In order to implement the "General Office of the People's Government of Henan Province on the forwarding of the five key reforms of the medical and health system in Henan Province in 2010 the main work of the notice" (Yu Zhengban [2010] No. 85) spirit, and solidly promote the reform of the city's medical and health system, the development of this program.
One, the overall requirements
2010 medical and health system five key reforms should be closely around the "basic, strong grass-roots, building mechanisms" of the overall requirements, highlighting the benefits of measures to enhance the effectiveness of the reform, and solidly promote the medical and health system five key reforms for the full completion of the three-year goal of the established Lay a good foundation for the full completion of the three-year target.
Second, the target responsibility
(a) accelerate the construction of the basic medical insurance system
1. consolidate and expand the coverage of basic medical insurance. The main objectives: (1) to expand the coverage of basic medical insurance for urban workers (hereinafter referred to as urban workers' medical insurance) and basic medical insurance for urban residents (hereinafter referred to as urban residents' medical insurance), with the number of insured persons reaching 367,000 and 518,000 respectively. The city will further do a good job in insuring employees of non-public economic organizations, college students, flexibly employed persons and migrant workers. (Municipal Human Resources and Social Security Bureau is responsible for) (2) basically solve the problem of insurance coverage for retirees of closed and bankrupt enterprises and employees of enterprises in difficulty. (Municipal Human Resources and Social Security Bureau, Municipal Health Bureau, Municipal Finance Bureau are responsible for) (3) consolidate the coverage of the new rural cooperative medical care (hereinafter referred to as the New Rural Cooperative Medical Care), participation rate stabilized at more than 90%. (Municipal Health Bureau is responsible for)
2. Further improve the level of basic medical insurance. The main objectives: (1) to raise the financing standards. The new rural cooperative and urban residents health insurance subsidies to implement the same standard, a unified increase to 120 yuan per person per year. Governments at all levels should implement local matching funds in accordance with the provisions, while appropriately raising individual contribution standards. (Municipal Health Bureau, Municipal Human Resources and Social Security Bureau, Municipal Finance Bureau are responsible for) (2) accelerate the promotion of outpatient coordination. Urban residents' medical insurance outpatient co-ordination to expand to 60% of the co-ordination area, the new rural cooperative outpatient co-ordination to reach more than 50% of the co-ordination area, urban workers' medical insurance outpatient co-ordination in the conditions of the region to explore first. The reimbursement ratio of outpatient expenses in primary healthcare institutions is significantly higher than that in hospitals. (Municipal Human Resources and Social Security Bureau, Municipal Health Bureau are responsible for) (3) increase the reimbursement rate. The reimbursement rate for hospitalization expenses within the policy scope of the urban residents' medical insurance and the New Farmers' Cooperative has reached over 60%, and the reimbursement rate for hospitalization expenses within the policy scope of the urban workers' medical insurance has been increased. The maximum payment limit of the integrated fund for urban workers' medical insurance, urban residents' medical insurance and the New Farmers' Cooperative Medical Scheme in all integrated areas has been raised to more than six times the average annual salary of local employees, the disposable income of residents and the average net income of farmers nationwide. (Municipal Human Resources and Social Security Bureau and Municipal Health Bureau are respectively responsible for) (4) Increase medical assistance. Low-income recipients, the five guaranteed households by the medical insurance reimbursement is still difficult to afford the medical expenses to give subsidies. Gradually carry out outpatient assistance, abolish the hospitalization assistance disease restrictions. Promoting the construction of urban and rural medical assistance systems, and gradually realizing comprehensive coverage of urban and rural medical assistance with the New Rural Cooperative Medical Insurance and the urban residents' medical insurance synchronized settlement system. Explore the implementation of major disease relief measures. (Municipal Civil Affairs Bureau is responsible for) (5) in accordance with provincial requirements to carry out children's leukemia, congenital heart disease and other children's major diseases, medical insurance pilot. (Municipal Health Bureau, Municipal Civil Affairs Bureau, Municipal Human Resources and Social Security Bureau is responsible for)
