Part I health center research report
The situation of township health centers is directly related to the quality of medical care and physical health of the rural masses. Township health center is an important link in the construction of rural health service system, in order to comprehensively understand the current situation of Junsai Township health center, understand the problems and constraints on the development of health centers, recently, I took this issue of Junsai Township health center construction research, analysis of constraints on the development of grass-roots health problems, looking for cracking ideas. The use of talks, visits, view the relevant information and field understanding of the form of Junsai Township Health Center basic situation of the investigation, the investigation is summarized as follows:
First, Junsai Township Health Center construction of the basic situation.
Junsai Township is located in the southeastern part of ** County, 98 kilometers away from the county south umbrella, is **, **, ** three counties in the combination of the township area of 186.18 square kilometers, forest coverage of 41%, elevation of 2978 meters above sea level, the lowest elevation of 530 meters above sea level, with greater climatic differences, the stronger the three-dimensional climate.
The township has 6 village committees, 43 natural villages, 69 village groups, inhabited by 11 ethnic minorities such as Han, Wa, Lahu, Lisu, De'ang and other ethnic minorities, the ethnic minority population accounted for 44% of the total population, it is one of the ethnic townships in ** County, and also the ethnic townships in Yunnan Province consisting of four main ethnic groups.In 2019, there was an agricultural population of 12,880 in the township, with a per capita net income of 4069 yuan .
There are seven medical institutions in the township, including one health center and six village health offices. Health center covers an area of 10 acres, building area of 3348 square meters (including the area of 1564 square meters in the construction of comprehensive business building), of which the area of 1264 square meters of dangerous buildings, accounting for 37% of the building area. The health center has 34 employees (including: 12 regular employees, 22 temporary workers), there are 3 licensed physicians, 4 licensed physician assistants, professional nurse practitioner 1 person.
The township has 6 village health rooms, with a floor area of 60 square meters (including: 2 brick structure, 4 brick structure). Existing village doctors 10 people, including: male village doctors 6 people, female village doctors 4 people (shortage of 2 people), village doctors in the high school education 4 people, junior high school education below 6 people.
Second, the difficulties and problems in the development process
1, insufficient staffing (authorized establishment of 12 people, the actual establishment of 12 people), part-time specialists prominent situation, resulting in low efficiency. The health center has been outside the temporary workers 22 people, used to supplement the shortage of posts to meet the needs of the work.
2, comprehensive business building construction gap is too large, the main project investment of 2.86 million yuan, auxiliary engineering investment of about 320,000 yuan, currently in place 1.9 million yuan, of which: 1.3 million yuan of project funds, the county level of 600,000 yuan, the gap of 1.28 million yuan, due to the limited ability of the health center to generate income, economic difficulties, and the monthly payment of a large number of temporary workers wages (about 35,000 yuan), has been incapable of paying the 1.28 million yuan shortfall funds.
3, the health center every year to send a number of people for further study, but the lack of talent in the short term still exists, especially the lack of a strong professional ability of the discipline leader.
4, backward infrastructure, working rooms and wards are seriously inadequate, there are working rooms 663.84 square meters, of which 138 square meters of dangerous rooms, staff quarters 1120.6 square meters (is a dangerous room), with the completion of the new complex, the use of the tense situation will be resolved.
5, as a result of years of insufficient investment in health care, health hospitals, thin base, can not invest more funds to update medical equipment in a timely manner, resulting in health hospitals have only basic medical equipment, medical equipment is old and rudimentary. The medical equipment used in health centers is relatively backward and insufficient compared to health centers of the same level, and can no longer meet medical needs.
6, the basic public **** health services archiving and management quality needs to be further improved, especially for maternal, child and chronic disease health management needs to be strengthened. The treatment of diabetes and hypertension is relatively difficult, first, the health center and health room doctors are not strong professional skills, treatment is not standardized; second, the treatment of diabetes and hypertension is relatively insufficient varieties of medicines; third, the patient's initiative to accept the physical examination and treatment of the awareness is not strong; fourth, the impact of the local customs and habits of life, healthy dietary habits are difficult to intervene. Due to the influence of transportation, the elderly living in mountainous areas, it is difficult to have the opportunity to go to the health center to receive a comprehensive health checkup, thus affecting the increase in the rate of systematic management.
