Reform measures of medical system reform

Since the deepening of medical reform, all localities have continuously intensified their exploration and deepened the work of medical reform. These explorations are in line with the direction of medical reform, with obvious effects and universal guiding and popularizing significance. In order to solve the shortage of talents at the grassroots level and enable doctors in large hospitals to go to the grassroots level, various forms such as up-and-down linkage and close integration have been explored.

Shenzhen City, Guangdong Province has improved the management system of the government-led "hospital-run hospital-managed" community health service center, established a general service team with responsible doctors as the main body, and improved the multi-post service system for technicians. Community health centers can directly obtain talents and technical support from the host hospitals, and residents can enjoy medical and health services provided by retired Chinese medicine practitioners and famous experts from large hospitals nearby.

Xiangxiang City, Hunan Province, promotes the "county management for township use" of health talents. Recruit medical college undergraduates and practicing doctors to work in township hospitals. Recruiters are managed by the Municipal Health Bureau, and basic salary, pension, medical care, maternity insurance and other units are guaranteed by the municipal finance. Recruiters enjoy the performance bonus and welfare benefits of their township hospitals. The appointment period is five years. After the expiration, upon my application, the Municipal Health Bureau passed the examination and can arrange to work in urban medical and health institutions.

Tianjin has established 143 standardized training bases for general practitioners and residents, involving secondary and tertiary hospitals 18 disciplines. All fresh graduates who are engaged in clinical work in medical institutions below the second level must participate in two years of general practitioner training.

Zhenjiang City, Jiangsu Province has established a system of free refresher training for community doctors, a system of standardized training for general practitioners and a system of doctors from higher hospitals sitting in communities, and sent pediatricians to their community health service centers to carry out full-time diagnosis and treatment services. The reform of payment method is of great significance to control medical expenses, standardize medical behavior and promote comprehensive reform. Several different payment modes have been explored in various places.

Ningxia Hui Autonomous Region implemented the "Innovative Payment System to Improve Health Benefits" project in Yanchi, Haiyuan and other counties and cities, and implemented a one-time prepayment system for outpatient and hospitalization expenses. 70% of the lump sum funds are allocated to medical and health institutions on a quarterly basis, and the remaining 30% are cashed according to the annual performance appraisal results.

Yiyang county, Henan province, implemented the reform of the comprehensive payment system of the new rural cooperative medical system according to the idea of "one disease and three paths": group A aimed at patients with general symptoms, group B aimed at patients with serious complications, and group C aimed at patients with serious and complicated conditions. Group a and group b charge at a fixed price and pay at a fixed amount; Group C is settled according to actual expenses and controlled in proportion.

In Hunan Province, the "fee-limited medical treatment" is implemented, and a certain limit is set for the outpatient and inpatient expenses of participating farmers in township health centers. If the medical expenses are within the limit, the participating farmers will pay according to the actual amount; If the quota is exceeded, the participating farmers will pay according to the quota, and the excess will be fully reimbursed by the new rural cooperative medical system. For example, the "10+ 100" model implemented in Lanshan County, participating farmers only need to pay for outpatient service 10 yuan, hospitalization 100- 150 yuan, and the rest expenses will be fully reimbursed by the New Rural Cooperative Fund. At present, we are exploring the expansion of the "fee-limited medical care" model to county-level public hospitals. After the cancellation of medical supplement with medicine in public hospitals, various localities explored the establishment of multi-channel compensation methods and implemented comprehensive reforms.

Price conversion method: Beijing Friendship Hospital and Chaoyang Hospital started the reform of "separation of medicine" on July 1 day and September 1 day, 2065438 respectively. 65438+February 1, Tongren Hospital, Tiantan Hospital and Jishuitan Hospital were officially launched. At the same time of canceling drug addition, registration fee and medical treatment fee, the medical service fee for outpatients is determined according to the doctor's level. Beijing Medical Insurance Fund reimbursed the "medical service fee" in a fixed amount, and everyone went to 40 yuan.

Financial Compensation Law: On the basis of government investment and adjustment of medical service charges, Shaanxi Province canceled the drug addition policy and implemented zero-difference sales. According to the principle of "how much to cancel and how much to compensate", the provincial, municipal and county governments will give full subsidies according to the reasonable income ratio of county-level hospitals.