3. Improvement of the basic medical insurance fund management. The main objectives: (1) vigorously promote the medical "one card" and other methods to facilitate the insured to seek medical treatment and settlement of medical expenses. In 80% of the urban workers' health insurance, urban residents' health insurance and New Farmers' Cooperative coordinated areas, instant settlement of medical expenses has been realized, and patients only need to pay out-of-pocket medical expenses. (Municipal Human Resources and Social Security Bureau, Municipal Health Bureau are responsible for) (2) in Xiangcheng County, Yanling County, the first pilot, the implementation of capitation payment, payment by type of disease, the total amount of pre-payment and other payment methods. About 50 diseases with clear clinical paths will be selected to carry out the pilot project of paying by disease. Explore the establishment of a negotiation mechanism between medical insurance organizations and medical institutions and drug suppliers, and play the role of medical insurance in restraining the cost of medical services and drugs. (Municipal Human Resources and Social Security Bureau, Municipal Health Bureau are responsible for) (3) according to the provincial requirements to do a good job of migrant workers and other migrant workers basic medical insurance relationship across the system, cross-region transfer work, and explore the real-time settlement of medical expenses in other places. Carry out the settlement service of medical treatment in other places with the focus on retirees resettled in other places. (Municipal Human Resources and Social Security Bureau, Municipal Health Bureau is responsible for) (4) according to the provincial requirements to explore to improve the level of basic medical insurance, medical insurance municipal integration. Scientific argumentation and orderly development of basic medical insurance management resources integration. (Municipal Human Resources and Social Security Bureau, Municipal Health Bureau is responsible for)
(2) the initial establishment of the national basic drug system
4. Further promote the implementation of the national basic drug system. The main objectives: (1) the implementation of the basic drug system, from January 1, 2011 onwards, in the city's all government-organized urban community health service institutions and counties (primary health care institutions) to implement the national basic drug system. National essential drugs and additional non-catalogue drugs are sold at a zero-differential rate. (Municipal Development and Reform Commission, the Municipal Health Bureau are responsible for) (2) standardize the bidding distribution of essential medicines, the implementation of essential medicines in order to provinces to recruit varieties of specifications, recruiting the number of recruiting, recruiting the price, recruiting the provisions of the manufacturer, and gradually realize the province's uniform price of essential medicines to protect the quality and supply of essential medicines. (Municipal Health Bureau, Municipal Finance Bureau is responsible for) (3) close tracking and monitoring of basic drug market prices and supply changes, according to the province's centralized bidding and procurement of drugs, timely adjustment of sales prices. (Municipal Development and Reform Commission is responsible for) (4) promote the clinical application of basic drugs guide and basic drugs prescription set, to ensure that the clinical first choice and rational use of basic drugs. (Municipal Health Bureau is responsible for) (5) the basic drugs for all varieties of sampling and testing and all varieties of electronic monitoring, improve the municipal adverse drug reaction reporting and evaluation system. (Municipal Food and Drug Administration is responsible for) (6) the implementation of the national basic drug health insurance reimbursement policy, to ensure that all basic drugs into the scope of health insurance reimbursement, reimbursement rate is significantly higher than non-basic drugs. (Municipal Human Resources and Social Security Bureau, the Municipal Health Bureau is responsible for) (7) closely track the implementation of the national basic drug system on the impact of the drug distribution industry, and actively study solutions. Strengthen the industry management and enterprise service work, guide the city's pharmaceutical industry enterprises in the production and supply of basic drugs. (Municipal Bureau of Industry and Information Technology is responsible for)
5. Reform of primary health care institutions compensation mechanism. The main objectives: (1) to further improve the compensation mechanism of primary health care institutions, and actively explore multi-channel compensation methods, the implementation of government-organized primary health care institutions to implement the implementation of zero-differential rate sales of essential medicines after the Government's investment policy to ensure their normal operation. (Municipal Finance Bureau, Municipal Health Bureau, Municipal Human Resources and Social Security Bureau are respectively responsible for) (2) According to the provincial regulations, to explore through the purchase of services to play the role of health insurance fund compensation for primary health care institutions. (Municipal Human Resources and Social Security Bureau, Municipal Bureau of Health are responsible for) (3) Encourage the conditions of the place will be non-public primary health care institutions into the scope of implementation of the basic drug system, to explore standardized and reasonable compensation methods. (Municipal Health Bureau, Municipal Finance Bureau, Municipal Human Resources and Social Security Bureau are respectively responsible for) (4) support the implementation of comprehensive reform of primary health care institutions, the provincial and municipal levels of finance through awards in lieu of subsidies for the implementation of the basic drug system progress fast, the effectiveness of the comprehensive reform of the institutional mechanism of primary health care institutions in the area of a good incentives and subsidies. (Municipal Finance Bureau, Municipal Development and Reform Commission are responsible for)
