Medical network - on February 4, 2017, the city will comprehensively promote reform of public hospitals, public hospitals widespread cancel drug addition, such as anhui and other places also want to cancel the consumables bonus. But it means medicines and chemical reagents, consumable zero bonus or public hospital debt problems will worsen.

In late January, the anhui provincial government office issued the debt on strengthening public hospitals to resolve and management opinion "(hereinafter referred to as" opinions "). It is reported, this is also the first introduced special opinions about the public hospital debt management of the province.

Buy equipment + doing construction, public hospital trillions of debt to resolve

, is the background of the "opinions" issued for many years, the public hospitals in anhui province in the development process of the debt for capital construction or purchase of medical equipment, etc., has formed some historical debt. As public hospital reform deepening, the medicine to cure mechanism gradually breaks down, the debt problem gradually become a bottleneck restricting the development of public hospitals.

On November 8, 2016, who in anhui province development planning commission director of virtue ambition of the province's people's congress for "about the reform of public hospitals report work in", by the end of 2015, the public hospitals in anhui province has reached more than 160 160 yuan worth of long-term debt.

Across the country, the state council on deepening the reform of medical health system work progress report shows: by the end of 2014, the country's 8677 the government public hospital long-term debt amounted to 233.3 billion yuan, including 52% hospitals above cities, district hospitals accounted for 9%, hospitals at the county level (39%).

In addition, according to the nearly 10 years of China health statistics yearbook, according to our country public hospital sheets from 169.7 billion yuan in 2005 began a sharp rise year by year, to total debt for more than $2014 mark, reached 1.0918 trillion yuan, the annual average debt compound growth rate of 20.5%; Compared with public hospitals gross income average annual compound growth rate of only 16%, the growth rate of debt significantly faster than income growth.

Graph: the public hospitals in 2005-2014 increase in debt

Medical management research center of tsinghua university, the university of international business and economics, a researcher at the Chinese economic development research center of Cao Jianceng wrote: "you can infer that public hospital short-term debt scale is about 800 billion yuan... assuming all public hospital for drugs and consumables production management enterprise payment days for four months, so the scale of the accounts payable will be 300 billion yuan. According to the public hospital to estimate the total scale of debt, there are nearly 500 billion yuan current liabilities is likely in public hospitals in short-term debt long throw or supplement daily operating funds, etc."

In 2016, hunan province is made with public hospitals large-scale pharmaceutical enterprise payment in arrears of big events.

On January 1, 2016, in changsha city to carry out the comprehensive reform of public hospitals, 20 pilot hospital has drugs zero rate and synchronous adjustment of medical service prices. But then, part of the hospital in the funding gap, by delaying the medicine distribution enterprise collection time to compensate. In changsha area, only 20 public hospitals more than 10 billion yuan on default distribution model, medicine circulation enterprises caused by capital turnover difficult.

In 2014, the guangdong zhuhai public hospitals has also been exposed default payment for goods is as high as 290 million yuan, 13 local enterprises and 10 medical institutions of hainan province drug firms in arrears payment of RMB 558 million, the longest in arrears and even up to 5 years.

2017, the city will comprehensively promote reform of public hospitals, public hospitals widespread cancel drug addition, such as anhui and other places also want to cancel the consumables bonus. But it means medicines and chemical reagents, consumable zero bonus or public hospital debt problems will worsen.

Anhui thinking: hierarchical classification of debt + control equipment

To solve the problem of debt problems of public hospitals in the province, anhui province in the "opinions" put forward, according to the "lock, stock control increment, in accordance with the law in accordance with the rules, hierarchical classification and comprehensive ShiCe" train of thought, the integrated use of the exchange, financial aid, self-raised funds, negotiations, strive for policy support and so on many kinds of ways, effectively solve the problem of public hospital debt, build new debt to resolve and management.

In accordance with the "opinions", the anhui province during 2017-2018, through the replacement of local government bonds, lock by the end of 2016 local government debt in the platform of public hospital type debt all replacement. Debt after replacement, all by government debt service main body responsibility, at the same level and into the fiscal budget management at the same level, repaid in time.

For debt of class ii and class iii, "opinions" requirement to audit and judge the parameter management, and implement "a school policy", support public hospitals of class ii and class iii stock to resolve the debt through multiple channels. Since 2017, the public hospitals in principle according to no less than 5% of the medical income to extract the special funds, used to pay off debts...

Until the end of 2020 in anhui province is put forward, and strive to resolve all the stock of debt of debt deadline; The stock of debt due to after 2020 year, various ways to reduce debt servicing costs and resolve in a timely manner.

