Fujian: The Provincial Medical Reform Office and the Provincial Health Planning Commission interpret the opinions on deepening grassroots medical reform.

A few days ago, the General Office of the Provincial Party Committee and the General Office of the Provincial Government issued the Notice on Further Deepening the Comprehensive Reform of the Grassroots Medical and Health System (Trial), including the Implementation Plan on Strengthening the Integrated Management of Rural Health Services and the Pilot Work Plan on Developing Family Doctors with Chronic Diseases in Cities.

It is the first time for Fujian Province to deepen primary health care reform with combined files. On December 15th, the Provincial Medical Reform Office and the Provincial Health Planning Commission jointly held a press conference to interpret the document.

comprehensively promote the comprehensive reform of county-level public hospitals at the beginning of next year

At the end of 214, Fujian Province started the reform of county-level public hospitals. At present, some areas, such as Sanming, have comprehensively promoted the comprehensive reform of county-level public hospitals, while most counties still stay on the progress of completing the single reform of zero difference rate of drugs, and the comprehensive reform has not been fully promoted at the county-level hospitals.

The Opinions require that all localities should make good preparations for the reform before the end of this year and comprehensively promote the comprehensive reform of county-level public hospitals early next year. With reference to Sanming's reform experience, we have carried out four reforms, namely, reforming the method of total wages, reforming the internal distribution system, reforming the personnel establishment system, and reforming the financial management system:

reforming the method of total wages

The calculation of total wages is only linked to medical income

The hospital's total income structure is divided into three parts, namely, medical consumables, inspection and laboratory tests, and surgical treatment income from nursing beds (the third part is collectively referred to as medical income). The calculation of the total salary of hospital staff is only linked to medical income, which fully reflects the labor value of medical staff.

reform the internal distribution system

break the original mode of linking wages with income generation of departments

the annual salary of the president is fully borne by the finance, and the president manages the hospital operation on behalf of the government. The target annual salary system for all staff is implemented. The annual salary of hospital staff consists of three parts: basic work points, workload work points and reward and punishment work points, which breaks the distribution mode of linking staff salaries with income generation of departments. The annual salary distribution of medical staff is independently approved by the hospital within the approved total salary. In principle, the distribution ratio of total wages is: doctors, nurses and administrative logistics teams account for 5%, 4% and 1% of total wages respectively.

reform the personnel establishment system

implement the appointment system of the president, gradually implement equal pay for equal work

implement the appointment system of the president; Innovating the establishment management of county-level public hospitals, county-level public hospitals can implement the establishment and use filing system of county-level public hospitals after defining the filing management methods and processes; Gradually implement the equal pay system for equal work.

Reform the financial management system

Implement the system of chief accountant; Strengthen the management of hospital surplus funds and clarify the corresponding payment scope and purpose of each fund; Strengthen the meticulous management of hospital finance and implement comprehensive budget and full cost accounting.

reform the staffing management system

set up a specialized agency to undertake the affairs and services

set up a grass-roots health technical personnel management service guarantee center in the county health planning department to specifically undertake the affairs and services of recruiting, managing and deploying personnel, and explore the management mechanism of "county management for rural use" for health technical personnel.

specific measures here

reforming the internal operation mechanism of primary medical institutions

the relevant person in charge of the provincial health planning commission explained that the first step of reforming the internal operation mechanism of primary medical institutions is to clarify the composition of the total performance pay of primary medical and health institutions, including the basic salary of personnel approved by the government, the national unified subsidy, the basic performance pay (including "five insurances and one gold"), the basic public health service income after deducting costs, and the medical income. The second is to make it clear that the basic public health service funds shall not offset the basic salary and basic performance salary (including "five insurances and one gold").

