Public-private reforms must touch institutional mechanisms
(Reporter Zhang Cancan) The General Office of the State Council has issued the “Work Arrangement for the Reform of Public Hospitals in 2011†(for interpretation, see today's 3rd edition). The "Working Arrangement" made it clear that the pilot reform of public hospitals has entered a new phase of integration and trial-and-error. It is necessary to implement a batch of well-defined and effective reform measures throughout the country, and to vigorously promote the pilot cities There are active explorations on comprehensive reforms in major institutional mechanisms such as separation, separation of government affairs, medical separation, profit-making and non-profit separation.
Strengthen the administrative responsibilities of the health administrative department across the industry The “Work Arrangements†clarified the working ideas, major tasks, and related requirements for the 2011 public hospital reform pilot. In carrying out the pilot reform of major institutional mechanisms, the "Working Arrangements" proposed that the first is to promote the separation of management and management and to deepen the reform of the public hospital management system. Strengthen the administrative responsibilities of the health administrative departments throughout the industry, and establish a unified, efficient, consistent power and responsibility government system. The heads of health administrative departments at all levels must not concurrently assume leadership positions in public hospitals. The second is to promote separation of government affairs and improve the corporate governance mechanism of public hospitals. Explore the establishment of various forms of corporate governance structure of public hospitals with the board of directors as the core, rationalize the rights and responsibilities of public hospital owners and managers, improve the appointment of presidents of public hospitals, encourage incentive measures, and establish the core of public welfare. Public hospital performance appraisal system to strengthen the supervision of public hospitals. The third is to promote the separation of medicine and improve the compensation mechanism for public hospitals. The reform adopts the mechanism of drug supplementation, explores multiple specific channels for the separation of medicines, gradually eliminates the policy of drug addition, and adopts measures such as increasing the service fee for public hospitals and adjusting the charging standards for some technical services. Medical security funds pay and increase government investment and other ways to compensate. The pharmacy service fee is included in the basic medical insurance payment range. Encourage the reform of the collection and payment system as an entry point to solve the problem of medicine for medicine. We will study and rationally adjust the prices of medical services and implement government investment policies such as the construction of public hospitals and the purchase of large-scale equipment, the development of key disciplines, retired personnel costs and policy-based loss subsidies that meet the requirements of the state. The fourth is to promote the separation of profit-making and non-profit, improve the classification management system of medical institutions, and strengthen the supervision of medical institutions organized by social capital.
Supporting 300 Further, the standardization of hospital construction in the county-level hospitals In promoting the development of public hospital service systems, the “Work Arrangement†requires that the first is to optimize the layout of public hospitals and focus on strengthening the capacity building of medical services in weak areas and weak areas. The second is to give priority to the development of county-level hospitals, and the central government will support the standardization of the 300 county hospitals this year. Counties (cities) with a population of more than 300,000 will basically complete a public hospital with at least one dime by the end of 2011. The third is to establish a division of labor and cooperation mechanism between public hospitals and primary health care institutions, and gradually form the pattern of first-level primary care, graded medical care, and two-way referral. Fourthly, accelerating the development of hospital informationization, promoting county-level hospitals and urban tertiary hospitals to carry out telemedicine activities. In 2011, the construction of remote consultation systems for 500 county-level hospitals and urban tertiary hospitals in remote areas was completed.
Regarding measures to promote the convenience of the people, the "Working Arrangements" require that the first is to improve the people's access to medical services, to conduct general appointment medical services, to optimize the hospital emergency room environment and procedures, to develop convenient outpatient services and to promote quality care services. The second is to control medical expenses, explore the reform of multiple basic medical insurance payment methods, achieve direct settlement of basic medical security costs, promote the priority allocation of public hospitals, use of essential drugs, extensive use of appropriate technologies, and improve methods for centralized bidding and procurement of drugs, and promote general Medical Consumables. Centralized tendering and procurement will reduce procurement costs and purchase prices while ensuring quality, strengthen hospital financial management, and strengthen supervision and control of medical expenses. The third is to strengthen the supervision of medical safety quality. It is necessary to study and formulate clinical pathways that meet the basic medical needs, continuously expand the scope of hospitals and diseases, and carry out the evaluation of medical safety quality control.
To improve the level of salaries of clinical first-line nurses and physicians, fully mobilize the enthusiasm of medical personnel. The “Work Arrangements†proposes six measures. The first is to improve the system of personnel and income distribution in public hospitals, so as to achieve more work, more rewards, and better rewards, and to raise the level of wages and benefits for clinical front-line nurses and physicians. The second is to reasonably determine the staffing of public hospitals, to study the solution to the shortage of nurses and to support the establishment of rural and grass-roots staff. The third is to create a good medical practice environment and build a harmonious doctor-patient relationship. The fourth is to create favorable conditions for career development, implement the standardized training system for general practitioners and specialists, establish 100 standardized training bases, and recruit 10,000 people to carry out standardized training. The fifth is to promote the rational flow of medical personnel and encourage practicing doctors in public hospitals to conduct basic medical and health institutions to carry out practice activities. Sixth, we must promote noble professional ethics and strengthen medical ethics.
Improving social capital The practice environment for the organization of medical institutions To promote the formation of a diversified medical service structure, the "Working Arrangement" requires that policies and measures to encourage and guide social capital in the organization of medical institutions should be clarified, so as to leave room for reasonable development for non-public medical institutions. Improve social capital, organize medical institutions to practice the environment, and promote the healthy development of non-public medical institutions.
