Report on the progress of public hospital reform work

Report on the Promotion of Public Hospital Reform 1

Yingcheng City is a pilot county and city for the comprehensive reform of county-level public hospitals. The Municipal People's Hospital and the Municipal Hospital of Traditional Chinese Medicine have been listed as pilot hospitals. In accordance with the requirements of "guaranteing the basics, strengthening the grassroots, and building mechanisms", and focusing on the reform requirements of separation of political affairs, separation of management and management, separation of medicine, separation of for-profit and non-profit, the key link is to eliminate the mechanism of "using medicine to supplement medical care" and adhere to The linkage of medical care, medical insurance, and medicine has effectively guaranteed the smooth progress of public hospital reform, ensured the return of public welfare and sustainable development of public hospitals, and initially achieved beneficial results for the people.

1. Basic situation of the pilot hospital

Yingcheng People’s Hospital currently has 953 employees, including 822 health professional and technical personnel, including 107 with senior professional titles and 314 with intermediate professional titles. It has 800 open beds, 39 clinical medical technology departments, 1 community outpatient clinic, and 11 Xiaogan municipal key specialties. It is the first batch of county-level public hospital reform pilot units. In 2014, there were 543,300 outpatient and emergency visits, 37,400 hospitalizations, and business turnover of 303 million yuan.

Yingcheng Traditional Chinese Medicine Hospital currently has 451 employees, including 355 health professional and technical personnel, including 29 with senior professional titles and 123 with intermediate professional titles. It has 293 open beds, 16 clinical departments, 9 medical technology departments, 2 provincial-level key specialties of traditional Chinese medicine, and 2 municipal-level key specialties of traditional Chinese medicine. It is the second batch of county-level public hospital reform pilot units. In 2014, there were 163,800 outpatient and emergency visits, 11,500 hospitalizations, and a business turnover of 70 million yuan.

2. Main practices and progress

(1) Strengthen three responsibilities and provide a strong guarantee for reform

First, strengthen government leadership responsibilities. A high-level leading group for public hospital reform work has been established, with the mayor as the leader, the executive deputy mayor and the mayor in charge as deputy leaders, and 7 people including development and reform, finance, human resources and social security, health planning, staffing, price, and drug supervision. units are members. The Municipal Party Committee and Municipal Government organize special meetings on the reform of public hospitals several times every year to clarify key work arrangements and roadmaps, and formulate and issue the "Implementation Plan for the Comprehensive Reform of Yingcheng Public Hospitals". The Municipal Medical Reform Leading Group has established and improved the work target responsibility system and performance appraisal system, held regular joint working meetings, studied and solved relevant problems, reported the progress of the reform work, implemented the accountability system, and made every effort to ensure the smooth progress of the reform of public hospitals. In order to learn from mature experience in other places, the Municipal Party Committee and Municipal Government also organized a trip to Sanming City, Fujian Province at the beginning of the year to inspect the "Sanming Medical Reform" model and broaden their ideas. At the end of last year, the provincial medical reform inspection team inspected and supervised the reform of public hospitals in our city and fully affirmed it.

The second is to strengthen departmental liaison responsibilities. Establish a comprehensive reform liaison system for public hospitals to regularly monitor work progress and developments. In accordance with the second batch of public hospital reform plans and time points, the Municipal Health and Family Planning Bureau, in conjunction with the price and finance departments, conscientiously completed the baseline survey on the reform of public hospitals in our city. Relevant departments have worked closely together and have successively issued the "Implementation Measures for the Reform of Payment Methods in Yingcheng Public Hospitals", "Yingcheng Public Hospitals Comprehensive Reform Medical Service Price Adjustment Plan", "Yingcheng City Medical Institutions Graded Diagnosis and Treatment Implementation Plan" and "Yingcheng Public Hospitals Implementation Measures for Performance Appraisal", "Implementation Rules for Financial Management of Yingcheng Public Hospitals", "Implementation Plan for Strengthening the Construction of Health Professional and Technical Talent Team in Yingcheng City", "Implementation Plan for the Corporate Governance Structure of Yingcheng Public Hospitals", "Comprehensive Reform of Yingcheng Public Hospitals" Compilation of supporting documents such as the "Implementation Measures for Registration Management" and the "Implementation Plan for the Reform of Job Settings and Income Distribution Systems in Yingcheng Public Hospitals" to improve the centralized bidding and procurement of drugs, regional health planning and the establishment of medical institutions are being further improved and will be released in the near future.