7, the basic public **** health services in the actual operation of the process, and human resources do not match the contradiction is increasingly apparent, mainly in the following three areas: First, the health hospitals are understaffed, public **** health, disease prevention, and maternal and child health care is not formal full-time staff management, the official part-time workers in a special situation, the need for external temporary workers to manage the work, coupled with the temporary worker wages Low (1300-1500 yuan), unstable work, mobility, public **** health service work lack of continuity of management personnel; Secondly, the village medical history is generally low, there are still a certain number of only elementary school culture of village doctors, this part of the village doctor literacy is not much, the acceptance of the ability to be limited, the work is very difficult, resulting in the work of the quality of the quality of work and the quality of service is not high; Thirdly, the village health room is not enough staff, especially the health room in the mountainous ethnic settlements, especially the village health room. Thirdly, the village health office is understaffed, especially in mountainous areas where ethnic groups live, the lack of village doctors, the lack of local talent, outside the professional and technical personnel are not willing to go or go and can not be retained, this situation has not yet been resolved, affecting the improvement of the overall quality of work.
8, "heavy medical light defense" problem. For a long time, the township health center "heavy medical light defense" phenomenon is very serious. At present, the township health centers are not only the number of defense personnel is too small, and the quality is low, so that the township health centers to prevent the effectiveness of the work greatly reduced. The provision of public health services should be the center of gravity of the work of township health centers, but because of the current system, the original function of the county, township, village three-level health institutions to cooperate with each other gradually turned into a comprehensive competitive relationship. In this case, due to the public **** health services can not bring obvious benefits, it is gradually weakened, resulting in the township health "heavy medical light prevention" tendency to continue to develop.
As the "sandwich layer" of the township health centers, in the medical field, its convenience and price of services is not as good as the village health room (office), in the medical level and difficult to compare with the urban hospitals, in the competition gradually fell into the wind. In recent years, as the government's attention to rural health work continues to increase, some of the benefits of the township health center policy has been introduced to improve the hardware facilities of the township health center, "New Rural Health Cooperative" in the reimbursement of the township health centers tilted to the township health centers, and in addition, "eighteen public **** health work," the development of the development of the opportunity for it. However, these policies only "save life" township health centers, so that they can maintain normal operation, not in the township health centers to return to its original positioning to make substantial contributions, most of the township health centers are still marching in the "emphasis on medicine and prevention" of the old road.
Third, the military race township health center next work opinion
1, continue to strengthen the training of talents, according to the actual needs of the health center, targeted arrangements for personnel to the higher level of medical institutions for further study, and strive to use 2-3 years to complete the training of all health centers, the village health center, 90% of the personnel to the health center for rotational training to the first line of the section have a subject leader, so that the health center's comprehensive service capacity on a higher level. Comprehensive service capacity on a stage.
2, in the near future, as soon as possible to complete the comprehensive building construction project, and put into use. Strive to achieve standardization, standardized operation, and strive to grade health hospital development.
3, continue to strengthen the basic public **** health services, focusing on strengthening the level of service management of special populations, to ensure that the quality of dynamic management of maternity, children 0-6 years old, elderly people over 65 years old, hypertension, diabetes, a substantial increase in quality. Increase the management of high-risk pregnant women, 100% of high-risk pregnant women into the system, 100% to achieve hospital delivery, to eliminate maternal mortality.
4, strengthen health education and publicity efforts, change the way of publicity, improve the rate of public health knowledge.
5, strengthen the paper file and electronic file standardized management, while strengthening the village doctor's electronic file entry management, so that the village doctor to fully grasp the computer operation technology, so that the dynamic management of special populations record the formation of electronic, normalized.
6, to strengthen the management of project funds, to ensure that funds are earmarked for the village doctor for each work should be audited, checking the correctness of the compensation funds can be issued only after the release of compensation funds, and on time the funds will be issued to the hands of the village doctor, to ensure the efficient operation of the public **** health work.