the second is to reform the performance distribution system. Primary medical and health institutions implement the target annual salary system of the president, and the annual salary of the president is determined by the county medical management Committee within the total salary of primary medical and health institutions. The annual salary of medical staff in the hospital is independently distributed by the hospital within the scope of the total salary, and the "double assessment and double hook" is implemented to break the pot. On the one hand, the county medical management committee evaluates the presidents of primary medical and health institutions, and the evaluation results are linked to the total performance salary, appointment and dismissal of the presidents, rewards and punishments, financial subsidies, etc. On the other hand, the hospital's assessment of internal departments and employees, the assessment results are linked to personal rewards and punishments, performance salary distribution, highlighting key indicators such as service quantity, quality, medical cost control, referral rate, medical ethics, and mass satisfaction, breaking egalitarianism and tilting towards key positions, business backbones and medical personnel who have made outstanding achievements.

the third is to reform the employment system. Grassroots medical and health institutions can employ personnel in two ways: in-service and out-of-service. The staff who are employed and those who are not employed will gradually receive equal pay for equal work, and the required basic salary and basic performance salary will be issued by the county finance. More than the total number of employees, the county medical management committee approved the number of personnel and wage payment standards.

reform the personnel establishment management system

set up a grass-roots health technical personnel management service guarantee center in the county health planning department, specifically undertake the work of recruitment, management and deployment of personnel, and explore the management mechanism of "county management for rural use" for health technical personnel.

Relax the academic qualifications of newly hired personnel in primary medical and health institutions, and the professional and technical personnel newly hired for clinical and public health positions in primary medical and health institutions can be relaxed to junior college education, and the professional and technical personnel in medical and nursing positions can be relaxed to secondary school education. Qualified talents who are in short supply and in urgent need can be openly recruited by direct examination or interview through the guidance catalogue, so as to improve the utilization rate of the establishment.

the staffing department adjusts and approves the staffing of primary medical and health institutions according to the classification. Study and improve the methods for the establishment and approval of community health service centers. County Medical Management Committee can reasonably allocate the staff of primary medical and health institutions within the approved total staffing.

relax the evaluation conditions for grass-roots professional titles. To declare senior professional titles for primary medical staff, there is no rigid requirement in academic papers, professional titles, foreign languages and computer application ability. The control standard for the proportion of senior professional titles in township hospitals and community health service institutions will be gradually raised to 15% and to 2% at the county level.

Reform the policy of primary medical insurance, price and essential drugs

In terms of price, cancel the general medical treatment fee policy of primary medical and health institutions (excluding village clinics), set the medical treatment fee and injection fee, and implement the medical insurance reimbursement policy at the same time, so as not to increase the personal expenses burden of the masses.

in terms of medical insurance, we should comprehensively sort out the existing primary medical insurance policies and widen the reimbursement gap between primary hospitals and hospitals of different grades or hospitals within and outside the county. Actively encourage the promotion of the use of basic drugs in primary general outpatient clinics to cancel the deductible line, and the referral in medical associations to cancel the second deductible line, so as to guide the masses to seek medical treatment reasonably.

With regard to the basic drug system, the drug procurement of primary medical and health institutions all implements the centralized bidding and purchasing policy of drugs in public hospitals, and online procurement is implemented to ensure the convergence of drug varieties between primary medical and health institutions and public hospitals.

the establishment of village health centers under integrated management should be based on factors such as the service population, service radius and convenient transportation conditions. In principle, each administrative village has an integrated management village health center, and administrative villages with a permanent population of more than 2, can set up a central village health center. Administrative villages with a small permanent population (less than 5) in remote mountainous areas and islands can be provided with services by surrounding village health centers or regularly visited by doctors appointed by township health centers. In principle, village clinics are equipped with 1 village doctor per thousand population, with a maximum of 3.

the salary of village doctors mainly comes from four parts: the basic allowance for village doctors, the subsidy for basic public health services, the subsidy for zero-difference rate of essential drugs and the general medical expenses paid by the new rural cooperative medical insurance fund. These village-level public health services related funds and various policy subsidies are packaged and handed over to township hospitals for unified management, and all of them are used for the personnel funds of village doctors after assessment. The salary and treatment of village doctors in village health centers shall be paid by township health centers on a monthly basis in accordance with the relevant cost standards of not less than the current government purchase services.

Recommended by Medical Education Network: 217 Medical Practitioner Examination Course is in hot registration! Click on the free trial course > >