The third is to strengthen financial investment responsibility. The municipal finance department carefully calculated the cancellation of drug mark-up income of the two public hospitals and adopted diversified compensation forms. The public hospital compensation was changed from three channels of service charges, drug mark-up income and government subsidies to two channels: service charges and government subsidies.

At the same time, a special subsidy of 5 million yuan will be provided to the comprehensive inpatient building of the Municipal People's Hospital, and various fees will be reduced or reduced by nearly 8 million yuan for new projects such as the Municipal People's Hospital and the Municipal Hospital of Traditional Chinese Medicine. This year, the municipal finance increased the supporting funds of the New Rural Cooperative Medical System by 5.7 million yuan, and provided 500,000 yuan for the standardized construction project of village clinics, providing funding guarantee for medical reform.

(2) Improve the three systems and improve the top-level design concept

First, strictly implement the price system. In accordance with the spirit of the provincial price documents and the principles of "total quantity control, structural adjustment, rising and falling, and gradual implementation", the markup on hospital drugs (except for traditional Chinese medicine pieces) will be completely cancelled, and zero-margin sales of drugs will be implemented. As a result, the hospital will reduce Reasonable income is achieved through adjusting the price of medical technical services and increasing government subsidies, as well as strengthening hospital accounting and saving operating costs. Among them, 1,173 adjustments were made to the Municipal People's Hospital and 905 adjustments were made to the Municipal Hospital of Traditional Chinese Medicine. From November 2014 to the end of April 2015, the two pilot hospitals gave away drug profits of 10.74 million yuan, the average cost of outpatient and emergency visits increased by 2.25% year-on-year, and the average cost of hospitalization dropped by 2.81% year-on-year.

The second is to reform the medical insurance payment system. Actively promote the total prepayment of the new rural cooperative medical care fund, promote the reform of medical insurance payment methods such as single-disease payment and total prepayment, and reasonably control the cost of diagnosis and treatment. Strengthen the monitoring of indicators such as the utilization rate of drugs outside the basic medical insurance catalog, the proportion of drugs, average hospitalization days, and referral rates, and improve the use efficiency of basic medical insurance funds. The Municipal Joint Management Office calculated and negotiated with the two pilot hospitals and selected 30 disease types in advance for trial implementation. At present, the Municipal People's Hospital has piloted single-disease quality management and control for 13 diseases, and implemented clinical pathway management for 68 diseases. Since November 2014, nearly 3,000 clinical pathways have been carried out, an increase of 20% year-on-year.

The third is to promote the hierarchical medical diagnosis and treatment system. We further improved the catalog of disease diagnosis and treatment in medical institutions and the standards for upward and downward transfers, and formulated the "Implementation Plan for Graded Diagnosis and Treatment in Yingcheng City". We will increase the minimum payment standards and proportions of various medical institutions, and effectively implement the minimum payment line for rural cooperative medical inpatients: 200 yuan for township health centers and a reimbursement rate of 85; the minimum payment for municipal secondary hospitals is 500 yuan and a reimbursement rate of 65. Strictly implement the abnormal referral reimbursement policy, and use policy levers to guide patients to choose medical institutions for treatment. The current treatment rate in the city reaches 93.25

(3) Innovate three mechanisms to strengthen the hospital’s connotation construction

First, adjust the revenue and expenditure mechanism of public hospitals. Guide public hospitals to change their concepts, increase the pace of changing methods and adjusting structures, formulate effective incentive and restraint mechanisms and scientific performance appraisal methods, strictly prohibit large prescriptions and excessive inspections, strengthen expenditure budget management, effectively reduce expenditure costs, and reduce the cost of public hospitals. Drug proportion.