7, continue to strengthen the standardization of village health room construction, improve the level of service of village doctors, improve the village health room medical environment, improve the comfort of the masses to meet the medical needs of the masses.
8, efforts to build the standardization of health centers, improve the comprehensive service capacity and competitiveness, expand the medical radiation from the current service of 13,000 people, expanding to the surrounding population of 3 counties, and strive to use 2 years to increase medical income to 3-4 million yuan, the construction of the health center to become a garden-type health centers for the satisfaction of the masses.
Four, accelerate the construction of township health centers a few thoughts
(a) clear functional positioning.
The card set up and improve the county, township, village rural three-tier health service network, is an important responsibility of the government. In this three-tier health service network, township health center is the "hub". It is public **** health-oriented, integrated to provide prevention, health care and basic medical services, and assume the jurisdiction of the public **** health management functions. Over the years, due to people's understanding of the township health center function positioning bias, and even treat it as a productive enterprise to operate, resulting in less investment in health centers, poor working conditions, the loss of health care personnel more difficult to survive the situation. To speed up the construction of township health centers, change the current situation, first of all, to further clarify the functional positioning of township health centers, change the concept, increase investment, and effectively take the work of township health centers as an important basic work of the government to grasp, and give full play to its role in the rural three-tier medical and health care network in the pivotal role of the realization of the "common illnesses do not go out of the townships," the goal.
(2) Increase investment, strengthen the basic card, deepen internal management.
Currently, there are problems such as obsolete medical instruments and lack of medical equipment in health centers, which require further investment from the government. To deepen the internal management of township health centers, gradually improve the internal management mechanism, through scientific management, improve the quality of medical care and service level of township health centers. Through the introduction of relevant policies to mobilize the majority of township health center health and technical personnel's work enthusiasm, and promote the work of township health centers. To further establish and improve the township health center management rules and regulations, to promote the township health center work toward scientific, institutionalized, standardized direction. To how the township health center construction and "new rural cooperative", "public **** health services" work organically combined as the current speed up the construction of township health center an important issue in-depth study.
(C) system policy, grasp the initiative to stabilize the rural health and technology team, to attract talented people, improve the overall quality of the team.
1, the development of relevant policies to encourage medical personnel to work at the grassroots level. The government allocates a certain amount of special funds every year to solve the basic problems of insurance, salary and treatment of rural health center health personnel, so that they can feel at ease and devote themselves to their work; develop and introduce the corresponding tilt policy to attract more excellent health talents, enrich the grass-roots health center personnel team, improve their overall quality level.
Part II Health Center Research Report
I, the basic situation
The county *** there are eight township health centers and two branch hospitals, of which the center of the health center of the three, the authorized staffing of 136 people, the existing in-service in the staff of 95, due to a lack of professionals, some townships, townships and health centers self-employed personnel 9 people. The county's 79 administrative villages have established a standardized village health room, 71 village health room is equipped with a qualified village doctor, 8 village health room is not equipped with a village doctor.
After the grass-roots health care reform, township health centers are positioned as public welfare institutions, is the hub of the rural health service network, bearing the top and bottom, directly responsible for the rural preventive health care, health supervision, basic medical care, health management and other tasks. In recent years, the county party committee, the county government attaches great importance to the construction of township health centers, township health centers, infrastructure construction has improved significantly, the comprehensive service capacity to further enhance, showing a better development trend.
