First, the basic situation of the pilot hospitals
Yingcheng People's Hospital has 953 employees and 822 health technicians, including senior title 107 and intermediate title 3 14. There are 800 open beds, 39 clinical medicine departments, community clinics 1, Xiaogan key college 1 1. It is the first batch of county-level public hospital reform pilot units. In 20 14, 543,300 outpatient and emergency visits were completed, 37,400 hospitalizations were made, and the business flow was 303 million yuan.
Yingcheng Hospital of Traditional Chinese Medicine has 45 employees1person and 355 health technicians, including 29 with senior titles and 23 with intermediate titles. There are 293 open beds, 6 clinical departments/kloc-0, 9 medical technology departments, 2 provincial key construction specialties of traditional Chinese medicine and 2 municipal key specialties of traditional Chinese medicine. It is the second batch of county-level public hospital reform pilot units. In 20 14 years, outpatient and emergency services were completed163,800 person-times, hospitalization10/500 person-times, and business flow was 70 million yuan.
Second, the main practices and progress
(A) to strengthen the three responsibilities, to provide a strong guarantee for reform.
The first is to strengthen the leadership responsibility of the government. A high-standard leading group for public hospital reform has been set up, with the mayor as the leader, the executive deputy mayor and the mayor in charge as the deputy heads, and seven units including development and reform, finance, people's society, health planning, organization, price and drug administration as members. The Municipal Party Committee and the Municipal Government organize special conferences on public hospital reform for many times every year, clarify the key work arrangements and road maps, and formulate the Implementation Plan for Comprehensive Reform of Public Hospitals in Yingcheng. The municipal medical reform leading group established and improved the target responsibility system and performance appraisal system, held regular joint working meetings to study and solve related problems, informed the progress of reform work, and implemented the accountability system, which fully guaranteed the smooth progress of public hospital reform. At the beginning of the year, the municipal party Committee and the municipal government also organized an inspection tour to Sanming city, Fujian province, in order to learn from the mature experience of other places? Sanming medical reform? Mode, broaden your mind. At the end of last year, the provincial medical reform supervision team inspected and supervised the reform of public hospitals in our city and fully affirmed it.
The second is to strengthen the responsibility of departmental contact. Establish a contact system for comprehensive reform of public hospitals, and regularly grasp the progress and trends of work. According to the second batch of public hospital reform plans and time nodes, the Municipal Health and Family Planning Bureau, together with the departments of price and finance, earnestly completed the baseline survey of public hospital reform in our city. In close cooperation with relevant departments, the implementation measures for the reform of payment methods in Yingcheng public hospitals, the price adjustment plan for the comprehensive reform of medical services in Yingcheng public hospitals, the implementation plan for graded diagnosis and treatment in Yingcheng medical institutions, the implementation measures for performance appraisal of Yingcheng public hospitals, the implementation rules for financial management of Yingcheng public hospitals, the implementation plan for strengthening the construction of health professional and technical personnel teams in Yingcheng, and the implementation plan for corporate governance structure of Yingcheng public hospitals have been successively promulgated. Supporting documents, such as the Implementation Measures for Compilation and Filing Management of Comprehensive Reform of Yingcheng Public Hospitals and the Implementation Plan for Post Setting and Income Distribution System Reform of Yingcheng Public Hospitals, are being further improved, and centralized bidding and purchasing of drugs, regional health planning and setting up of medical institutions are being further improved and will be introduced in the near future.
The third is to strengthen the responsibility of financial input. The municipal finance carefully accounted for the cancellation of drug bonus income in two public hospitals and adopted diversified compensation forms. The compensation of public hospitals is changed from three channels of service charges, drug bonus income and government subsidies to two channels of service charges and government subsidies. At the same time, the special subsidy for the comprehensive inpatient building of the Municipal People's Hospital reached 5 million yuan, and the new projects such as the Municipal People's Hospital and the Municipal Hospital of Traditional Chinese Medicine reduced the fees by nearly 8 million yuan. This year, the municipal finance increased the matching funds of the new rural cooperative medical system by 5.7 million yuan, and solved the standardized construction project of village clinics by 500,000 yuan, which provided financial guarantee for medical reform.
(2) Improve the three systems and the top-level design concept.
First, strictly implement the price system. According to the spirit of the provincial price document, according to? Total control and structural adjustment, rising and falling, gradually in place? In principle, the hospital's drug addition (except traditional Chinese medicine decoction pieces) should be completely abolished, and the zero-difference sales rate of drugs should be implemented. By adjusting the price of medical technical services, increasing government subsidies, strengthening accounting and saving operating costs, the reasonable income of hospitals should be reduced. Among them, the Municipal People's Hospital adjusted 1 173 items and the Municipal Hospital of Traditional Chinese Medicine adjusted 905 items. From 20 15/October 20 10 to the end of April 20 15, the average outpatient and emergency expenses increased by 2.25% year-on-year, and the average hospitalization expenses decreased by 2.8 1% year-on-year.