The second is to improve the drug supply guarantee mechanism. Reduce the cost of drugs and high-value medical consumables, and carry out centralized bidding and procurement through methods such as integrating recruitment and procurement, linking quantity and price, and secondary negotiation. Establish and improve the inspection and supervision system, strengthen the supervision and inspection of the implementation of drug prices, standardize price behavior, strengthen the monitoring of medical staff's prescription behavior, promote electronic prescriptions, establish a systematic, standardized and continuously improved prescription review system in accordance with regulations, and promote reasonable Use medication to protect the legitimate rights and interests of patients. The usage ratio of essential medicines in our city’s People’s Hospital reached 51.5, and that of traditional Chinese medicine hospitals reached 45.6.

The third is to improve the service performance evaluation mechanism. Establish a performance appraisal and performance salary incentive system with service quality and job objectives as the core. The assessment and evaluation system is based on 5 first-level indicators, 19 second-level indicators, and 37 third-level indicators such as medical quality, medical safety, and medical level. Break it down down to departments and people. Highlight social benefits and work efficiency, and implement the policy that the income of medical staff is not linked to drugs, examinations, and treatments. At the same time, we vigorously carry out the "Action to Further Improve Medical Services", increase convenience measures, add service windows, implement flexible scheduling, early start of window departments and delayed services, optimize service processes, and shorten patients' waiting time for medical treatment. The Municipal People's Hospital has launched a 114 appointment platform to carry out appointment registration, volunteer services and other projects. Since November 2014, more than 200 people have made appointments.

(4) Coordinate three major projects to promote coordinated development of the industry

First, implement the village clinic construction project. Actively strive for the construction of village clinics in the province, and implement the five-unified model of unified planning, unified design, unified bidding, unified construction, and unified acceptance. This year, 50 standardized village clinics will be built in Huali Village, Sanhe Town, Tian Construction has started in 12 villages including Zhachen Village in Dian Town and is scheduled to be completed by the end of July. We strengthened the training of village doctors and held 3 training courses for nearly 200 people to improve the first diagnosis ability at the grassroots level. Strengthen the performance assessment of village clinics, conduct monthly audits, promote equalization of basic public health services, and implement zero-margin sales of essential drugs.

The second is to implement the resident health card project. We have actively signed a letter of responsibility with Yingcheng Rural Credit Cooperative, and have completed the unified deployment of HIS systems in each township (town), the construction of dedicated health networks, and the verification of resident health card personnel identity information to ensure that the city’s resident health card will be launched by the end of August. The card issuance workload for 50% of the participating groups will be completed before November 1st, and the card issuance work for more than 80% of the participating groups will be completed before December 31st. Next year, we will strive to achieve full coverage of urban and rural residents in the city.

The third is to implement social medical policy projects. Social capital was introduced to establish Modern Hospital and Renai Hospital. The Municipal Health School has successfully transformed, and the Municipal Health School Nursing Home has been added to implement the "integration of medical and nursing care" to effectively meet the needs of patients for diverse and high-quality medical services.

3. Difficulties and problems exist

First, personnel autonomy needs to be further improved. The reform of public hospitals clearly stipulates that hospitals enjoy personnel autonomy under the control of total staffing. However, at present, the recruitment of all personnel in our city requires a unified examination by the human resources and social security department. In addition, the subjects of the introduced personnel are different, and the examination content is single, which cannot highlight the characteristics of urgently needed professionals. After recruitment, staffing cannot be handled, and personnel agencies can only be implemented. According to regulations, the Municipal People's Hospital has a fixed staffing ratio of 1:0.9 to 1.1 between the number of beds and the number of staff, and a fixed staffing ratio of 1:1 to 1.2 for the Traditional Chinese Medicine Hospital. The Municipal People's Hospital has 1,000 beds and the Municipal Traditional Chinese Medicine Hospital has 500 beds. However, the actual Municipal People's Hospital The designated staff is 640, and the city's traditional Chinese medicine staff is 270. A large number of in-service personnel are not established. This problem is even more prominent in township health centers. The city's 18 township health centers have a designated staff of 922 people, but only 408 are actually on the job. Currently, there are 6 township health center directors who have no staff and are personnel agents. On the one hand, there are vacancies in the establishment, and on the other hand, there is a large number of non-employed personnel, which has affected the healthy development of the health and family planning undertakings. At the same time, the establishment of new personnel has not been implemented, making it difficult to solve a series of problems such as professional and technical promotion, pension insurance, and household registration.

