Medical network - on November 10, on November 8, deepening medical and health system reform leading group of the state council issued "about further promote deepening medical and health system reform experience of several opinions" (hereinafter referred to as "opinions" below), file specifically summarizes the eight years since the reform of article 24 of the typical experience.
The general office of the central committee of the communist party and the state council on forwarding the "opinions", and issued a circular, urged all localities departments combined with real earnest implementation.
Previously, the national health development planning commission all sorts of routine conference also often about health care around the successful experience, and publicity around to learn from, but are required by learning, advocates of no written required.
This time, but in various areas of the mature experience of health reform together into the file, and forward by the party central committee and the state council general office, this experience has been gained at the highest level for approval, and must carry out the policy of rise.
The following is a "opinion" mentioned in article 24 typical experience content:
(a) set up the system of strong leadership and medical treatment, health care, medicine, "3 d" joint operation mechanism, organization guarantee for deepening the reform
1, strengthen the leadership of party committee and government on health reform.
Deepening the reform work shall be the responsibility of the local party and government charge. By the party committee and government is mainly responsible for comrades or a is mainly responsible for comrades to reform leading group leader, give full play to the leading group for reform of overall coordination effect, earnestly implement the leadership responsibility of the government on health reform, guarantee responsibility, management responsibility, supervision and responsibility.
2, establish and improve the work promoting mechanism.
Stresses the responsibility division of labor mechanism, establish a system reform task parameter, blame layer upon layer in place. Implementing supervision mechanism and specific inspection key reform task, as the important basis of the annual appraisal. Catch assessment accountability mechanism, reform task completion included in the government performance appraisal comprehensively deepen reform and target management performance evaluation, serious lack of accountability reforms to promote regional and individual commendation and reward for positive innovation, effective area and individuals.
(2) break with medicine cure, establishing and perfecting the public hospital operation mechanism
3, according to the empty room, structure, cohesion of the basic path gradually straighten out the medical service price.
Actively yet prudently proceed with medical service price reform, in ensuring that public hospital benign operation, affordable medical insurance fund, the burden of the masses under the premise of the overall increase, according to the total amount control, structural adjustment, mixed, gradually in place, classification guidance straighten out different level medical institutions and medical service price comparison between relations. All public hospitals cancelled drug addition, as a whole consideration of the local government determine the compensation policy, pricing precision measurement, synchronous adjustment of medical service prices. By regulating the behavior of diagnosis and treatment, and reduce drug, consumables, etc. Make room, dynamic adjustment of medical service prices. Price adjustment should focus on improving the medical personnel technical services value in the diagnosis and treatment, surgery, nursing, rehabilitation and medical projects such as the price of traditional Chinese medicine, to lower the price of large medical equipment examination treatment and inspection, etc, and with health care payments, classification of diagnosis and treatment, such as cost control policy to connect each other. Through comprehensive ShiCe, gradually increasing the income of medical services (excluding medicines and chemical reagents, consumables, inspect and test income) in the hospital the proportion of total, establish a public hospital operation mechanism.
4, the implementation of public hospital drug procurement classification.
Distinguish different drugs, through tendering, negotiation, hanging net, fixed-point production directly form a reasonable purchase price. Adhere to the principle of concentration belt quantity purchase, for clinical use, the purchase amount is high, the enterprise production and a number of essential drugs and generic drugs, centralized bid procurement by provincial drug procurement agencies. Public hospital comprehensive reform pilot cities can take in the city on the provincial drug centralized purchasing platform to purchase. Encourage the cross-regional joint procurement and joint procurement specialist hospital. Practice the medical consumables procurement sunshine, to carry out the high value medical consumables, inspection detection reagent and centralized purchasing large medical equipment. For part of patent medicine, the sole drug production, establish a transparent, participating mechanism of price negotiation. Negotiation result on national drug supply security integrated management information platform, hospital drug procurement according to the negotiation result. With health care payment policy of cohesion, in accordance with the provisions, will conform to the conditions of drugs into the compliance costs of medical insurance.
5, public hospital drug procurement gradually implement the "two votes".
