Guiding Opinions of the General Office of the State Council on Further Strengthening the Construction of the Rural Doctor Corps
Guo Ban Fa [2011] No. 31
People's governments of provinces, autonomous regions and municipalities directly under the central government, and the ministries and commissions of the State Council, as well as institutions directly under the central government:
Rural doctors, as health workers with Chinese characteristics rooted in rural areas in the vast countryside, have long played an irreplaceable role in maintaining the health of the vast majority of They have long played an irreplaceable role in maintaining the health of the rural population. With the reform of the rural economic system and the deepening of medical reform, the development of the rural doctor team has encountered new situations and problems. In order to ensure that rural medical and health services "bottom of the net" is not broken, to ensure that the majority of rural residents of basic medical and public **** health services fairness, accessibility, according to deepen the reform of the medical and health system of the spirit of the State Council agreed to further strengthen the construction of the rural doctor team to put forward the following guiding opinions:
I, General requirements
In accordance with the requirements of basic protection, strengthening the grass-roots level, and building mechanisms, from a practical point of view, clarify the duties of rural doctors, improve the place of practice, and realize the full coverage of village health offices and rural doctors; include village health offices in the implementation of the basic medicines system and the outpatient coordination of the new rural cooperative medicine (hereinafter referred to as the New Rural Cooperative Medical Scheme), improve the compensation and pension policies for rural doctors, improve the training system, standardize the practice behavior, strengthen the management guidance, and improve the quality of rural doctors' health care. practice behavior, strengthen management guidance, improve the service level of rural doctors, and provide rural residents with safe, effective, convenient and inexpensive basic medical and health services.
II. Defining the responsibilities of rural doctors
Rural doctors (including practicing physicians and assistant physicians, hereinafter referred to as "rural doctors") are mainly responsible for providing rural residents with public **** health and basic medical services, including carrying out basic public **** health services in accordance with service standards and norms under the guidance of specialized public **** health institutions and township health centers; assisting specialized public **** health institutions in implementing major public **** health services; and providing assistance to rural residents in the implementation of major public **** health services, including the provision of basic health services. health institutions to implement major public **** health service projects, timely reporting of infectious disease outbreaks and poisoning according to regulations, disposal of public **** health emergencies, etc.; the use of appropriate drugs, appropriate technology and traditional Chinese medicine methods for rural residents to provide general diagnosis and treatment of common diseases and diseases, and will exceed the diagnosis and treatment capacity of the patient in a timely manner to the township health centers and county-level health care institutions; commissioned by the health administration department to fill out statistics and reports, maintain relevant information, and carry out propaganda. It is also entrusted by the health administration department to fill in statistical reports, keep relevant information, carry out publicity and education, and assist in the financing of the New Rural Cooperative.
Three, the realization of the village health room and rural doctors full coverage
(A) clear village health room planning and setting and construction standards. County health administrative departments in accordance with regional health planning and medical institutions set up planning, comprehensive consideration of the service population, residents' needs and geographic conditions and other factors, reasonable planning for the village health room set up. In principle, each administrative village to set up a village health room, more populated or scattered administrative villages may be appropriate to set up more; township health centers are located in administrative villages, in principle, do not have a village health room.
Village health rooms can be jointly organized by rural doctors, individually organized, or organized by the government, collective or unit, approved by the county-level health administrative departments. The rooms and basic equipment of the village health room are equipped according to the standards set by the state. Each region shall adopt various methods, such as public construction and private operation and government subsidies, to support the construction of houses and the purchase of equipment for village health rooms.
(2) Rational allocation of village doctors. Rural doctors may practice in village medical and health institutions (including village health offices and other medical and health institutions such as clinics in accordance with relevant state regulations). In the village health office practice of rural doctors by the county-level health administrative departments in conjunction with the relevant departments to determine the assessment, in principle, there should be 1 rural doctor per 1,000 people, living in dispersed administrative villages can be increased appropriately; each village health office at least 1 rural doctor practicing.
All localities should conduct a comprehensive mapping of the situation of village health rooms and rural doctors, there is currently no village health rooms and rural doctors in administrative villages, the government should actively encourage qualified personnel to organize village health rooms, or by the government to build the village health room; actively take the directional training, commissioned training, township health hospitals to send people to be stationed in a variety of ways to guide the rural doctors to the village health room to practice, to ensure that by the end of 2011 By the end of 2011, every administrative village that should have a village health office will have a village health office, and every village health office will have a rural doctor.