The "Working Arrangements" emphasizes that all regions and relevant departments must fully understand the importance, complexity, and urgency of the reform of public hospitals, strengthen leadership, organize meticulously, and carefully deploy and coordinate closely. Governments at all levels must strengthen support for support, increase investment, strengthen the management of the use of fiscal funds, improve the efficiency of the use of funds, and formulate and improve relevant supporting policies.
Strengthen the administrative responsibilities of the health administrative department across the industry The “Work Arrangements†clarified the working ideas, major tasks, and related requirements for the 2011 public hospital reform pilot. In carrying out the pilot reform of major institutional mechanisms, the "Working Arrangements" proposed that the first is to promote the separation of management and management and to deepen the reform of the public hospital management system. Strengthen the administrative responsibilities of the health administrative departments throughout the industry, and establish a unified, efficient, consistent power and responsibility government system. The heads of health administrative departments at all levels must not concurrently assume leadership positions in public hospitals. The second is to promote separation of government affairs and improve the corporate governance mechanism of public hospitals. Explore the establishment of various forms of corporate governance structure of public hospitals with the board of directors as the core, rationalize the rights and responsibilities of public hospital owners and managers, improve the appointment of presidents of public hospitals, encourage incentive measures, and establish the core of public welfare. Public hospital performance appraisal system to strengthen the supervision of public hospitals. The third is to promote the separation of medicine and improve the compensation mechanism for public hospitals. The reform adopts the mechanism of drug supplementation, explores multiple specific channels for the separation of medicines, gradually eliminates the policy of drug addition, and adopts measures such as increasing the service fee for public hospitals and adjusting the charging standards for some technical services. Medical security funds pay and increase government investment and other ways to compensate. The pharmacy service fee is included in the basic medical insurance payment range. Encourage the reform of the collection and payment system as an entry point to solve the problem of medicine for medicine. We will study and rationally adjust the prices of medical services and implement government investment policies such as the construction of public hospitals and the purchase of large-scale equipment, the development of key disciplines, retired personnel costs and policy-based loss subsidies that meet the requirements of the state. The fourth is to promote the separation of profit-making and non-profit, improve the classification management system of medical institutions, and strengthen the supervision of medical institutions organized by social capital.
Supporting 300 Further, the standardization of hospital construction in the county-level hospitals In promoting the development of public hospital service systems, the “Work Arrangement†requires that the first is to optimize the layout of public hospitals and focus on strengthening the capacity building of medical services in weak areas and weak areas. The second is to give priority to the development of county-level hospitals, and the central government will support the standardization of the 300 county hospitals this year. Counties (cities) with a population of more than 300,000 will basically complete a public hospital with at least one dime by the end of 2011. The third is to establish a division of labor and cooperation mechanism between public hospitals and primary health care institutions, and gradually form the pattern of first-level primary care, graded medical care, and two-way referral. Fourthly, accelerating the development of hospital informationization, promoting county-level hospitals and urban tertiary hospitals to carry out telemedicine activities. In 2011, the construction of remote consultation systems for 500 county-level hospitals and urban tertiary hospitals in remote areas was completed.
Regarding measures to promote the convenience of the people, the "Working Arrangements" require that the first is to improve the people's access to medical services, to conduct general appointment medical services, to optimize the hospital emergency room environment and procedures, to develop convenient outpatient services and to promote quality care services. The second is to control medical expenses, explore the reform of multiple basic medical insurance payment methods, achieve direct settlement of basic medical security costs, promote the priority allocation of public hospitals, use of essential drugs, extensive use of appropriate technologies, and improve methods for centralized bidding and procurement of drugs, and promote general Medical Consumables. Centralized tendering and procurement will reduce procurement costs and purchase prices while ensuring quality, strengthen hospital financial management, and strengthen supervision and control of medical expenses. The third is to strengthen the supervision of medical safety quality. It is necessary to study and formulate clinical pathways that meet the basic medical needs, continuously expand the scope of hospitals and diseases, and carry out the evaluation of medical safety quality control.
To improve the level of salaries of clinical first-line nurses and physicians, fully mobilize the enthusiasm of medical personnel. The “Work Arrangements†proposes six measures. The first is to improve the system of personnel and income distribution in public hospitals, so as to achieve more work, more rewards, and better rewards, and to raise the level of wages and benefits for clinical front-line nurses and physicians. The second is to reasonably determine the staffing of public hospitals, to study the solution to the shortage of nurses and to support the establishment of rural and grass-roots staff. The third is to create a good medical practice environment and build a harmonious doctor-patient relationship. The fourth is to create favorable conditions for career development, implement the standardized training system for general practitioners and specialists, establish 100 standardized training bases, and recruit 10,000 people to carry out standardized training. The fifth is to promote the rational flow of medical personnel and encourage practicing doctors in public hospitals to conduct basic medical and health institutions to carry out practice activities. Sixth, we must promote noble professional ethics and strengthen medical ethics.
Improving social capital The practice environment for the organization of medical institutions To promote the formation of a diversified medical service structure, the "Working Arrangement" requires that policies and measures to encourage and guide social capital in the organization of medical institutions should be clarified, so as to leave room for reasonable development for non-public medical institutions. Improve social capital, organize medical institutions to practice the environment, and promote the healthy development of non-public medical institutions.
The "Working Arrangements" emphasizes that all regions and relevant departments must fully understand the importance, complexity, and urgency of the reform of public hospitals, strengthen leadership, organize meticulously, and carefully deploy and coordinate closely. Governments at all levels must strengthen support for support, increase investment, strengthen the management of the use of fiscal funds, improve the efficiency of the use of funds, and formulate and improve relevant supporting policies.
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