(1) Formulate county-level public hospital development plan. County governments should, under the guidance of regional health planning and based on the principles of "revitalization of stock, control of increase, optimization of structure and dynamic management", formulate plans for the setting up of medical institutions (including non-public hospitals) on the basis of the existing medical resources and in conjunction with the local socio-economic development situation. Focus on running a general hospital, a hospital of traditional Chinese medicine, a maternal and child health center, and specify its corresponding size and establishment.
(2) clarify the functional positioning of county-level public hospitals. County-level public hospitals are county medical and health centers and rural three-level medical and health service network leader, mainly responsible for the county residents of common diseases, common diseases diagnosis and treatment, rescue and treatment of patients with serious illnesses, difficult illnesses, the first diagnosis, referral, the promotion of the application of appropriate medical technology, township hospitals and other grass-roots health care institutions, training of health personnel, technical guidance, as well as natural disasters and health emergencies, such as public *** health emergency medical care work.
(3) Elimination of drug markups and reform of the compensation mechanism.
1?Reform the mechanism of compensating doctors with medicines. On the basis of government investment and medical service fee adjustment in place, the abolition of the drug markup policy, the implementation of zero-differential rate sales. For hospitals to abolish the drug markup on the reduction of reasonable income, in accordance with the "abolition of how much, compensation for how much" principle, by the provincial, municipal and county governments to give full subsidies in proportion to the three levels.
2?The full implementation of county-level public hospitals centralized procurement of drugs "three unified" management. Directory of drugs must be through the county-level drug procurement clearinghouse for online procurement, unified distribution, unified settlement; priority equipment, the use of essential drugs, increase the proportion of essential drugs, and gradually realize all the equipment and use of essential drugs; the implementation of the medical consumables provincial open bidding, centralized purchasing.
3?Reasonable adjustment of medical service prices. In accordance with the principle of total control and structural adjustment, reduce the price of drugs and high-value medical supplies. Government-funded acquisition of large-scale medical equipment according to the cost of equipment depreciation is not included in the development of examination and treatment prices, and appropriately increase the value of technical services reflecting the value of diagnosis and treatment, nursing care, surgical fees and other medical service prices, so that health care institutions through the provision of high-quality services to obtain reasonable compensation. Price adjustments should follow the principle of reducing overall medical charges, reducing the burden on patients, and connecting with health insurance payment policies.
4?Reform of health insurance payment methods. Explore the establishment of a negotiation and consultation mechanism and risk-sharing mechanism between medical insurance agencies and medical institutions. Gradually implement total prepayment, payment by type of disease and other health insurance payment methods, and promote the formation of a third-party fee-control mechanism. Reimbursement rates have been increased, immediate settlement of expenses has been realized, and municipal coordination of urban medical insurance and joint medical care funds has been implemented in due course. The urban health insurance and joint treatment organizations should allocate the necessary working capital for county-level public hospitals.
5?Implementation of financial investment policy. County government is the county-level public hospital organizers, should protect the basic salary of hospital employees and daily operating expenses, the specific guarantee ratio according to the level of economic development in the county and hospital revenue and expenditure to determine the degree of protection to fully reflect the nature of the public welfare of the hospital to ensure that the hospital's normal operation; the hospital's capital construction and the purchase of large-scale equipment, the key specialties to develop, in line with the national provisions of the cost of retired personnel, policy losses , undertake emergency treatment, disaster relief, support the grassroots and other public **** service funding should be given full protection; hospitals historical debt unified packaging divestment, repaid by the government year by year. Gradually establish a stable growth mechanism of financial subsidies, the increase is not less than the growth rate of recurrent financial expenditures. Provincial and municipal governments in accordance with the economic development of the counties to give appropriate financial support.
(D) the establishment of modern hospital management system.
1?Explore the establishment of hospital councils and other forms of corporate governance structure. Council members include representatives of the government-run medical subject, hospital staff representatives, representatives of service users, experts and scholars. The Council is responsible for finalizing the hospital's development plan, financial budget; major business, charter formulation and revision; presidential selection and assessment; supervision of hospital operations and other duties.