Four: Strengthening the management of rural doctors and village health centers
(1) Strict licensing qualifications for rural doctors. Rural doctors must have a rural doctor practice certificate or practicing (assistant) physician certificate, and registered in the health administrative department and obtain the relevant practice permit. In the village health office engaged in nursing and other services should also have the appropriate legal practicing qualifications. County-level health administrative departments shall strictly follow the Law on Practicing Physicians and the Regulations on the Administration of the Practice of Rural Doctors and other relevant laws and regulations to strengthen access management. New entrants to village health offices to engage in prevention, health care and medical services should, in principle, have the qualifications of practicing assistant physicians and above. It is strictly prohibited and resolutely combating the illegal practice of medicine by unqualified persons.
(2) Strengthen the management responsibilities of county-level health and other departments. County-level health administrative departments should include rural doctors and village health offices in the scope of management, supervision of their service behavior and the use of drugs and equipment. They shall establish and improve rules and regulations and business and technical processes that are consistent with the functional positioning of village health offices, and organize training for rural doctors. It is necessary to scientifically divide the functions of township health centers and village health offices into a division of labor, reasonably allocate the amount of basic public **** health service tasks, and strengthen performance appraisal. The results of the assessment are publicized in the administrative villages where they are located, and are used as a basis for accounting for financial subsidies and for dynamic adjustment of rural doctors practicing in village health offices. County health, finance, price and other departments to strengthen the supervision of rural doctors and village health room subsidies for the use of funds, urging them to standardize accounting and financial management, open medical services and drug charges and prices, so that the charges have documents, accounts have records, expenditure vouchers.
(3) Strengthening the operational guidance and management of village health offices by township health centers. Encourage localities to actively promote the integrated management of township health centers and village health rooms without changing the personnel status of rural doctors and village health rooms under the premise of legal person and property relations, the county-level health administrative department entrusted township health centers to rural doctors and village health rooms to provide technical guidance, business and drug and equipment supply management and performance assessment. Township health centers should strengthen the business guidance to rural doctors through business lectures, regular meetings and other ways, and carry out daily supervision on the use of medicine and equipment supply and financial management of rural doctors and village health rooms, and assess the quality and quantity of services of rural doctors and village health rooms under the unified organization of the county-level health administrative departments.
(4) Improving the level of informationization of village health offices. The village health office will be included in the scope of information construction and management of primary health care institutions, make full use of information technology to strengthen the management and performance assessment of their service behavior, the use of drugs and equipment supply, and improve the service capacity and management level of rural doctors and village health offices. According to the functional positioning of the village health office design software, the establishment of a unified standardized electronic health records of residents, the implementation of township health centers and village health offices unified electronic bills and prescription pads.
V. Incorporation of village health centers into the scope of implementation of the relevant system
(I) Implementation of the basic drug system in village health centers. The village health room into the basic drug system implementation scope, the implementation of the basic drug system of the policies, the implementation of basic drugs centralized procurement, equipped with the use and zero-differential rate sales. Rural doctors practicing in village health centers are required to use all basic drugs, which are supplied by township health centers.
(2) Actively incorporate village health centers into the scope of implementation of outpatient coordination of the new rural cooperative. Will be eligible for the village health office into the new rural cooperative designated medical institutions management, and the village health office charged general diagnosis and treatment fees and the use of basic drugs into the new rural cooperative payment scope, the payment ratio is not less than in the township health center to pay the proportion of medical treatment. It is necessary to give full play to the role of the New Rural Cooperative in regulating the medical fees and service behaviors of rural doctors and village health offices. Localities are encouraged to combine the promotion of the outpatient coordination of the NIC with the simultaneous reform of the payment method of the NIC, exploring a variety of payment methods, such as capitation payment and total prepayment, and utilizing the payment policy to guide rural doctors and village health offices to change their service behaviors and improve the quality of their services. To strengthen the supervision of the new rural cooperative payment of village health clinics diagnosis and treatment and drug costs, to prevent fraudulent billing, fraudulent use of the new rural cooperative funds.
VI. Improving compensation and pension policies for rural doctors
(1) Improving multi-channel compensation policies. According to the quantity and quality of services provided by rural doctors to be compensated through multiple channels.
The basic public **** health services provided by rural doctors are reasonably subsidized mainly through the government's purchase of services. County-level health administrative departments, based on the duties of rural doctors, their service capacity and the number of people they serve, specify the specific content of the basic public **** health services that should be provided by rural doctors, and reasonably authorize the amount of their tasks to ensure that they are compatible with their functional position and service capacity. According to the actual workload, the corresponding proportion of the national basic public **** health service funds will be allocated to rural doctors, and shall not be squeezed, retained or misappropriated.