Around to adjust measures to local conditions, gradually implementing public medical institutions and drug purchase "two votes" (production enterprise to open an invoice of enterprises and circulation enterprises to open an invoice) of medical institutions, encourage other medical institutions to implement the "two votes", reduce the drug circulation of the intermediate links, improve circulation enterprises concentration, hit "money laundering", lower drug prices artificially high, purifying the circulation environment. By integrating pharmaceutical trading enterprises, warehousing and transportation resources, speed up the development of pharmaceutical logistics, encourage regional drug distribution of urban and rural integration, to promote the "two votes" to provide basic conditions. Build system of commercial bribery enterprise blacklist, rake-off of commercial bribery of pharmaceutical production and circulation enterprises, cancel the qualification of suppliers.
6 and regulating the behavior of diagnosis and treatment.
Using informatization technology to all outpatient treatment behavior and expenses, hospitalization medical institutions to carry out the entire monitoring and intelligent audit, be warned, matter controls, afterwards audits. Carry out prescription reviews, strengthen information disclosure and social supervision. Strengthen the rational use of drugs and adverse drug reactions monitoring, the price is high, large dosage, non drug establish monitored directory, such as auxiliary treatment for tracking monitoring, early warning. Key drugs may purchase a filing, clear purchase quantity, the doctor prescribed, after the head of the examination and approval by the medical institutions to drug purchase department for the record. Strictly control the scale of public hospital too fast growth.
7, the implementation of the government responsibility.
The full implementation of government policy on the investment of public hospitals. In accordance with the relevant regulations, and gradually public hospital long-term debt repayment and resolve of provisions.
(3) play a fundamental role health care, to strengthen the external restriction of medical services
8, strengthen the function of orgnaization of health care management.
Integration of urban and rural residents basic medical insurance system, to achieve coverage, financing policy, to ensure treatment, medical insurance directory, fixed management, fund management, and other "six unity". Straighten out management system, unified basic medical insurance agency management, can carry out the establishment of medical insurance fund management center, undertake fund pays and management, medicines procurement and payment, the payment standard negotiations, the designated agency agreement management and settlement functions, give full play to medical care for medicine production and circulation enterprises, hospitals and doctors supervision function, the gripper for linkage reform. After the unification of insurance agency orgnaization to more efforts to promote the reform of medical insurance payment methods, further play to health care to control the medical expense unreasonable growth role.
9, comprehensive promote the reform of payment.
Gradually reduce pay by project, perfect the medical insurance payment total amount control, carry out mainly by macro-reforms, capitation payment, pay by bed, and total prepaid the compound payment method of combining a variety of payment methods to pay according to the disease diagnosis related group (DRGs), medicare payment reform gradually cover all medical institutions and medical services. Conditional region points method can be combined with budget management, according to macro-reforms, promote orderly competition between medical institutions and rational allocation of resources. Establish balance retention, reasonable overruns share the incentive constraints mechanism, stimulate medical institutions regulating behavior, control the cost of endogenous power.
Orgnaization of 10 basic health care, the innovation service mode.
According to the principle of tube separated, promote the orgnaization of agency of health care professional. On the premise of ensuring the safe and effective supervision of the funds, the way the government purchasing service with qualifications entrusted by the orgnaization of business insurance institutions and other social forces to participate in the basic health care services, to undertake a serious illness insurance, urban and rural residents to introduce competition mechanism, improve the efficiency of orgnaization of health management service and quality. Encourage the development of commercial health insurance.
(4) promote the separating, tube separated, to establish modern hospital management system
11, making a government-run medical system.
Around to adjust measures to local conditions, explore effective organization form, perform the duty of a government as a whole.
12, the implementation of public hospital operation management autonomy.
Transform government functions, the competent administrative departments at all levels from direct management of public hospitals to industry management, strengthen the policy laws and regulations, industry planning, formulation of standards and regulations and the supervision and guidance. Improve public hospital corporate governance structure, implement internal personnel management, organization setup, income distribution, deputy recommendation, appointment or dismissal of cadres in the middle, such as annual budget execution autonomy. Improve public hospital internal decision-making and restriction mechanism, strengthen management, play to the staff and workers' congress function, strengthen the democratic management.