2. Establishment of the dean employment system. Clearly the dean, vice president of the appointment conditions, take the public selection, social recruitment and other ways to select the dean, vice president candidates, according to the cadres management authority for approval, by the hospital council appointment. The implementation of the term of office of the president, vice president and target responsibility management.
3? The implementation of the dean's responsibility. The president is fully responsible for the operation and management of the hospital. The establishment of scientific and democratic decision-making procedures within the hospital, major decisions, project investment, the use of large sums of money, the appointment and removal of personnel above the middle level should be considered democratically and reported to the Council for approval.
4?Improve the internal management system. Focusing on the new hospital management structure, improve and perfect the hospital's internal decision-making, operation and management, asset management, medical risk warning system. Gradually form the decision-making, implementation and supervision of mutually adaptable operation and management mechanism.
5. Control medical costs. Through single-patient payment and clinical path management, medical costs are controlled within a reasonable range, and a management model centered on cost and quality control is established. Strengthen performance appraisal, taking control of medical costs, quantity of medical services, improvement of medical quality and service efficiency, and social satisfaction as the main quantitative assessment indicators. Strictly implement the hospital financial accounting system, explore the implementation of the chief accountant system, and implement internal and external audits.
(E) Reform of the personnel allocation system.
1?Authorized staffing. County governments based on regional health planning and medical service demand, determine the size of the county public hospital set up, reported to the municipal government for approval. According to the ratio of beds and personnel 1:1.5 approved staffing, doctors, nurses and other professional and technical personnel not less than 85% of the total establishment. Among them, the establishment of clinical nurses is not less than 0.4 persons per bed. Explore the implementation of county-level public hospitals to record the establishment of the system, and gradually establish a dynamic adjustment mechanism.
2?Deepen personnel system reform. County-level public hospitals in the establishment of the scale and job categories within the scope of the independent determination of positions. The full implementation of the post employment system, adhere to the competition, according to the post employment, can be in and out, can be up and down, contract management, and gradually change the status of management for the management of the post. Take a variety of ways to properly resettle the non-recruited and non-medical professional streaming staff.
3?Implementation of job performance pay system. The medical staff salary income and medical service technology level, quality, quantity, cost control, patient satisfaction and other assessment results linked to do more work more pay, merit pay, equal pay for equal work. Income distribution is tilted toward the clinical front line. Increase the proportion of hospital personnel expenses to operating expenses, hospitals can take out a certain percentage of the balance of income and expenditure to improve the treatment of medical personnel, to ensure that the income of medical personnel increased year by year.
(F) Enhancing the service capacity of county-level public hospitals.
1?Accelerate the pace of standardization of county hospitals. Counties should formulate or revise public hospital construction plans in a timely manner in accordance with regional health planning and medical service needs. For public hospitals whose operational rooms cannot meet the needs of the public, new construction, expansion and reconstruction projects can be initiated in a planned manner. During the Twelfth Five-Year Plan period, at least one hospital in each county will reach the level of Grade 2A. In the process of standardization, we should focus on improving the county emergency service system, fever clinic, intestinal disease clinic, obstetrics, pediatrics, pathology, intensive care, hemodialysis, neonatal and other key specialties.
2?Strengthening the information construction of county-level public hospitals. In accordance with the unified standards, make full use of the existing resources, integrate the existing information platform, and build the county-level hospital management and service information system with electronic medical records as the core. It is connected to the information systems of health insurance agencies and primary health care institutions, and gradually realizes interconnection; it strengthens the construction of telemedicine information systems, and gradually realizes teleconsultation, tele(pathology) diagnosis and tele-education; it establishes county medical and health care information networks based on residents' health records, and gradually implements the residents' health card, and effectively utilizes the information materials of the residents' health records.