Comprehensive compensation method: all drugs in county-level hospitals in Anhui province are sold at zero difference rate, and the reduced expenses are made up by increasing government subsidies (25%) and collecting consulting fees (75%); Reduce the inspection and treatment price of large medical equipment, and make up for it by adjusting the operation fee, nursing fee and bed fee on the basis of total balance.

Zhejiang Province canceled the drug addition policy of county hospitals and established a "five-ring linkage" mechanism, that is, adjusting medical service charges, reforming medical insurance payment system, improving financial investment policy, strengthening medical service behavior management and establishing hospital internal management mechanism.

Shenzhen City, Guangdong Province has implemented the "1+6" comprehensive reform for 67 public hospitals. "1" means to cancel the drug addition in all public hospitals; "6" means reforming the compensation mechanism of public medical institutions, the payment system of medical expenses, the competition system of drug circulation, the procurement system of drug consumables, strengthening the prevention and control of commercial bribery in public hospitals and strengthening the behavior supervision of public hospitals. On the basis of improving the procurement policies such as the integration of grass-roots recruitment and recruitment, double envelope system and centralized payment, and in line with the reform of public hospitals, we will accelerate the reform of drug bidding and procurement mechanism.

Anhui Province adheres to the principle of giving priority to quality and reasonable price, adopts the bidding and purchasing method of "linking quantity and price, combining recruitment and procurement", uniformly formulates the centralized bidding and purchasing catalogue of drugs in county-level hospitals, and implements centralized online bidding and purchasing throughout the province. The basic drug list of county hospitals is selected from the national basic drug list (including provincial supplementary drugs), the provincial new rural cooperative medical system drug list and the urban medical insurance drug list, with *** 1048 kinds.

Henan Province implements unified bidding and purchasing of essential drugs and medical consumables, and adopts transparent operation before, during and after bidding to disclose relevant information in time; Adopt the principle of combining quantitative evaluation with qualitative evaluation and giving priority to comprehensive evaluation, fully consider the differences in the use of various medical institutions at all levels to meet the needs of different groups of people; Standardize the operating system to ensure fair and open bidding. Exploring and controlling the excessive growth of medical expenses is an important task for deepening medical reform. Many practices have been explored in various places.

Fujian province promotes centralized bidding and purchasing of general medical consumables to reduce procurement costs and prices; Expand the pilot scope of payment for diseases and single diseases, and carry out pilot projects of total prepayment system and per capita payment for new rural cooperative medical system in more than half of counties (cities, districts), effectively curbing the excessive upward trend of medical expenses.

Since 20 10, Zhejiang province has put forward the requirement of zero growth of outpatient and hospitalization expenses for three consecutive years, and put it into the annual medical reform responsibility target to implement. Through the implementation of administrative fee control measures, the establishment and improvement of hospital active fee control mechanism and medical insurance fee control mechanism will be promoted. All localities actively explore and implement integrated rural management to solve the problem of old-age security for rural doctors and stabilize the "net bottom" of rural health service system.

Jiangsu Province has gradually brought qualified village clinic staff or those who have obtained the qualification of practicing (assistant) doctors into the unified management of township health centers, established a rotation system for township health center staff in village clinics, and included rural doctors into the old-age insurance for urban workers, giving certain financial support.

Yuxi City, Yunnan Province, established the withdrawal mechanism of rural doctors and improved the guarantee mechanism. Rural doctors who have gone through the exit formalities according to the age policy will be given a monthly retirement allowance, which will be distributed in three grades according to the continuous length of service. The training funds for rural doctors are included in the annual fiscal budget of districts and counties according to the standard of per capita 0.5 yuan of agricultural population.

Qinghai province implements special subsidies for village doctors, with a standard of 8,000 yuan per person per year. For village doctors who have obtained the qualification of practicing (assistant) doctors or technical secondary school or above, each person will receive an additional subsidy of 1000 yuan per year. At present, rural doctors in the province have participated in the new rural insurance or other old-age insurance according to different standard grades.