Payment for basic medical services provided by rural doctors is mainly made by individuals and the new rural cooperative fund. Each region should be in accordance with the "General Office of the State Council on the establishment and improvement of primary medical and health care institutions compensation mechanism of the views" (State Office of the State Council [2010] No. 62) requirements, a reasonable development of the village health office of the general diagnosis and treatment fee standards as well as the New Farmers' Cooperative Payment Standards and methods. Under the premise of comprehensive consideration of the affordability of the New Rural Cooperative Fund and not to increase the personal burden of the masses, give full play to the role of the New Rural Cooperative compensation for rural doctors.
After the implementation of the basic drug system in village health centers, in order to ensure that the reasonable income of rural doctors practicing in village health centers will not be reduced, localities should take into account the compensation for basic medical care and public ****health services, and take the form of a special subsidy to give fixed compensation to rural doctors practicing in village health centers. Subsidy standards can be set in accordance with the number of people served or the number of approved rural doctors, and the level of subsidies is linked to the level of subsidies for local village cadres. Specific compensation policies are formulated by the provincial (autonomous regions and municipal) governments in light of the actual situation.
Encouraging places with the conditions to further increase the level of subsidies for rural doctors with long years of service and practicing in remote and difficult areas.
(2) actively solve the rural doctors' pension problems. All localities should combine the promotion of the new rural social pension insurance system (hereinafter referred to as the new rural insurance), actively guide eligible rural doctors to participate in the new rural insurance, and pay pensions to rural doctors who meet the conditions for receiving the new rural insurance benefits. Local governments can take a variety of forms such as subsidies to properly solve the security and livelihood difficulties of elderly rural doctors, the specific measures to be formulated by the local government in conjunction with the actual situation.
Seven, improve the training system of rural doctors
(A) to strengthen the training of rural doctors. Provinces (autonomous regions and municipalities) health administrative departments to rationalize the development of rural doctors training planning, clinical training, centralized training, urban and rural counterparts to support a variety of ways to select and send rural doctors to the county-level medical and health institutions or medical schools to receive training. County-level health administrative departments of rural doctors practicing in the village health office free training no less than twice a year, the cumulative training time of no less than two weeks.
(2) Strengthen the construction of the reserve force of rural doctors. County-level health administrative departments to find out and dynamically grasp the administrative region of the practice of rural doctors, focusing on the long term, the preparation of rural doctor team construction planning, the establishment of a reserve pool of rural doctors from the local selection of personnel for targeted training, and timely replenishment to the village health office. Where possible, localities should formulate preferential policies to attract retired urban doctors, practicing (assistant) physicians and graduates of medical schools to work in village health offices. Localities should combine the exploration of the establishment of general practitioner teams and the promotion of the contracted service model, and actively do a good job of bridging the construction of the village doctor team and the general practitioner team.
VIII, effectively do a good job of organization and implementation
(1) Strengthen organizational leadership. Local people's governments at all levels should attach great importance to the important role of rural doctors in the primary health care service system, and take the construction of rural doctor teams as an important part of the health care reform, put it on the agenda, improve the relevant supporting policies, and ensure smooth implementation. All relevant departments should conscientiously fulfill their responsibilities, strengthen collaboration and cooperation, and increase supervision and guidance to ensure that the work is solidly advanced.
(ii) the development of implementation programs. Provinces (autonomous regions and municipalities) should be combined with the local reality, further refinement, actualization of the relevant policies and measures, within 30 working days of the introduction of this opinion, the development of a specific implementation plan, and reported to the State Council Office of Medical Reform, the Ministry of Health, the Ministry of Finance, the Ministry of Human Resources and Social Security for the record.
(C) the implementation of funding. Each region should supervise and guide the county-level people's governments to actively adjust the structure of financial expenditure, to improve the compensation and pension policy of rural doctors and village health room construction and other aspects of the funds required into the annual financial budget, and timely disbursement in place, to ensure that the funds are earmarked for specific purposes, shall not be squeezed and misappropriated. Provincial people's governments will assume responsibility for coordinating and further increasing transfer payments to areas in difficulty. The central government will increase its support to difficult areas through transfer payments, and will give necessary subsidies to rural doctors practicing in village health offices for the implementation of the basic drug system. It is strictly prohibited to collect or distribute fees other than those stipulated by the state to rural doctors in any name, and to create a favorable practice environment for rural doctors.
General Office of the State Council
July 2, 2011