13, the implementation of public hospital performance evaluation.
Evaluation system, set up public welfare oriented function orientation, duties to perform, social satisfaction, cost control, performance index, financial management, etc. Organize regular public hospital performance appraisal and dean annual and term target responsibility appraisal. The assessment results and hospital financial aid, medical insurance pay, merit pay total and dean, appointment, rewards and punishments, etc., to establish the incentive constraints mechanism.
14 the elaborating management, strengthening the public hospital.
Improve the medical quality and safety management system and the quality monitoring evaluation system, promote the clinical pathway management, promote the medical quality continuous improvement. Implements the comprehensive budget management, to carry out cost accounting, the balance of the overall analysis, budget implementation, cost efficiency and solvency, etc., as the important basis of hospital operation management decisions. Implementation of the third party accounting audit supervision system, strengthen the regulation of economic operation of the state-owned assets, to the hospital.
(5) establish the personnel salary system in accordance with industry characteristics, arouse the enthusiasm of the medical staff
15, to set up the flexible mechanism of choose and employ persons.
Innovation of public hospital management mode, perfect management method, actively explore trial preparation of management reform of public hospitals will be carried out. Within the total local existing establishment, determine the total public hospital preparation, records and shall be gradually practised in some large and medium cities third rate reform of public hospitals to carry out the preparation of management, personnel management pilot. Implement recruitment system, post management system, personnel management system such as the open recruitment system. Simplify the process of professional and technical personnel recruitment, shortage of professional and technical personnel to hospital or high-level personnel can adopt the method of inspection shall be in accordance with the provisions, the hospital recruitment. Increase the grassroots health institutions, senior positions in proportion, broadening the medical staff career development space.
16, promote the reform of salary system.
Where can be combined with the actual, according to the relevant provisions of the reasonable public hospital compensation levels, gradually improve staff spending accounts for the proportion of business spending. To work outside of time more labor, high-level medical talents converging, public welfare goal task heavy, signing the family doctor service public medical institutions, will be tilted during the performance of the approved total payroll. To strengthen the long-term incentive of medical personnel, the establishment of public welfare oriented performance evaluation mechanism, compensation in maintaining moderate growth based on the current level of implementation. Merit pay total amount of the approved public medical institutions according to the assessment results of autonomous performance wage distribution. Total compensation for approval and distribution of personal merit pay not with medical institutions of medicines and chemical reagents, consumables, large medical examination and other business income, salary distribution of posts, risk, technical content contribution, etc., it is strictly prohibited to medical staff set revenue targets. Grassroots medical institutions can be approved in accordance with regulations of the financial system in balance of payments to extract the worker welfare funds and rewards.
(6) by signing the family doctor service and medical association as main fulcrum, accelerate the construction of the classification system
17, promote family doctor signing service.
To form a family doctor as the core, provide the technical support specialist contract service team, provide residents with long-term continuous public health and basic medical and health management service. Optimize the signing service connotation, in medical treatment, referral, medicine, health care and other aspects of signing residents adopted a policy of differentiation, promote the first option at the grass-roots level. Sound on the basis of the standardized work performance appraisal system. Can guide residents or family at the same time of signing with the family physician team, choice a secondary hospital, a tertiary hospital, to establish the combination of "1 + 1 + 1" signing service mode, within residents can be combined in contract signing select a medical institution, if to the outside of the combination of visits by the family doctor referral, guide residents to change habits, form a reasonable medical treatment order.
18, a medical association.
According to the government leading, voluntary association, regional coordination, the principle of convenient to the masses, sharing resources and talent sinking oriented, establish the longitudinal association of medical resources, promote grass-roots service ability. Within the medical association clear urban tertiary hospital, secondary hospital and has relations of the basic medical and health institutions, and two-way referral agreement, and improve the mechanism of related management, operation and examination etc. Promote the health technical personnel county township, township Guan Village, establish flexible talent flow mechanism, take turns to the service. Intensify counterpart aid, accurate support grassroots health institutions specialized subject construction and talents training, promote balanced urban and rural medical resources allocation. Relying on the counterpart support channels, and integration of medical resources, increase the old revolutionary base areas, ethnic minority areas, border areas and poor areas of medical and health undertakings support, further completes the xinjiang medical talent "author" Tibet work.