Service capacity has been enhanced. First, improve the medical environment. Through the grass-roots medical reform, combined with the construction of standardized township health centers, township health centers have been basically guaranteed business premises. The second is to expand the service program. Most townships are basically able to carry out ultrasound, electrocardiogram and x-ray diagnostic techniques, which facilitates rural residents' access to medical care. Third, service capacity has been upgraded. A number of health professionals have been recruited to work in township health centers, and the operational strength of township health centers has been enriched. By carrying out county-level hospitals to support township health centers, township health centers to select the backbone of the force to participate in the public **** health program training and further study and other ways to pass on, and further enhance the overall quality of grass-roots medical personnel. Over the past few years, 12 people in *** participated in general practitioner education and training, 19 people participated in standardized residency training, 78 people participated in the relevant public **** health project training, 39 people participated in the provincial and municipal township health center management project training. Fourth, it is convenient for the public to seek medical treatment. Township health centers and village health clinics opened the new rural cooperative outpatient coordination, the implementation of centralized purchasing and zero-differential rate sales of drugs; strict implementation of provincial and municipal development of medical service project fee standards; and actively carry out basic medical services and so on. Compared with the medical reform before, the price of drugs decreased significantly, the number of outpatient visits increased significantly, such as the price of drugs decreased by more than 37.8%, the number of outpatient visits increased by 12.79%, the average outpatient fee, the average hospitalization fee decreased by 28.6% and 36.7%, effectively alleviating the masses of "difficult to see a doctor", "The company's products and services have been widely recognized by the public and the public.
Significant improvement in infrastructure. Over the past few years, the investment of 2.2 million yuan to complete the seven towns, large performance of the township health center business room expansion project, investment of 1.75 million yuan to start the construction of township health center turnover room, investment of 2.5 million yuan of the town of Xianxu, Dingxiang Township Central Health Center business room expansion project is under construction, investment of 1.25 million yuan of the Isetan township health center business room expansion project is about to start the construction. At the same time, 400,000 yuan was invested in medical equipment for township health centers, such as x-ray machines, ultrasound machines, electrocardiographs, urine analyzers, and so on. The construction of infrastructure to improve the township health center working and living conditions.
Public **** health services have been steadily carried out. Through the grass-roots health care reform, the township health centers in accordance with the "township health center reform program" requirements, timely adjustment of work functions, changed the past "heavy medical, light prevention" business model, in addition to providing the general public with "safe, effective, convenient, inexpensive" basic medical services. In addition to providing the general public with "safe, effective, convenient, inexpensive" basic medical services, vigorously carry out various public **** health services, such as the establishment of personal health records, health education, the implementation of preventive vaccination, with the disposal of public **** health emergencies. By the end of 2019, 67,832 electronic files have been built, with a filing rate of 72.9%, of which the standardized management of 8,776 elderly people over 65 years old, 9,896 hypertensive patients with filing, 1,595 diabetic patients with filing, and the management of patients with severe mental illnesses has reached 100%. The majority of farmers' health and safety gradually increased.
Second, there are problems
Talent team building needs to be strengthened. First, the grass-roots health centers due to the relatively difficult working environment, low treatment, resulting in new graduates are reluctant to work in health centers, recruitment targets often can not be implemented in place. At the same time, the ageing of the team, the lack of successor problem is more prominent. Second, the phenomenon of personnel loss is serious. Grass-roots health care reform over the past three years, **** for the public recruitment of professional and technical personnel 52 (mostly from the village health office), but there are 7 people who have given up or resigned voluntarily. Thirdly, there is a lack of professional and technical personnel.
The distribution system is not dynamic enough, the connotation of medical reform is not fully reflected. In the past, the hospital to the market, the implementation of the "medicine to support doctors", medical staff wages and economic benefits directly linked. After the medical reform, township health centers are positioned as public welfare institutions, the county government in the case of very tight financial resources, increased investment in health centers to protect the operation of health centers and personnel treatment, but after the reform of health centers service consciousness, the concept of consciousness is still to be transformed, in particular, "within the vitality of the" performance allocation incentive is not strong, the workers! For a long time to form a file salary (basic salary, allowances, performance pay) as due compensation, township health centers in the performance appraisal of the distribution of the existence of an average distribution of the concept of income disparity between employees, coupled with the medical staff on night duty, overtime work on holidays and unpaid, a small portion of the clinical medical staff motivation is not high, the initiative is not strong. The company's business is also a major source of revenue for the company's customers, and the company's customers have a lot of money to spend on the company's products and services.