In resolving the debt at the same time, in anhui province is put forward in the "opinions", perfect the public hospital development input mechanism, standardize the development of construction projects and debt for examination and approval mechanism, strict controls of new debt, promote the sustained and healthy development of public hospitals in the province.

To this end, on the one hand, to adhere to the public welfare of public hospitals, increase the government for public hospital infrastructure and equipment purchasing, etc.

, on the other hand, we will strictly implement the relevant provisions of the state council on strict controls of debt in the public hospital, according to the regional health planning reasonable at all levels, all kinds of public hospital layout and quantity, strictly control the basic construction and public hospital medical equipment configuration of the standard, the scale, improve and implement the basic construction and equipment purchase projects and debt for examination and approval mechanism, strictly control the debt, put an end to illegal borrowing.

According to "views", the anhui province will be to do not conform to the regional health planning, not to carry out the construction funds, stock to resolve the debt of the public hospital, not according to stipulations shall examine and approve the new project. The approved large medical equipment purchase funds, in principle by the governments at various levels in the public hospital subsidy funds as a whole.

Attachment: anhui province people's government of the general office on strengthening public hospitals and resolve the opinion of the management work

Municipal and county people's government, provincial government departments, directly affiliated institutions:

Over the years, our province in the development process of public hospital debt for capital construction or purchase of medical equipment, etc., has formed some historical debt. As public hospital reform deepening, the medicine to cure mechanism gradually breaks down, the debt problem gradually become a bottleneck restricting the development of public hospitals. In order to strengthen the management of public hospital and resolve work, effectively reduce the debt burden of public hospitals, improve the hospital running efficiency and service quality, to adhere to the basic medical and health cause of public welfare, deepen the comprehensive reform of medical health system, safeguard people's health level enhances unceasingly, has important and far-reaching significance. For the further implementation of the national and the provincial department of health and health conference spirit, strengthen the public hospital debt resolve and management work, according to the state council about print and distribute "much starker choices-and graver consequences-in" deepening medical health system reform plan circular (guo fa [2016] no. 78), "the people's government of anhui province about deepening medical and health system in anhui province" comprehensive reform pilot program notice (anhui administration [2015] no. 16) requirements, subject to consent by the provincial government, put forward the following opinions:

First, general requirements

Fully implement the party's 18 large and 18 sixth plenary session of 3, 4, 5, spirit, carry out general secretary xi series of important speech especially visit anhui's important speech spirit, in accordance with the "five one" the overall layout and the "four" comprehensive strategic layout, and firmly establish and implement the innovation, harmonious and green, open, sharing development concept, in accordance with the "lock, stock control increment, in accordance with the law in accordance with the rules, hierarchical classification and comprehensive ShiCe" train of thought, sum up experience, the innovation, the integrated use of the exchange, financial aid, self-raised funds, negotiations, strive for policy support and so on many kinds of ways, effectively solve the problem of public hospital's debt, build public hospital debt resolve and management mechanisms.

In identifying audit determined on the basis of the distinction between public hospital nature of the stock of debt and categories, in accordance with the relevant regulations and principles, to the end of 2020 to resolve all the stock of debt of debt deadline; The stock of debt due to after 2020 year, various ways to reduce debt servicing costs and resolve in a timely manner. At the same time, improve the public hospital development input mechanism, and perfecting the public hospital, the mechanism of debt management and debt for examination and approval mechanism, development and construction project overhaul of new debt, promote the sustained and healthy development of public hospitals in the province.

Second, the basic principles

(a) adhere to the hierarchical classification, clear service main body. , according to the principle of the governance adapted to expenditure responsibility, classification management and classification, provincial, city and county (city, area) the government at the corresponding level in public hospitals and resolve management overall responsibility, according to public hospital debt category, classified disposal and repay.

(2) stick to discriminate, outstanding debt. In a public hospital to resolve the debt at the same time, the audit identifying the government guaranteed liability category of debt and other types of debt and long-term debt flows, real debt and government debt financing debt, locking the stock of debt, the parameter management. According to the running status of public hospital total debt and balance the integrated use of a variety of effective ways, a courtyard, respectively formulate debt solution, overall planning, amortized over years, gradually resolved.

(3) adhere to in accordance with the law in accordance with the rules, put an end to illegal borrowing. Strictly implement the relevant provisions of the state council on strict controls of debt in the public hospital, according to the regional health planning reasonable at all levels, all kinds of public hospital layout and quantity, strictly control the basic construction and public hospital medical equipment configuration of the standard, the scale, improve and implement the basic construction and equipment purchase projects and debt for examination and approval mechanism, strictly control the debt, put an end to illegal borrowing.