Second, financial investment needs to be further increased. In recent years, although the city's various medical reforms and health investment have increased year by year, due to the city's limited financial resources, the basic construction and equipment purchase of public hospitals, the development of key disciplines, talent training, retiree expenses in compliance with national regulations, and the construction of key talent turnover rooms , policy losses, public health tasks and emergency treatment are not guaranteed, and financial investment is obviously insufficient.

Third, government policy compensation needs to be further implemented. After operating in recent months, the two pilot hospitals have found that the government compensation of 20% through adjusting medical service prices has not been included in the fiscal budget, leaving a large funding gap. Xiaogan Municipal Price Bureau and Xiaogan Municipal Health and Family Planning Bureau reviewed the reported data from the survey on the operation of the medical service price adjustment plan. The city’s medical price adjustment compensation was only 49.5, and the city’s Traditional Chinese Medicine Hospital only accounted for 15.6 of the reduction. Based on this calculation, the annual gap reached more than 13 million yuan (including nearly 9 million yuan for the People's Hospital and nearly 4 million yuan for the Municipal Hospital of Traditional Chinese Medicine), which had an impact on the normal operation and sustainable development of the hospital.

IV. Next step work plan

We will focus on key points, overcome difficulties, reform and innovate in accordance with the requirements for comprehensive reform of public hospitals across the country and the province, and continue to promote the comprehensive reform of public hospitals in our city. reform.

First, clarify the responsibilities of departments and strengthen the main responsibilities of the government.

As the main responsibility for the reform of public hospitals, the municipal government will conduct in-depth investigations, promptly solve the difficulties and problems in the reform of public hospitals, urge relevant departments to improve reform plans and supporting measures, and actively and steadily promote the comprehensive reform of public hospitals.

The second is to strengthen team building and make breakthroughs in standardizing staffing management. According to the guiding principle of classification, the pilot hospital staff adopts a one-time verification, step-by-step, and dynamic management method. The staff is fixed and posts are not fixed, and the staff and registration system management is implemented; for township health centers and public health units, the staff is based on academic qualifications, Conditions such as position, length of service, etc. will be assessed through examinations among existing employees. The step-by-step recruitment method will take about three years to resolve the remaining issues. New employees will be required to take the exam when they are admitted.

The third is to increase funding guarantees and make breakthroughs in the financial investment compensation mechanism. Further increase national and provincial transfer payments, gradually increase capital construction and large equipment purchase costs, especially increase special subsidies for the liquidation of historical debts of hospitals, and promote the healthy development of public hospitals.

The fourth is to implement reform responsibilities and make breakthroughs in reforming the management system. To improve the corporate governance structure, our city is a pilot project for Xiaogan City to establish a corporate governance structure. It will establish a corporate governance structure with the board of directors as the core in county-level public hospitals, implement the president's responsibility system, and establish a modern hospital management system. Promote hierarchical diagnosis and treatment, and focus on urban and rural grouping and rural integration of medical institutions to form Yingcheng characteristics. Promote single-disease payment, and gradually expand the types of single-disease payment based on the principle of implementation, improvement, and improvement. By 2017, we will fully implement payment based on disease, pay per capita, and pay per bed day, etc. Composite payment method. Improve hospital performance assessment, optimize the allocation of health and family resources, implement job performance management, implement measures to facilitate and benefit the people, improve people's satisfaction with medical treatment, and strive to achieve the goal of: minor diseases do not leave the village, common diseases do not leave the countryside, and serious diseases do not leave the county (city) )?, the medical treatment rate in the county reaches more than 90%.