3?Improving the service capacity of traditional Chinese medicine. In response to major local diseases, local Chinese medicine resources are actively utilized, giving full play to the characteristics and advantages of Chinese medicine in terms of simplicity, testing and inexpensiveness, improving the level of diagnosis and treatment, as well as strengthening the support and guidance for primary healthcare institutions, and promoting the entry of Chinese medicine into the grassroots and rural areas, in order to prevent and treat illnesses for the masses. Strengthen the capacity of county-level hospitals to provide Chinese medicine services, and implement the policy of tilting investment in Chinese medicine hospitals.
4?Implement measures to benefit the people. County-level public hospitals should optimize the medical process, extend outpatient hours, staggered services and time-sharing clinics; improve the referral appointment and two-way referral system; promote quality care services, implement the nursing responsibility system, improve service attitude and quality; extensive use of appropriate technology; the implementation of the mutual recognition of examination results of the medical institutions at the same level; improve the mechanism for dealing with patients' complaints, and strengthen the communication between the doctor and the patient; increase the number of frequent, infectious and chronic diseases, health education, tobacco control, and the prevention and control of chronic diseases; and improve the quality of medical services. Prevention and control and health education, tobacco control, public **** hygiene and other publicity efforts to guide the public to cultivate healthy habits and reduce the incidence of disease.
(7) Strengthening the construction of medical and health care personnel in the county.
1?Increase the introduction of talents. The government has given financial and policy support to attract senior and middle-level technical talents, subject leaders and graduates of higher medical schools to work in county hospitals on a long-term basis. During the "Twelfth Five-Year Plan" period, more than 30% of the professional and technical personnel in county-level public hospitals with bachelor's degree or above will be employed. County-level public hospitals are not subject to staffing restrictions on the introduction of health professionals with senior titles and bachelor's degrees or higher. Adjustment of the title evaluation policy for grassroots medical personnel to increase the proportion of technical personnel with senior titles.
2?Establish and improve the standardized training system for resident doctors, and strengthen the construction of training bases. New residents in county-level public hospitals must undergo standardized training. Training costs are shared by provincial and municipal governments.
3?Strengthen personnel training. The implementation of county-level backbone physician training program, each county to participate in the training of no less than 10 people per year, the province's annual training of 1,000 people; to explore the establishment of county-level public hospitals on-the-job postgraduate training system, the province's annual selection from the county-level public hospitals to participate in the on-the-job postgraduate education of 50 or so physicians; the county government to support the public hospitals each year, selecting a certain number of medical staff to the city of the third-tier hospitals to study for further training. Municipalities can use three to five years to rotate the training of medical personnel in county-level hospitals.
4?Implementing the integrated management of county and town medical institutions and the counterpart support system. The integrated management of counties and towns is being actively carried out to promote the sinking of high-quality medical resources to the grassroots level, gradually forming a pattern of primary care, graded medical care, and two-way referral. City hospitals continue to do a good job of providing counterpart support to county hospitals, and city hospitals that are in a position to do so may adopt various effective forms of counterpart support to county hospitals, such as hosting and dispatching management teams. At the same time, the strict implementation of urban doctors in the promotion of the title of attending physician or deputy director of the physician to serve in rural areas for one year before the implementation of urban hospitals to send long-term physician counterparts to support the county hospitals system, to improve the level of management of public hospitals at the county level and the ability to provide services.
(VIII) Improvement of county-level public hospital regulatory mechanism.
1?Strengthen the supervision of the health sector. Strictly in accordance with the relevant laws and regulations on the county-level public hospital medical service quality, safety and other supervision, to strengthen the budget, income and expenditure, assets, costs and other financial management supervision, to carry out the county hospitals to monitor the growth of medical costs and management.
2?Give full play to the role of medical insurance institutions to guide and supervise and control. The use of basic medical insurance drug directory preparation rate, utilization rate and out-of-pocket drug control rate, drug ratio, average cost, hospitalization rate, the average hospitalization day and other indicators to assess, strengthen real-time monitoring, the results of the fund payment and other links.
3?Strengthen price supervision and inspection. All relevant departments to strengthen collaboration and linkage, and increase the investigation and punishment of illegal behavior. Establish an integrity system and assessment files for medical personnel. The implementation of fair and transparent methods of evaluation of public satisfaction, and strengthen social supervision.