The lagging reform of public hospitals has been dragging down the effect of the new medical reform. In response to this pain point, Beijing, as the first batch of pilot cities for public hospital reform in the country, yesterday released a "big move" for public hospital reform. The "Implementation Plan for the Comprehensive Reform of Beijing Urban Public Hospitals" (hereinafter referred to as the "Plan"), which has been brewing for a long time, clearly states that by 2017, the city's public hospitals will completely eliminate the mechanism of supplementing medical treatment with drugs. "This reform plan for Beijing's public hospitals can be described as a powerful dose of medicine. The time is also very tight. There are certain difficulties in completing it as scheduled. But more importantly, the reform of public hospitals has always been very complicated. If we want the effects to last, we must We must take various measures to "regulate" and cannot pursue short-term effects," Wang Zhaoping, a researcher at the Institute of Health Policy and Medical Management of Shanghai Jiao Tong University, told a reporter from Beijing Business Daily.
According to the plan, after summarizing the pilot experience of five hospitals including Beijing Friendship Hospital, the city’s public hospitals will accelerate the separation of medicines. Specific methods include: overall consideration of the characteristics of hospitals at all levels, formulating medical service fee pricing policies that are conducive to the realization of hierarchical diagnosis and treatment, and medical service fees being included in the scope of medical insurance reimbursement; implementing sunshine procurement of pharmaceutical products, reforming payment methods, strengthening hospital internal management, and improving government investment methods to effectively reduce the price of medicines; simultaneously adjust the prices of medical services, gradually rationalize the compensation channels for public hospitals, and establish a scientific and reasonable compensation mechanism. Explore ways for patients to independently choose to purchase medicines at hospital outpatient pharmacies or retail pharmacies with prescriptions, and eliminate the mechanism of using medicines to supplement medical care.
Since 2012, five municipal hospitals including Beijing Friendship Hospital, Chaoyang Hospital, Tongren Hospital, Tiantan Hospital and Jishuitan Hospital have implemented the separation of medicines in three batches, canceling drug markups, registration fees and diagnosis and treatment fees. Establish medical service fees. Feng Guosheng, director of the Beijing Municipal Medical Administration Bureau, previously stated that as of the end of February last year, the proportion of drugs for outpatient medical insurance patients in the five pilot hospitals had dropped from 70 in the past to 58.8 now, and the average medical expenses per outpatient visit had dropped by 54.84 yuan. The cost (the cost of medication for one outpatient visit) decreased by 82.85 yuan. The patient's personal out-of-pocket expenses decreased by 60.4 yuan.
The relevant person in charge of the Beijing Municipal Medical Reform Office pointed out that the newly implemented public hospital reform plan, in order to achieve the purpose of "vacating space and adjusting structure", cancels drug markups, implements sunshine procurement, and separates medicine and medical services. Price adjustments make room. What deserves particular attention is that the New Deal implements differentiated reform policies in terms of medical insurance payment, price adjustment, financial investment, performance evaluation, etc. for public hospitals in different regions, different levels, and different types.
A reporter from Beijing Business Daily also noticed that the plan pointed out that in the process of canceling drug mark-ups (except for traditional Chinese medicine pieces) and establishing a new operating mechanism to separate medicine from public hospitals, municipal hospitals, district hospitals, and national The separation of medicine and medicine in hospitals under the jurisdiction of the National Health and Family Planning Commission shall be organized and implemented by the superior units of each hospital; for hospitals run by the military, armed police forces, public institutions, state-owned enterprises, etc., the organizing units shall be responsible for the organization and implementation. In this regard, Wang Zhaoping analyzed that the higher-level units of Beijing public hospitals are very complex, and there is no department capable of overall management, which increases the difficulty of reform.
In addition, some people in the industry believe that the proposal in the plan that "Beijing should reform the hospital pharmaceutical management system, explore the establishment of a chief pharmacist system, and carry out prescription negative list management and prescription reviews" is very novel. The operation method is likely to be to set up a chief pharmacist's office under the Pharmacy Department of the Hospital Authority, and hire pharmacists from municipal tertiary hospitals to be responsible for the quality and safety of medications in multiple hospitals, and to prevent and treat over-medication. However, there has always been a pharmacist position in tertiary hospitals, but it has not played a significant role in controlling problems such as over-medication. How to implement the chief pharmacist system in the future remains to be detailed.