The distribution of basic drugs is not standardized, it is difficult to adapt to the basic medical needs. The first is that the types of basic medicines are fewer. Secondly, the commonly used basic drugs online procurement can not be timely delivery in place, especially the most basic drugs with low profits, the distribution of enterprises simply do not distribution, resulting in township health centers drug varieties, difficult to meet the basic medical needs.
Third, a few suggestions
Residence strong team building, comprehensively improve the level of medical services. First, we must adhere to the introduction and supplementation of health professionals, combined with the actual, further simplify the recruitment process, shorten the recruitment cycle, to create conditions for the introduction of personnel. Second, the establishment of a sound mechanism for the education and training of medical personnel, regular medical personnel to carry out health care business knowledge, medical skills and other aspects of education and training, and effectively improve the quality of medical personnel. The third is to strengthen the construction of medical ethics, and constantly improve the medical staff to serve the public awareness, strengthen the humanistic education of medical staff, strengthen the supervision system and measures, and constantly improve the professional ethics of medical staff.
Helm one step to clarify the performance allocation method. In accordance with the annual target task, the number of work, quality and public satisfaction and other comprehensive assessment to determine the performance of the wage distribution methods, open income distribution gear, reflecting the more work more pay, really do the treatment of employees can be high and low, such as township hospitals can consider the implementation of the income and expenditure after the balance of the funds of the 30% of the funds included in the end of the year incentive performance appraisal, health care personnel night shift and holiday overtime to make up for the incentive policy, the superior pay, to ensure that the performance of the wages issued more scientific and rational. The performance of the payroll is more scientific and reasonable.
Part III Health Center Research Report
The township health center is the hub of the three-tier health network in rural areas, assuming the functions of rural preventive health care, basic medical care, and public ****health management for the convenience of the farmers to seek medical treatment, to protect the health of the farmers and play a positive role. Now on the township health center development status as well as the difficulties and problems faced by the Bureau for the township health center (including the central health center) infrastructure, medical conditions, service capacity, service functions, etc. made a detailed investigation.
First, the current situation of rural health
1, infrastructure and equipment configuration
Our township health centers (including central health centers), the average business premises of about 3956 square meters, set up 51 beds, configured with x-ray machines, biochemical analyzers, gastric lavage machines, respiratory machines, anesthesia machines, integrated surgical beds, electrocardiogram machines and other equipment, and another three central health centers configured with a common ct; Some of the township health centers are lower than the configuration, and some of the equipment has been aging, these equipment can only basically meet the medical needs of local farmers.
2, health services carried out
Center health center basic set of 12 business departments, internal medicine, obstetrics and gynecology, surgery, ophthalmology, traditional Chinese medicine, emergency medicine, pediatrics and preventive health care and other departments, the township street health center business departments lower than the set, the average number of outpatient (emergency) clinic visits 42,164 in 20xx, the number of discharges of 949, the number of surgical units 134 , bed utilization rate of 68.65%; public **** health service rooms, section construction, staffing basically meet the requirements of the Ministry of Health; obviously, both basic medical services and public **** health services are at a low level.
3, health manpower situation
I district township health centers (including central health centers) personnel results of aging, there is the phenomenon of the break, most of the township health centers medical staff is still the past teacher of Chinese medicine is the main, a serious lack of talent, the lack of highly educated people, especially undergraduate clinical graduates, as well as a scarcity of high-level titles, intermediate titles on average no more than 10 people to the junior Most of the introduction and training of talents has become an obstacle to the development of township health centers.
Second, the problems of rural health
One of the cruxes: "can not afford to lose"
Medical institutions set up irrationally, so that the limited health resources and the unreasonable allocation of resources to produce contradictions, resulting in a waste of health resources; township health centers is not a simple medical institutions, in addition to the rural masses to provide basic medical services.
Crux of the problem: "who to raise"
Limited financial support, governments at all levels do not attach importance to health, the central government's policy on health is not enough to implement. So that the township health hospitals `input is not big, more funds had shrunk; and township health hospitals bear the cost of a large number of employees need to pay a variety of insurance amount is large, retired employees and in-service workers in the personnel funds are tight; medical equipment updates, medical environment improvement, medical personnel training and daily operation of hospitals and other financial expenses required, by who to bear? And now require hospitals to zero profit on drugs, not allowed to use drugs to support doctors, and hospitals by "who to support"?
