry out medical services for the benefit of the public. Continue to implement the existing "four exemptions", "ten commitments", "ten concessions" and other medical relief and subsidy policies in our region, and on the basis of the medical assistance scheme for urban residents in difficulty issued by the municipal government, provide medical services for the poor in accordance with the requirements of the government's policy. On the basis of the measures for medical assistance, according to the scope of our district's power and financial resources, we will increase our efforts to provide medical assistance to special groups, and take low-income households, marginal urban populations, and chronically ill patients who do not participate in medical insurance as the target recipients of assistance, and adopt the methods of outpatient medical subsidies, partial fee waivers for medical consultations, and one-time relief, etc., so as to gradually establish and improve a long-term mechanism for medical assistance that gives priority to key populations, and alleviate the problem of expensive or unaffordable medical care for this group of people. Third, the introduction of centralized bidding for medicines should be explored. Third, the practice of centralized bidding and procurement of medicines should be explored. In view of the fact that the price of medicines accounts for a large portion of the public's medical expenditure, our region should explore ways to strengthen the unified supervision and regulation of medicines. Consider coordinating the jurisdiction of the medical institutions to form a drug procurement alliance, as far as possible to reduce the price of drugs, to provide the residents with the benefits of the masses.