6. Deepen the reform of personnel distribution system of primary health care institutions. The main objectives: (1) the implementation of primary health care institutions and public **** health institutions to implement performance pay policy. (Municipal Human Resources and Social Security Bureau, the Municipal Finance Bureau, the Municipal Health Bureau, the Municipal Population and Family Planning Commission are responsible for) (2) the implementation of the ability to enter and exit the employment system, the establishment of the quality of service, the number of services and the public's satisfaction as the core of the assessment mechanism, to improve and implement the performance appraisal. (Municipal Human Resources and Social Security Bureau, the Municipal Health Bureau are responsible for) (3) according to the township health center establishment standards, complete the township health center staffing approved. (Municipal Editorial Office, Municipal Health Bureau, Municipal Finance Bureau is responsible for)
7. Transformation of primary health care institutions operating mechanism. The main goal: to move the primary health care institutions to take the initiative to serve, door-to-door service, to carry out medical tours, for urban and rural residents to provide basic medicines, basic medical care and public **** health services, so that the township health centers and community health service institutions outpatient clinics accounted for the proportion of the total number of outpatient clinics of health care institutions has increased significantly. (Municipal Health Bureau is responsible for)
(C) sound primary health care service system
8. Further strengthen the public **** health and primary health care institutions. The main objectives: the construction of three county hospitals (one new, expanding two), the central budget investment of 68 million yuan, the provincial financial special investment of 12.8 million yuan, the local investment of 91.41 million yuan; expansion of two central township health centers, the central budget investment of 2 million yuan, the provincial financial special investment of 90,000 yuan, the local investment of 210,000 yuan; the construction of 816 village health rooms (provincial arrangements for the project), the provincial subsidies of 8.16 million yuan, municipal and municipal health care institutions, and the construction of the village health center. Subsidies 8.16 million yuan, the city, county (city, district) at least 8.16 million yuan; expansion of six community health service centers, the central budget investment of 10.5 million yuan, the provincial financial investment of 1.64 million yuan, local investment of 3.51 million yuan. The above projects to ensure that the local funds in place in full and on time, completed and put into use. (Municipal Development and Reform Commission, the Municipal Finance Bureau are responsible for)
9. Launch the implementation of general practitioners as the focus of primary health care team building program. The main objectives: (1) the development of rural health care jobs demand plan, start the implementation of higher medical schools in rural areas of free training program, in 2010 for township health centers to enroll 20 free medical students directed. Actively carry out the reform of higher medical education for the training of grassroots health personnel, and strengthen the training of general medicine teachers. (Municipal Health Bureau is responsible for) (2) start the first batch of general medicine direction of the standardized training of residents, arrange for 80 primary health care institutions on the job for the transfer of general practitioner training. (Municipal Health Bureau is responsible for) (3) consolidate and improve the third-level hospitals and county hospitals in the long-term collaborative relationship. Strengthen the county hospital health care personnel training, arrange 15 county hospitals backbone personnel to the third-level hospitals for further study, to carry out specialized direction of the standardized training of resident doctors. (Municipal Health Bureau is responsible for) (4) to encourage and guide health care personnel to grass-roots services. 2010 for the township health centers to recruit 4 licensed physicians, the central subsidy of 80,000 yuan, wages and salaries are not lower than the level of local personnel of the same type, the shortfall by the municipal and county finances to make up for the full; on-the-job training of township health personnel for 324 person-times; training of health personnel in the village health room for 3,428 person-times; training of urban community health service personnel for 170 person-times, the central government, the central government to train health personnel, the central government to train health personnel, the central government to train health personnel in the urban community health service personnel. 170 people, the central subsidy of 216,000 yuan. (Municipal Health Bureau, Municipal Finance Bureau are responsible for) (5) improve the use of primary health care personnel mechanism, encourage the development of general practitioner county and township linkage pilot. (Municipal Health Bureau, Municipal Development and Reform Commission, Municipal Bureau of Human Resources and Social Security are responsible for) (6) the implementation of national policy on general practitioner training and title assessment. (Municipal Health Bureau, Municipal Bureau of Human Resources and Social Security are responsible for)