The second is to reform the medical insurance payment system. Actively promote the total prepayment of the new rural cooperative medical fund, promote the reform of medical insurance payment methods such as single disease payment and total prepayment, and reasonably control medical expenses. Strengthen the monitoring of indicators such as drug utilization rate, drug proportion, average hospitalization days and referral rate outside the basic medical insurance catalogue, and improve the efficiency of the use of basic medical insurance funds. The municipal joint management office calculated and negotiated with two pilot hospitals, and selected 30 diseases for pilot projects in advance. At present, the Municipal People's Hospital has tried out single disease quality management control for 13 diseases, and implemented clinical pathway management for 68 diseases. Since 20 14 and 1 1, nearly 3000 cases of clinical pathway have been developed, an increase of 20% over the previous year.
The third is to promote the medical grading diagnosis and treatment system. Further improve the catalogue of disease diagnosis and treatment in medical institutions and the standard of up-and-down transfer, and formulate the implementation plan of graded diagnosis and treatment in cities. Expand the Qifubiaozhun and proportion of medical institutions, effectively implement the Qifubiaozhun of rural cooperative hospitalization in township hospitals, and the reimbursement rate is 85%; 500 yuan, the deductible line of the municipal secondary hospital, will be reimbursed by 65%. Strictly implement the reimbursement policy for abnormal referral, and guide patients to choose medical institutions through policy leverage. At present, the city's medical treatment rate is 93.25%.
(3) Innovating the three mechanisms and strengthening the connotation construction of hospitals.
The first is to adjust the revenue and expenditure mechanism of public hospitals. Guide public hospitals to change their concepts, increase the pace of transformation and structural adjustment, formulate effective incentive and restraint mechanisms and scientific performance appraisal methods, prohibit over-prescription and over-inspection, strengthen expenditure budget management, effectively reduce expenditure costs and reduce the proportion of drugs in public hospitals.
The second is to improve the drug supply guarantee mechanism. Reduce the cost of drugs and high-value medical consumables, and adopt the methods of combining recruitment with procurement, linking quantity and price, and secondary bargaining to conduct centralized bidding and procurement. Establish and improve the inspection and supervision system, strengthen the supervision and inspection of the implementation of drug prices, standardize the price behavior, strengthen the monitoring of medical staff's prescription behavior, promote electronic prescriptions, and establish a systematic, standardized and continuously improved prescription review system according to the norms to promote rational drug use and protect the legitimate rights and interests of patients. The proportion of basic drugs used in people's hospitals in our city reached 5 1.5%, and that in traditional Chinese medicine hospitals reached 45.6%.
The third is to improve the service performance appraisal mechanism. Establish a performance appraisal and performance salary incentive system with service quality and job objectives as the core, and divide the appraisal system into departments and employees according to five first-level indicators such as medical quality, medical safety and medical level, 19 second-level indicators and 37 third-level indicators. Highlight social benefits and work efficiency, and implement the policy that medical staff's income is not linked to drugs, inspection and treatment. At the same time vigorously carry out? Actions to further improve medical services? , increase convenience measures, add service windows, implement flexible scheduling, window departments go to work in advance and delay services, optimize service processes, and shorten patients' waiting time for medical treatment. The Municipal People's Hospital opened an appointment platform 1 14 to carry out appointment registration, volunteer service and other projects. Since 20 14, 1 1, more than 200 people have made an appointment to register.
(D) Co-ordinate the three major projects to promote the coordinated development of industries.
The first is to implement the village clinic construction project. Actively strive for the construction projects of village clinics in the province, and implement unified planning, unified design, unified bidding, unified construction and unified acceptance. Five unification? Mode, 50 standardized village clinics will be built this year, and the construction of Huali Village in sanhe town, Zhachen Village in Tiandian Town and other 12 villages has started, and it is planned to be completed by the end of July. Strengthen the training of rural doctors, hold three training courses for nearly 200 people, and improve the ability of first diagnosis at the grassroots level. Strengthen the performance evaluation of village clinics, carry out monthly inspections, promote the equalization of basic public health services, and implement zero-difference sales of essential drugs.
The second is to implement the residents' health card project. Actively sign a letter of responsibility with Yingcheng Rural Credit Cooperatives, complete the unified layout of HIS system in each township (town), the construction of health private network and the verification of identity information of residents' health cards, and ensure that the residents' health cards in our city will be launched at the end of August, and 50% of the insured personnel will be distributed before 1 1 and1.