“In fact, the National Health and Family Planning Commission proposed a few years ago that it would be necessary to eliminate the use of drugs to supplement medical treatment, but now it seems that the time node is constantly moving back, which also reflects the difficulty of implementing this policy. Very big.
"Wang Zhaoping said, "To eliminate the use of drugs to supplement medical care, it is not simply to cancel the drug markup. When the price of doctor's services is too low, there are shortcomings in drug bidding and procurement, and large public hospitals have long occupied a monopoly in the market, chronic diseases in the industry are difficult to break. It can be effective in a short time, but if we want to cut off the profit chain of using drugs to supplement medical treatment in the long term, multiple policies must be promoted together and support each other. ”
The full text is as follows:
Implementation Plan for Comprehensive Reform of Urban Public Hospitals in Beijing
Since this city took the lead in launching the pilot comprehensive reform of urban public hospitals in 2012, Various reform measures have been implemented one after another, achieving phased results and accumulating valuable experience, laying a solid foundation for deepening the reform in the next step. However, the reform of public hospitals is a long-term, arduous and complex systematic project, and there are still some outstanding contradictions. and problems, which urgently need to be gradually solved through the reform of systems and mechanisms. "Several Opinions on Deepening the Reform of the Medical and Health System" (Jingzhengfa [2014] No. 30) requires further promoting the comprehensive reform of public hospitals and formulating this implementation plan based on the actual situation of this city.
1. Reform ideas. , Principles and Goals
(1) Overall Idea
Thoroughly implement the spirit of the 18th National Congress of the Communist Party of China and the Second, Third, Fourth and Fifth Plenary Sessions of the 18th Central Committee, in accordance with The Party Central Committee and the State Council have made decisions and arrangements to deepen the reform of the medical and health system as an important measure to protect and improve people's livelihood, give full play to the public welfare nature and main role of public hospitals, and effectively implement the government's medical responsibilities; deepen the reform of payment methods and play their key role, establish Scientific and reasonable compensation mechanism; adjust and optimize the pattern of the medical service system, take the lead in establishing a basic medical and health system and a modern hospital management system covering both urban and rural areas, and promote the in-depth development of the city's medical and health system reform, focusing on promoting "two separations, three mechanisms, and two." system, three supports" system and mechanism reform, that is, continue to promote the separation of medicine, continue to deepen the separation of management and office, focus on making breakthroughs in the reform of the medical insurance control mechanism, price adjustment mechanism, and financial investment mechanism, and continue to promote the reform of the personnel compensation system and hierarchical diagnosis and treatment System construction, giving full play to the supporting role of talent training, discipline development and information construction
(2) Basic principles
1. Adhere to policy linkage and integrate the comprehensive reform of public hospitals into the city’s medical and health care. Make overall arrangements for institutional reform, promote the linkage of medical care, medical insurance, and medicine, promote the simultaneous reform of public hospitals within the administrative region of this city, take into account the reform of large hospitals and grassroots medical and health institutions, take into account the coordinated development of public hospitals and private hospitals, and take into account disease prevention, control, and treatment and rehabilitation, and enhance the systemic, holistic and coordinated nature of the reform.
2. Adhere to the classified reform and clarify the functional positioning of urban public hospitals and give full play to their role in providing basic medical services, critical illness and difficult diseases. It plays a key role in diagnosis and treatment. Based on reality, differentiated reform policies should be implemented for public hospitals in different regions, different levels, and different types of medical insurance payment, price adjustment, financial investment, and performance evaluation.
3. Adhere to key breakthroughs. Under the reform direction and principles determined by the central government, boldly explore and innovate, focus on making breakthroughs in key reform areas such as medical insurance payment, medical separation, price reform, personnel compensation, and hierarchical diagnosis and treatment, and establish a system that is consistent with the capital. actual institutional mechanisms.