Crux of the third: "no one"
Most of the township health centers are in short supply of personnel, only a few people in the health centers to send people out to study, let alone improve or carry out new business, which is both "out of the way" and "in the wrong". This "can't get out" and "can't get in" situation has resulted in some of the government's newly purchased equipment being left unused and unoperated. Hard life, poor conditions, and even normal wages can not keep, such a situation, how can attract talent? The first time I saw this, it was a very good thing that I was able to get it to work.
Third, facing opportunities
1, the country's investment gradually increased, the National Rural Health Work Conference, the people's governments at all levels to increase investment year by year, the growth rate is not less than the growth rate of financial recurrent expenditures over the same period, from 20xx to 20xx, the annual increase in the health of financial institutions at all levels of health care costs are mainly used for the development of rural health care, to 20xx basically completed! County medical institutions, county preventive health institutions and township (township) health centers housing equipment renovation and construction tasks. And our region relies on the national debt funds as well as the Red Cross assistance and other funds, part of the township health centers in our region to carry out housing renovation and equipment additions.
2, farmers' health investment gradually increased, the gradual improvement of the new rural cooperative medical system, the work of the township health hospitals in our region has brought a new opportunity, the facts have proved that from the development of the new rural medical system, the township health centers in our region, the volume of business has increased significantly; with the gradual increase of financial inputs at all levels of health, the farmers' demand for health care will be increased significantly.
Fourth, the township health far development proposals and countermeasures
1, to make full use of the national debt construction funds.
With the implementation of the national bond project and China's policy support for rural health work to increase, the future will continue to build and equip a number of township health centers with development potential, the construction of health centers should be based on the long-term, moderate control of the development of the scale, to avoid the waste of investment and equipment, to create high-quality products, the development of special hospitals and specialties on the work.
2, strengthen the health care function.
The health center can not maintain the survival of the health center, to maintain or limit the scale of its medical care, the limited resources and the upcoming investment in preventive health care tilt, highlighting the prevention and protection functions. The unused houses and re-expansion of rooms directly for township preventive health care, focusing on township preventive vaccination clinics, with certain professional expertise to fill the prevention and protection of personnel to the team, and its basic medical services by the proximity of the strength of the strong health center to undertake.
3, the integration of health services, vigorously expand the scope of services.
Clarify the functional positioning of the health service network at all levels, and give full play to the overall function of the rural health network. Establish the status of government-organized township health institutions as business guidance centers in rural preventive health care and medical services, and clarify their responsibilities in rural preventive health care, basic medical care, first aid and training of grassroots health personnel and business guidance. Township health centers focus on public *** health services, provide comprehensive preventive health care and basic medical services, and are entrusted with health management functions by county-level health administrative departments. Township health centers to reform the operating mechanism, explore new service models, through the state support, the founding of rural community health service center system, vigorously promote the implementation of rural health regional planning, the formation of rural community health service network, for farmers to effectively provide basic health services.
4, increase investment, the implementation of the national rural health economic policy.
In addition to the active introduction of the national and provincial financial input, with the development of the economy, local governments should increase the investment in rural health, and seriously fulfill their responsibilities, in particular, should be the full implementation of the national requirements of the matching funds policy, to avoid exacerbating the increase in non-performing debt of the township health centers. The non-performing debt of the township health center has been formed through the government transfer payment and other means to be canceled, and effectively reduce the burden of the township health center has been formed in the process of historical development.
The solution to the current problems of township health centers is a complex and arduous work, requiring all aspects of the **** with efforts. To clarify the function of township health centers in the three-tier health network positioning, fully understand the township health centers in solving the peasant masses "difficult to see a doctor, see a doctor expensive" and other aspects of the fundamental role. Continuously rationalize the management system, the establishment of township health centers of public welfare nature, reduce the market-oriented operation, play the role of township health centers in the protection of farmers' basic medical and public **** health services.