The third is to implement the social medical policy project. Social capital was introduced, and modern hospitals and renai hospitals were established. The successful transformation of the municipal health school, the addition of nursing homes in the municipal health school, the implementation? Combination of medical care and nursing? Effectively meet the needs of patients with diversified and high-quality medical services.
Three. Difficulties and problems
First of all, personnel autonomy needs to be further improved. The reform of public hospitals clearly stipulates that hospitals enjoy personnel autonomy under the control of the total staffing. However, at present, the introduction of all personnel in our city requires a unified review by the human and social departments. In addition, the subjects of imported personnel are different, and the examination content is single, which can not highlight the characteristics of urgently needed professionals. Moreover, staffing cannot be handled after recruitment, and only personnel agents can be implemented. According to the regulations, the establishment of the Municipal People's Hospital is 1: 0.9 ~ 1. 1:1~1.2, and the establishment of the Municipal People's Hospital is 1000 beds. This problem is more prominent in township hospitals. There are 922 people in township hospitals in the whole city 18, and 408 people are actually on the job. At present, there are 6 directors of township hospitals, who have no establishment and belong to personnel agency. On the one hand, the staffing is vacant, on the other hand, a large number of supernumerary personnel are used, which affects the healthy development of health and family planning. At the same time, the new staffing has not been implemented, leading to a series of problems such as subsequent professional and technical promotion, pension insurance and household registration.
Second, financial input needs to be further increased. In recent years, although the investment in medical reform and health care in our city has increased year by year, due to the limited financial resources of our city, the capital construction and equipment purchase, the development of key disciplines, personnel training, retirees' expenses in line with state regulations, the construction of turnover rooms for key talents, policy losses, undertaking public health tasks and emergency treatment are not guaranteed, and the financial investment is obviously insufficient.
Third, government policy compensation needs to be further implemented. After several months' operation, the funds for the two pilot hospitals to obtain 20% government compensation by adjusting the price of medical services were not included in the fiscal budget, and the funding gap was very large. Xiaogan Municipal Price Bureau and Xiaogan Municipal Health Planning Bureau reviewed the data reported by the investigation on the operation of the medical service price adjustment scheme. The compensation for medical price adjustment in our city is only 49.5%, and Chinese medicine hospitals only account for a decrease of 15.6%. According to this calculation, the annual gap is more than130,000 yuan (including nearly 9 million yuan in People's Hospital and 4 million yuan in Municipal Hospital of Traditional Chinese Medicine), which affects the normal operation and sustainable development of hospitals.
IV. Next Work Plan
In accordance with the requirements of comprehensive reform of public hospitals in the whole country and the whole province, we will focus on key points, overcome difficulties, reform and innovate, and continue to promote comprehensive reform of public hospitals in our city.
The first is to clarify the responsibilities of departments and strengthen the main responsibility of the government. As the main body responsible for the reform of public hospitals, the municipal government will thoroughly study and solve the difficulties and problems in the reform of public hospitals in time, urge relevant departments to improve the reform plan and supporting measures, and actively and steadily promote the comprehensive reform of public hospitals.
The second is to strengthen team building and make a breakthrough in standardizing staffing management. According to the guiding principle of classification, the establishment of pilot hospitals adopts the methods of one-time verification, step by step and dynamic management, and the establishment of posts and posts is implemented. For township hospitals and public health units, according to the qualifications, positions, length of service and other conditions, the existing on-the-job personnel will be assessed and gradually hired, and it will take about 3 years to solve the remaining problems. New employees need to take the exam.
The third is to increase the funding guarantee and make a breakthrough in the financial input compensation mechanism. Further increase national and provincial transfer payments, gradually increase the cost of capital construction and large-scale equipment purchase, especially increase the special subsidy for clearing the historical debts of hospitals, and promote the healthy development of public hospitals.
The fourth is to implement the responsibility of reform and make a breakthrough in the reform of management system. In order to improve the corporate governance structure, our city is establishing a pilot corporate governance structure in Xiaogan City. Establish a corporate governance structure with the Council as the core in county-level public hospitals, implement the president responsibility system, and establish a modern hospital management system. Promote graded diagnosis and treatment, focus on promoting urban and rural collectivization and rural integration of medical institutions, and form the characteristics of the city. The implementation of single-disease payment, in accordance with the principle of implementation, improvement and improvement, and gradually expand the single-disease paid diseases. By 20 17, the compound payment methods such as payment by disease, payment by head and payment by bed day will be fully implemented. Improve hospital performance appraisal, optimize the allocation of medical and health resources, implement post performance management, implement measures to facilitate the people and benefit the people, improve people's satisfaction with medical treatment, and strive to achieve? Minor illnesses do not leave the village, common diseases do not leave the village, and serious illnesses do not leave the county (city)? The county's medical treatment rate is over 90%.