10. To play the village health office in the rural three-tier health service network in the bottom of the network function. The main objectives: (1) play the role of the government, collective, individual and other parties to strengthen the construction of the village health office, the government focus on strengthening the village health office and rural doctors technical support, actively and steadily promote the integrated management of rural areas. (Municipal Health Bureau is responsible for) (2) the implementation of rural doctors to undertake public **** health services and other tasks of the subsidy policy, to protect the reasonable income of rural doctors. Will meet the conditions of the village health office into the new rural cooperative designated medical institutions, improve the reimbursement rate. (Municipal Health Bureau, Municipal Finance Bureau are responsible for)
(D) to promote the gradual equalization of basic public **** health services
11. Improve the nine types of basic public **** health services. The main objectives: (1) in urban and rural primary medical and health care institutions in general implementation of residents' health records, health education, immunization planning, prevention and treatment of infectious diseases, children's health care, maternal health care, health care for the elderly, chronic disease management, the management of patients with severe mental illness and other nine types of basic national public **** health services, the implementation of supporting funds, subsidies for the standard of 15 yuan / person (of which the central government subsidies of 9 yuan / person, provincial subsidies 3 yuan / person, and the central government subsidies 3 yuan / person, and the central government subsidies 3 yuan / person, and the provincial subsidies 3 yuan / person, and the central government subsidies 3 yuan / person. Subsidies 3 yuan / person, city subsidies 1 yuan / person, county, city, district subsidies 2 yuan / person); standardized urban residents' health records filing rate of more than 40%, rural residents' health records filing rate of 20%, and improve the level of information technology of residents' health records. (Municipal Health Bureau, Municipal Finance Bureau are responsible for) (2) the development of basic public **** health service program assessment methods, improve the efficiency and effectiveness of services, to ensure that the public **** health institutions performance pay at the end of 2010 in the basic cash in place. (Municipal Health Bureau, Municipal Human Resources and Social Security Bureau are responsible for)
12. Continue to implement major public **** health service programs. The main objectives: (1) to continue to the population under 15 years of age to make up for the vaccination against hepatitis B, in 2010 and then 123,737 people. (Municipal Health Bureau is responsible for) (2) in 2009, on the basis of the completion of breast cancer screening 2,000 people, the central and provincial subsidies totaling 120,000 yuan; 55,000 rural maternal hospital delivery subsidies, the central subsidy for 16.5 million yuan; continue to carry out the free folic acid supplementation program for rural women giving birth. (Municipal Health Bureau, Municipal Finance Bureau are responsible for) (3) for 1,000 cases of poor cataract patients free of charge to carry out blindness-restoring surgery, the central subsidy of 800,000 yuan. (Municipal Health Bureau, Municipal Finance Bureau are responsible for) (4) complete the 2009 7300 households harmless sanitary latrine construction tasks, do a good job in 2010 5320 households harmless sanitary latrine construction preparatory work, the central subsidy of 2.128 million yuan, the city below (including the city) supporting funds in accordance with the signed "Henan Province in 2010 the task of the project to apply for commitment to rural latrines" to implement. (Municipal Health Bureau is responsible for) (5) the implementation of HIV mother-to-child transmission interruption program. (Municipal Health Bureau is responsible for) (6) Assessment and evaluation of the implementation of major public **** health service projects. (Municipal Health Bureau is responsible for)
13. Strengthen the public **** health service capacity building. The main objectives: to start the implementation of mental health prevention and treatment system construction and development planning, reconstruction and expansion of a mental health professional institutions, the central budget investment of 26 million yuan, the provincial financial special investment of 3.45 million yuan, local investment of 8.05 million yuan; to ensure that the local funds in full and timely manner in place, on time to complete the put into use. (Municipal Development and Reform Commission, the Municipal Finance Bureau are responsible for)
(E) to promote the pilot reform of public hospitals