Director, deputy directors, and members, the comprehensive reform of public hospitals is an important measure to protect and improve people's livelihood. 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 municipal government, we will Under the supervision and guidance of the National People's Congress, with a fuller spirit, a more solid style, and more powerful measures, we will strive to promote the comprehensive reform of our city's public hospitals and make new and greater contributions to creating a healthy city. Report on the progress of public hospital reform 2

In November 2016, the 34th meeting of the Standing Committee of the Twelfth Provincial People's Congress heard and reviewed the Provincial People's Government's "Report on the Reform of Public Hospitals in the Province" ", and put forward deliberation opinions and submitted them to the provincial government for study and processing. The provincial government attaches great importance to the deliberative opinions of the Provincial People's Congress Standing Committee and carefully studies and handles them. The summary of the handling report is now published as follows.

1. Strengthen government responsibilities and coordinate and promote the joint reform of "three medical services". The work of deepening medical reform will be the responsibility of party and government leaders at all levels, with medical care, medical insurance, medicine and the three medical services under one leadership. Plan to establish provincial public hospital management committees, give full play to the role of public hospital management committees at all levels, and perform the government's medical functions; implement the medical and health service system plan (2016-2020) and formulate implementation opinions in 2017; study and formulate comprehensive medical reform Pilot evaluation standard system, evaluate the implementation effect every quarter; study and formulate public hospital investment and debt resolution policies, and make institutional arrangements for government investment and debt resolution; carry out comprehensive medical reform pilots? Looking back?, focus on reform key points such as investment systems, personnel compensation, etc. Difficulty in improving top-level design.

2. Implement reform policies and accelerate the establishment of a new operating mechanism for public hospitals.

Implement the autonomy of public hospitals in personnel management; establish a staffing and turnover pool system; allow medical and health institutions to break through the current salary control level of public institutions in accordance with the regulations, allow medical service income to deduct costs and withdraw various funds in accordance with regulations, mainly for personnel rewards ? Requirements: implement the reform of the salary system for medical personnel; improve the county's medical service capabilities and levels, and strengthen efforts to attract, retain and cultivate talents; dynamically adjust the price of medical services, promote the pilot reform of charging based on disease type, and promptly review new medical service items; Establish a performance appraisal reporting system and carry out monitoring and analysis in public hospitals at level 2 and above across the province.

3. Improve the medical mechanism and effectively reduce the medical cost burden of the people. Implement the two-invoice system reform for drug procurement and encourage the implementation of the one-invoice system; explore the establishment of reference prices for medical insurance payment for high-value medical consumables; promote the construction of a drug circulation traceability system, strengthen drug circulation supervision, and establish commercial bribery policies for drug production and distribution enterprises. Blacklist system; explore the establishment of a drug price comparison supervision system; carry out strict rectification of unhealthy practices in pharmaceutical purchase and sales and medical services; carry out prescription reviews and standardize rational clinical use of drugs; the overall increase in medical expenses in 2017 is controlled within 10%. 4. Deepen comprehensive medical reform and enhance the public’s sense of achievement of reform results. On the basis of unifying the basic medical insurance policy for urban and rural residents, we will gradually promote the "three guarantees into one" medical insurance for urban and rural residents and employees. Establish a unified urban and rural basic medical insurance system, further improve the differentiated payment policies for medical insurance at different levels of medical institutions, and basically realize the direct settlement of medical insurance for out-of-town hospitalization expenses that comply with referral regulations in 2017; further improve the level of medical insurance financing and security benefits, and policy scope The internal expense payment ratio reaches 75; establish and improve a performance appraisal mechanism that combines performance indicators such as hospitalization rates for chronic disease patients with work quantity indicators; improve the functions of the medical convenience service platform; fully implement the multi-site physician practice system and increase medical insurance reimbursement in community hospitals Proportion; Implementing a project to meet the standards of primary medical and health institutions, the compliance rate in 2017 was 95%. In some towns and villages with large populations, central health centers were renovated and expanded to reach the scale of second-level hospitals; the proportion of inpatient appointments for examinations in different periods reached 100% in 2017. The rate of time-scheduled appointments for outpatients is not less than 50% of patients who make appointments; in 2017, 50% of discharged patients from tertiary hospitals and 70% of discharged patients from secondary hospitals were managed according to clinical pathways, and more than 50% of discharged patients were paid according to disease type; Strengthen the monitoring of patients' out-of-pocket expenses and enhance the public's sense of gain from medical treatment.