(4) insist, strengthening the construction of long-term mechanism. Adhere to the public welfare of public hospitals and strengthen public hospital debt form source control, establish a sound and effective implement of public hospital in government policies, increase investment in basic construction and equipment purchase, etc. Strengthen public hospital financial budget, cost control and so on basic management, construct public hospital long-term development mechanism.

Three, the main task

(a) by way of local government debt replacement to resolve public hospital of the stock of debt. Financial departments at all levels should, in accordance with the central fiscal unification deployment, during the period of 2017-2018, through the replacement of local government bonds, will be by the end of 2016 local government debt platform all replacement lock in the kind of debt. Debt after replacement, all by government debt service main body responsibility, at the same level and into the fiscal budget management at the same level, repaid in time. (responsibility unit: the provincial financial department, provincial health and family planning commission, provincial education department, top of column for the lead responsibility unit, hereinafter the same)

(2) the overall audit and identify, locking public hospital of class ii and class iii stock of debt. Led by the auditing department, jointly with the finance and national development and reform, health, family planning, education and other departments, through a comprehensive self-examination, cross peer-reviewed and, to the end of 2016 local government debt management platform in the debt of class ii and class iii audit screened, weed out the actual used for hospital development and construction of government financing loans and to expand to improve standards, "the compound interest, interest rates turn this" high-interest loans and other debt, issue a report on audit screening. Establish public hospital debt parameter of class ii and class iii, uniform number, XiaoHao management, and timely adjustment of local government debt in accordance with provisions platform data, lock the stock of debt. Audit in the screening, can reference the stock of local government debt audit audit plan as a whole, such as Treasury stock of local government debt to clear identify report results. (responsibility unit: provincial bureaus, the provincial financial department, the provincial development and reform commission, provincial family planning commission, provincial education department of health)

(3) "a court a strategy", support public hospitals of class ii and class iii stock to resolve the debt through multiple channels. Public hospitals at all levels should be according to the amount of debt and assets structure, hospital business income and expenses, effective resources, etc., for two, three types of debt stock solution, and reported to the government (or public hospital management committee) at the same level for approval before implementation. Public hospitals should strengthen the comprehensive budget management, strengthen the internal cost control, regulate balance of payments accounting, optimize expenditure structure, compression recurring expenses, actively raise debt capital. Since 2017, the public hospitals in principle according to no less than 5% of the medical income extract repayment special funds, including the annual should also principal and interest is lower than 5% of the public hospital medical income, provision of principal and interest according to the actual capital demand, special used to repay debts that are due, the specific proportion determined by local financial department under the state council in conjunction with the relevant departments. Government entities at all levels shall actively build platform, support of public hospitals with full consultation between bank debt, in the lending rates are higher than the same period bank benchmark interest rate under the premise of compressed by the end of 2016 servicing period is more than 5 years of debt maturity, strive for the bank to take payment of stope, debt relief and other ways to reduce the debt burden; Support for temporarily cannot be compressed debt repayment deadline, public hospitals through for policy Banks and other financial institutions for medium and long-term loans replacement stock of debt, reduce the debt servicing costs. Conditional place financial department can arrange appropriate debt interest subsidy funds. Public finance will resolve to provincial public hospital public hospitals and counties in debts to give award to fill. Public hospitals at all levels will be all kinds of funds, financial aid public hospitals to eliminate the fiscal subsidy on public health, personnel training, basic construction, equipment purchase, such as special funds, not less than 10% of the proportion of arrangements for repayment, the specific proportion by local finance department under the state council in conjunction with the relevant departments, including provincial financial aid at the county level public hospital zero rate fund arranged by no less than 50% proportion; Annual without spending all kinds of public hospital subsidy funds, in accordance with the relevant provisions of the stock account balance fund management, to continue to use the priority for repayment of the debt. To speed up the disposal of idle land, housing public hospital assets such as resources, in accordance with the related provisions on state asset management, will the proceeds used to pay off debt. (responsibility unit: province, provincial departments of health and family planning commission, provincial department of education)

(4) strengthen the public hospital construction project management. Around and departments concerned should strengthen the regulation of public hospitals, the organization when necessary for public hospital construction project size standards to be reviewed, funding sources, and so on and so forth, for the excessive super scale construction, the construction funds are not need loans of the construction of the project, to suspend construction, complete after continuous stay relevant conditions. Conform to the conditions, the use of debt capital after the review of project under construction, continue to press clear when project financing mode or the original bank loan agreement extension; Construction projects are indeed no other source of construction fund, should be mainly by the government and social capital cooperation mode and the local government debt to solve the follow-up funds. (responsibility unit: province health and family planning commission, provincial education department, the provincial development and reform commission, provincial bureaus, the provincial financial department)