14. Adjust the layout and structure of public hospitals, improve the management system. The main objectives: (1) adjust and optimize the regional layout and structure of public hospitals, and clarify the number of public hospitals in the administrative region, the layout, the main functions and bed size, large medical equipment configuration. Research and explore part of the public hospitals converted to non-public medical institutions. (Municipal Health Bureau is responsible for) (2) issued to further encourage and guide the development of social capital in the medical and health care views, encourage social capital into the field of medical services. (Municipal Development and Reform Commission, Municipal Health Bureau, Municipal Finance Bureau, Municipal Bureau of Human Resources and Social Security are responsible for) (3) the establishment of public hospitals and urban and rural primary health care institutions of the division of labor and coordination mechanism, to strengthen the exchange of personnel training and business guidance, and explore the establishment of the community's first diagnosis and treatment system of two-way referral and other hierarchical diagnosis and treatment. (Municipal Health Bureau is responsible for) (4) to explore the separation of government affairs, management and operation of the effective form of separation. Improve the hospital corporate governance structure. Deepen the personnel system reform, the implementation of the employment system and job management system. (Municipal Health Bureau, Municipal Editorial Office, Municipal Bureau of Human Resources and Social Security are responsible for) (5) in accordance with the deployment and arrangements of the higher levels, combined with the actual pilot units of public hospital reform, research and development of public hospitals preparation standards, scientific and reasonable to determine the staffing of public hospitals. (Municipal Editorial Office, Municipal Health Bureau, Municipal Finance Bureau are responsible for) (6) the establishment of social supervision mechanisms, strengthen information disclosure, and explore multi-party participation in the public hospital quality supervision and evaluation system. (Municipal Health Bureau, Municipal Human Resources and Social Security Bureau are responsible for) (7) start the implementation of standardized residency training. Explore registered physicians to carry out multi-practice pilot. (Municipal Health Bureau, Municipal Human Resources and Social Security Bureau, Municipal Finance Bureau is responsible for)
15. Reform of public hospital compensation mechanism. The main goal: to explore the separation of medicine, and gradually abolish the drug markup, so that the pilot public hospitals to gradually realize by the service charges and government subsidies for compensation. (Municipal Health Bureau, Municipal Finance Bureau, Municipal Development and Reform Commission are responsible for)
16. Strengthen the internal management of public hospitals. The main objectives: (1) to further optimize the diagnosis and treatment process, the promotion of diagnosis and treatment appointments, the implementation of the same level of medical institutions, mutual recognition of test results, shorten the waiting time of the masses, strengthen the clinical care work, improve the medical environment. (Municipal Health Bureau is responsible for) (2) to promote the national unified hospital electronic medical record standards and norms, accelerate the construction of hospital information technology. (Municipal Health Bureau, Municipal Bureau of Human Resources and Social Security are responsible for) (3) strict hospital budgets and revenue and expenditure management, strengthen cost accounting and control. (Municipal Finance Bureau, Municipal Health Bureau are responsible for) (4) standardize the public hospital clinical examination, diagnosis, treatment, medication behavior, in accordance with the requirements of the higher business sector, and gradually promote 100 kinds of common diseases clinical path, and continue to promote the clinical path management pilot work. (Municipal Health Bureau is responsible for)
Three, safeguard measures
(a) the implementation of the target responsibility system. 2010 annual health care reform work objectives to be implemented by the end of March 2011 in place. In order to further implement the responsibility to ensure that the work is completed on schedule, the city to deepen the reform of the medical and health system leading group office will deepen the reform of the medical and health system with the counties (cities, districts) leading group to sign the responsibility, the counties (cities, districts) should also be with the grass-roots implementation of the unit to establish the target responsibility system.
(2) strengthen financial security. Governments at all levels to the 2010 medical reform required government investment funds into the financial budget and timely implementation. To actively adjust the structure of financial expenditure, innovative financial input mechanism, the establishment of mechanisms and increase the organic combination of input. To strengthen supervision and management, improve the efficiency of the use of funds, and effectively prevent all kinds of illegal and irregular use of funds.
(C) strengthen the assessment. Municipal deepening of medical and health system reform leading group office in conjunction with the relevant departments to strengthen the progress of the reform and the effect of supervision and assessment, the establishment of regular assessment and information notification system, timely analysis of the new situation, new problems, and actively study the solution, and to organize and carry out the implementation of five key reforms of the effect of the mid-term assessment work.
(4) correctly guide public opinion. Adhere to the correct orientation of public opinion, reasonable guidance of social expectations, take the initiative to announce to the community the progress of health care reform, all the concerns of the hot issues in a timely manner to answer and respond to mobilize all parties to participate in and promote the health care reform of the enthusiasm, initiative and creativity, in order to deepen the reform to create a good atmosphere of public opinion and the social environment.