Ladies and gentlemen, the comprehensive reform of public hospitals is an important measure to protect and improve people's livelihood, and it has become a hot and difficult issue of concern to the whole society. Under the correct leadership of the Municipal Party Committee and the supervision and guidance of the Municipal People's Congress, we will strive to promote the comprehensive reform of public hospitals in our city with more full spirit, more solid style and more powerful measures, and make new and greater contributions to building a healthy city.
Report on the reform of public hospitals 22016110 In October, the thirty-fourth meeting of the Standing Committee of the 12th Provincial People's Congress heard and deliberated the report of the provincial people's government on the reform of public hospitals, and put forward deliberation opinions, which were submitted to the provincial government for study and handling. The provincial government attaches great importance to the deliberation opinions of the Standing Committee of the Provincial People's Congress and seriously studies and handles them. The summary of the treatment report is now published as follows.
First, strengthen the government's responsibility and promote it as a whole? Three doctors? Linkage reform. Deepening medical reform is the responsibility of party and government leaders at all levels. Medical care, medical insurance, medicine? Three doctors? A leader is in charge. Plan to set up provincial public hospital management committees, play the role of public hospital management committees at all levels, and perform government medical functions; Do a good job in the planning of medical and health service system (20 16? 2020) and formulate 20 17 implementation opinions; Study and formulate a comprehensive medical reform pilot evaluation standard system, and evaluate the implementation effect every quarter; To study and formulate policies for public hospital investment and debt resolution, and make institutional arrangements for government investment and debt resolution; Comprehensive medical reform pilot? Look back? Improve the top-level design of key and difficult reforms such as investment system and personnel compensation.
The second is to implement the reform policy and accelerate the establishment of a new mechanism for the operation of public hospitals. Implement the autonomy of personnel management in public hospitals; Establish the establishment? Turnover pool? System; Follow? Allow medical and health institutions to break through the current wage control level of public institutions, allow medical service income to deduct costs and withdraw funds according to regulations, which will be mainly used for personnel rewards? Requirements, the implementation of medical staff salary system reform; Improve the ability and level of county medical service, and increase the intensity of attracting, retaining and cultivating talents; Dynamically adjust the price of medical services, promote the pilot reform of charging according to diseases, and timely review new medical services; Establish a performance appraisal reporting system in public hospitals above the second level in the province and carry out monitoring and analysis.
Third, improve the medical mechanism and effectively reduce the burden of medical expenses for the masses. Implement drug procurement? Two votes system? Reform encourages implementation? One vote system? ; Explore the establishment of high-value medical consumables medical insurance payment reference price; Promote the construction of drug circulation traceability system, strengthen drug circulation supervision, and establish commercial bribery in drug production and circulation enterprises? Blacklist? System; Explore the establishment of drug price comparison supervision system; Carry out activities to strictly eliminate unhealthy practices in the purchase and sale of drugs and medical services; Carry out prescription review and standardize clinical rational drug use; The growth rate of medical expenses in 20 17 years is generally controlled within 10%. Fourth, deepen comprehensive medical reform and enhance the people's sense of acquisition of reform results. On the basis of unifying the basic medical insurance policies for urban and rural residents, we will gradually promote medical insurance for urban and rural residents and employees? Three packs in one? . Establish a unified urban and rural basic medical insurance system, further improve the differential payment policies of medical insurance in different levels of medical institutions, and basically realize the direct settlement of hospitalization expenses in different places 2017; Further improve the level of medical insurance financing and security benefits, and the proportion of expenses paid within the policy scope will reach 75%; Establish and improve the performance appraisal mechanism combining the effect indicators such as hospitalization rate of patients with chronic diseases with workload indicators; Improve the function of medical convenience service platform; Fully implement the multi-point practice system of doctors and increase the proportion of medical insurance reimbursement in community hospitals; Implement the standard-reaching project of primary medical and health institutions, and the standard-reaching rate will reach 95% in 20 17 years, and rebuild and expand the central hospitals in some populous towns to reach the scale of secondary hospitals; In 20 17 years, the proportion of inpatients who make appointments by time reaches 100%, and the rate of outpatient appointments by time is not less than 50% of patients who make appointments; In 20 17 years, 50% patients discharged from tertiary hospitals and 70% patients discharged from secondary hospitals were managed according to clinical pathway, and more than 50% patients were paid according to diseases; Strengthen the monitoring of patients' out-of-pocket expenses and enhance the people's sense of medical treatment.