(5) establish a mechanism of public hospital and management work for resolve. Provincial departments of public hospital and resolve management assessment measures, around the stock of debt audit annually to identify new debt, debt repayment progress, control and so on carries on the appraisal. Before 2020, the provincial fiscal year certain additional debt quota alone, according to the appraisal situation to give award to fill, and the northern anhui dabie mountain old revolutionary base areas, and there is no debt or tilt region to give complete debt to resolve the task ahead of time. And departments concerned should also make public hospitals around the assessment method and management work, resolve the assessment results and director compensation and total wages shall be renewed, hospital performance, such as financial aid funding arrangements. Conditional local finance department can arrange special funds, to resolve and management work of good public hospitals give prize. (responsibility unit: the provincial financial department, provincial health and family planning commission, provincial education department, provincial human resources social security hall)

(6) to strengthen the new debt source control management, improve the input mechanism. The strict implementation of regional health planning, reasonable at all levels, all kinds of public hospital layout and number, effectively control the scale of public hospitals, it is forbidden to violate compasses construction of debt. For public hospital infrastructure projects, review and submit to the government at the same level by the relevant competent department or public hospital management committee, by the national development and reform department at the same level in accordance with the procedures for examination and approval. Does not meet the regional health planning, not to carry out the construction funds, stock to resolve the debt of the public hospital, not according to stipulations shall examine and approve the new project. Public hospital approved the funds required for the basic construction projects, in principle, by all levels of government budget as a whole fund arrangement. The approved large medical equipment purchase funds, in principle by the governments at various levels in the public hospital subsidy funds as a whole. Improve public hospitals government input mechanism, the establishment of system of allowance of financial comprehensive performance. (responsibility unit: province development and reform commission, provincial departments, health and family planning commission, provincial education department, provincial bureaus)

Fourth, safeguard measures

(a) strengthen organization and leadership. Everywhere, all the departments concerned should strengthen the leadership, clear responsibilities, coordination and advance together. Led by the financial department, in conjunction with the national development and reform, health, family planning, education, audit, human resources, social security and health departments, establish a system of joint conference for public hospital and resolve such management, under the leadership of the government at the same level as a whole to promote resolve and management work. Financial department responsible for the management of coordinate and resolve, together with the relevant departments work plan and money management, debt lock, evaluation award system, such as to arrange the necessary audit screening work. Development and reform department is responsible for providing infrastructure for examination and approval of relevant information, improve the project examination and approval mechanism, basic construction fund arrangement as a whole. The auditing department is responsible for the debt audit identify plan formulation and implementation of organization work, issue a report on audit screening work. Family planning, health education authorities at various levels shall be responsible for public hospital infrastructure construction project review, supervise and urge guide public hospitals to establish "a school policy" program, the implementation of regional health development planning. Public hospitals should actively make debt introspection, comprehensive debt audit identify relevant information in a timely manner. Health departments at all levels to the supervision and management work in medical reform and resolve target responsibility appraisal scope.

(2) to strengthen the work carries out. Around to formulate specific implementation opinions based on the actual research, combining with local resources, hospital operation, debt structure, government subsidies and other factors, the public hospital repayment plan list, detailed service project, amount of principal and interest, funding sources, responsible and schedule, etc. , the relevant departments in all localities should finish the stock of debt audit identify public hospital according to the requirement, adjust the local government debt in platform data, lock, stock, etc. Around to local implementation opinions according to the requirement, relevant schemes, screening of audit report, repayment schedule list and other documents submitted to the provincial financial department.

(3) strengthening the management of funds. Around and departments concerned should strengthen public hospital service management and use of funds, debt service fund for financial arrangements, shall be paid directly; To hospitals raise debt capital and appropriated to reduce link, full specified amount paid in a timely manner. Around the insolvency fund set up to explore the condominium account for each channel arrangement of a sinking fund only door management, closed operation, dedicated account business accounting, the specific measures shall be formulated by the financial department under the state council in conjunction with the relevant departments around. To fraudulently collecting, intercept misappropriate, show the insolvency fund, all recover funds, shall be investigated for relevant responsible persons responsibility strictly, suspected of a crime, handed over to the judicial organs shall be investigated for criminal responsibility according to law.

(4) strengthen the publicity and guide. Around and departments concerned should be based on the economic and social development, and health and health to take a variety of ways, publicity and public hospitals and resolve the great importance of management work, strengthen policy interpretation and public opinion monitoring, timely response to social concern, effectively guard against and dissolve the risk and create a good working atmosphere.

Anhui province people's government office

On January 21, 2017