All third-level, second-level, and first-level public hospitals within the city’s administrative region are included in the scope of the reform. Reform policies on planning access, industry supervision, price, medical insurance, separation of medicines, drug circulation and procurement, third-party evaluation and other aspects apply to all public hospitals. The reform policies on management system, financial investment, personnel compensation, performance appraisal and other aspects are applicable to municipal and district public hospitals. Hospitals organized by national ministries and commissions, the military, the armed police force, public institutions, state-owned enterprises, etc. in Beijing can refer to the implementation. In accordance with the national and For relevant requirements of the military, the competent departments shall formulate specific rules and ensure the implementation of policies.
(3) Reform Goals
By the end of 2017, establish a hospital management system, operating mechanism and medical service system that are consistent with the characteristics of the capital, so that the people can benefit, medical staff can be encouraged, and The development of the hospital adds vitality and ensures sustainable funding. Specific goals:
1. Initial establishment of a scientific and reasonable compensation mechanism. The mechanism of using drugs to supplement medical care has been completely eliminated, medical service prices have been gradually rationalized, breakthroughs have been made in the reform of medical insurance payment methods, and differentiated financial investment policies have been further improved. The unreasonable increase in medical expenses has been effectively controlled, and the increase in total health expenses has been coordinated with the increase in the region's GDP.
2. The hierarchical diagnosis and treatment system is solidly advanced. The functional positioning of different levels and types of public hospitals in the medical service system has become clearer, and the order of medical treatment has been improved. The proportion of general outpatient visits in urban tertiary hospitals to the total number of visits in medical and health institutions has gradually decreased. A hierarchical diagnosis and treatment model that separates acute and chronic diseases and links upper and lower hospitals has been initially established.
3. Establish a prototype of a personnel compensation system that conforms to industry characteristics. The personnel system is made more reasonable, the employment mechanism is more flexible, the incentive effect of the income distribution mechanism is more active and effective, and the value of the technical labor services of medical personnel is reasonably reflected.
4. The modern hospital management system has been initially established. The capital's localized, industry-wide medical management system is more complete, the public hospital assessment and supervision system is more complete, and the cooperation between the government and social forces in running hospitals is standardized and orderly.
5. Doctor-patient satisfaction is effectively improved. Medical behavior is more standardized, basic medical services are more equitable and accessible, and the medical environment is safer and orderly; medical cost burden remains at a reasonable level, and the proportion of personal health expenditures in total health expenditures remains at about 20; patients and medical staff are satisfied with public hospitals Gradually improve.
2. Establish a new system for public hospital governance
(4) Implement the government’s medical responsibility
Implement the government’s planning layout, functional positioning, goals and tasks in public hospitals , leadership responsibilities in the selection and selection of teams, etc., in public hospital establishment, financial investment, prices, salaries, infrastructure, equipment and facility purchase and maintenance, development of key specialties, public health investment, emergency support for emergencies, establishment and improvement of Guarantee responsibilities in terms of operating mechanisms that are in line with public welfare, management responsibilities in major decisions such as personnel, finance, and materials in public hospitals, external investment cooperation, cost and expense control, promotion of efficiency and public welfare, and promotion of legality of hospitals and medical personnel. Supervision responsibilities for compliance with practice, improvement of medical service quality, and ensuring safety.
From 2016 to 2017, efforts will be made to promote the implementation of medical responsibilities by the municipal and municipal governments and promote the implementation of medical responsibilities by public hospitals.
(5) Deepen the reform of separation of management and administration
Strengthen the functions of health and family planning administrative departments at all levels in unified planning, unified access, and unified supervision of the medical and health industry, and improve the coordination of medicine and health in the capital The overall coordination mechanism of the committee (hereinafter referred to as the First Medical Committee) and give full play to its role, strengthen territorial coordination and regional linkage, and establish and improve the industry-wide management mechanism. Further clarify the management rights and responsibilities of various relevant departments for different types of public hospitals, clarify the medical responsibilities of hospital management departments as representatives of government investors, and clarify the rights and responsibilities between hospital management departments and the hospitals they operate. Strengthen the standardized management of hospitals, promote the construction of modern hospital management systems, and optimize the allocation and structural adjustment of medical resources. Explore the central construction and management mechanism for hospitals in Beijing, and the municipal and urban governments will provide support in planning access, land use guarantees, construction approvals, and government purchase of services.