19, giving full play to the advantages of Chinese medicine service.
Strengthen grass-roots medical institutions of traditional Chinese medicine library construction, and promote comprehensive service mode of traditional Chinese medicine, widely use of traditional Chinese medicine appropriate technology, give full play to their role in the prevention and control of common disease, frequently-occurring disease and chronic disease of traditional Chinese medicine. In improving medical service price, manifest the value of technical services of traditional Chinese medicine of traditional Chinese medicine, on the basis of reasonable standards of traditional Chinese medicine press disease to pay. For grassroots service system is not sound, weak ability of Chinese medicine in the area, will the doctor of traditional Chinese medicine hospital outpatient medical services into the first option in TCM and meet the needs of the people first option to see the traditional Chinese medicine. The innovation of traditional Chinese medicine diagnosis and treatment patterns.
20 supporting policies and improve the classification diagnosis and treatment.
Reasonable division and carry out the duties of medical institutions at all levels diagnosis and treatment, the clear referral procedures and standards, carrying out responsibility system of first diagnosis and referral system of examination and approval. Give play to the role of health policy adjustment, the medical institutions to carry out the clinical duties and referral linked to performance appraisal and allocated medical insurance fund. Explore collaboration (such as medical association pattern of vertical cooperation total medicare pay, guide the two-way referral. Improve the level of different medical institutions differentiation to pay for health care policy, promote the first option at the grass-roots level. For the referral of patients, according to regulations on the reimbursement policy to tilt.
(7) make full use of Internet technology, improve the masses go to a doctor
21, to strengthen the construction of health information infrastructure.
Build mutual sharing and business collaboration of national, provincial, city and county level 4 population health information platform, improve the residents to electronic health records, electronic medical records, electronic prescription based database as the core, through all kinds of medical and health institutions channel data resources sharing, and improve the classification based on the technology of Internet, big data medical information system, to achieve continuous, coordination and integration of medical and health services to provide technical support.
22, vigorously promote the service for the convenience of huimin.
Optimization of diagnosis and treatment process, improve the medical environment, overall arrangement booking, inspection, diagnosis and treatment, referral, payment and settlement, promote the Internet booking triage, mobile payment, clinic and settlement, and the results query applications. Perfect inspection results mutual recognition mechanism, enlarge high quality resources radiation effect, convenient masses to the nearest hospital. Using mobile client, the Internet of things, such as technology, doctor-patient communication platform, for health consultation, and patient feedback provide convenience, health management, etc. Make full use of informatization technology, remote medical service, first opened 834 counties of remote medical system. Promoting residents' health card, social security card application integration, such as activating residents electronic health records applications, strengthen information publishes, connectivity, to promote prevention, treatment, rehabilitation and health management of electronic health services. Reasonable allocate health resources, science and number of various professional consultation of doctors, ensure physician examined have plenty of time, improve the quality of medical services.
(eight) development and standardize social do medical, meet the demand of diversified medical services
23, enhance the level of social do medical development.
Regional health planning and the planning of the establishment of medical institutions do medical leave enough space for the society, priority for non-profit medical institutions. Optimize social do medical development environment, promote the public medical institutions and the public medical institutions in market access, social insurance, key specialty construction, title evaluation, academic communication, grade evaluation, technical access to the same treatment. Support social do medical chain operation, build brand, group development, to provide high-end services, and shortage of rehabilitation, aged care and other services. Encourage social forces according to the relevant provisions of the establishment of an independent medical examination, medical imaging diagnosis, disinfection supply and blood purification.
24, strengthening standard management.
Pushing local administrator, strengthen the industry regulation, all medical institutions unified planning, unified access, unified supervision, in accordance with the standard social do medical organizations working behavior. To crack down on illegal practice medicine. In accordance with the relevant "pipes" reform requirement, simplifying access of optimization of examination and approval procedures, strengthen the supervision of things after the event. Strengthen the nonprofit social do medical institutions property rights, financial operation and supervision over the use of capital surplus management, promote the development of social do medical health. |