From 2016 to 2017, we will focus on studying and deepening the reform plan for the separation of management and operation, focusing on promoting the industry-wide management of medical and health institutions, optimizing the government medical system, and strengthening the territorial management and coordination of medical and health institutions.
(6) Improve the legal person structure and governance mechanism of public hospitals
Improve the board of directors system, president responsibility system and board of supervisory system of the pilot hospitals with corporate governance, and standardize the internal decision-making and control mechanisms of the hospital , to further implement the independent legal person status of the pilot hospital.
Encourage public hospitals and medical consortiums with diversified assets and entrustment to explore the establishment of legal person governance structures and mechanisms through various forms. Hospital presidents and vice presidents shall be appointed or dismissed by the board of directors in accordance with regulations, and explore the implementation of open competition. Promote professionalism and implement the dean's term target responsibility assessment and accountability system. The assessment results serve as an important basis for the dean's work evaluation, salary determination, and appointment and dismissal. Explore the abolition of administrative levels in public hospitals, and heads of health and family planning administrative departments at all levels are not allowed to concurrently hold leadership positions in public hospitals.
, focusing on improving the legal person governance operating mechanisms of Beijing Friendship Hospital and Beijing Chaoyang Hospital. In 2017, efforts were made to explore various corporate governance models in hospitals such as Beijing Children's Hospital and Tsinghua Chang Gung Memorial Hospital.
(7) Strengthen the performance appraisal and industry evaluation of public hospitals
Improve the performance appraisal system of public hospitals, highlighting functional positioning, duty fulfillment, expense control, operational performance, financial management, and cost control and social satisfaction and other assessment indicators to guide public hospitals to adhere to the direction of public welfare; regularly organize public hospital performance assessments and dean annual and term target responsibility assessments, and the assessment results are related to hospital financial subsidies, medical insurance payments, total wages, and dean's salary, appointment and dismissal , rewards and punishments, etc. Develop public welfare-oriented industry evaluation standards, organize industry evaluations regularly, and disclose assessment results to the public.
, carry out performance appraisal and industry evaluation of urban two-level public hospitals. From 2016 to 2017, we continued to carry out industry evaluations of public hospitals and announced the evaluation results to the public.
(8) Improve the multi-party supervision mechanism
Strengthen the medical service supervision functions of the health and family planning administrative departments (including the traditional Chinese medicine management department). Strengthen hospital information disclosure, standardize information disclosure content, and establish a regular disclosure system. Comprehensively implement electronic supervision of drug production and circulation, promote the extension of electronic drug supervision to medical institutions, and realize closed-loop supervision from production to consumers. Give full play to the role of medical industry associations and societies, strengthen industry self-discipline, supervision and professional ethics construction, and guide medical institutions to operate in accordance with the law and exercise strict self-discipline. Establish a social supervisor system to give full play to the supervisory role of the National People's Congress, the Chinese People's Political Consultative Conference, supervisory and auditing agencies, and the social level. Promote the construction of a credit system for medical institutions and doctors. Improve the assessment and evaluation mechanism for third-party professional institutions to participate.
, carry out inspections of third-level hospitals, and publish relevant information about second-level and above public hospitals. From 2016 to 2017, the city’s industry supervision and management methods for medical institutions will be improved, and hospital inspections will be carried out across the city; a public hospital medical expense monitoring system and a medical expense control assessment and accountability mechanism will be established to control unreasonable increases in medical expenses.
(9) Improve the management and service level of public hospitals
Strengthen hospital financial accounting management and implement the chief accountant system of third-level public hospitals. Further strengthen the management of revenue and expenditure budgets of public hospitals and promote cost accounting and cost control of public hospitals. Strengthen medical quality management and control, and standardize clinical examination, diagnosis, treatment, use of drugs and implantable (interventional) medical devices. Promote innovation in medical service models, continuously optimize medical service processes, improve patients' medical environment and medical experience, and promote harmonious doctor-patient relationships. Comprehensively consider factors such as medical service quality and safety, basic medical needs, etc., formulate clinical pathways and strengthen management. In-depth development of high-quality nursing services.
, study and formulate guidance on strengthening comprehensive budget management of public hospitals. From 2016 to 2017, we will standardize diagnosis and treatment behaviors and continue to innovate medical service models.