Query on hospital investigation report

According to the annual work arrangement of the Standing Committee of the District People's Congress, in order to solve the problem of "difficult and expensive medical treatment", the Standing Committee of the District People's Congress reviewed the implementation of the reform policy of public hospitals in the whole region. The Education, Science, Culture, Health and Work Committee has formulated a detailed research plan, and some district people's congress representatives have conducted decentralized research on the reform.

On September 1 day, Xiong Jun, deputy director of the Standing Committee of the District People's Congress, led some of the Standing Committee members to conduct centralized research. The research team visited the District People's Hospital and the Second People's Hospital, held a forum, listened to the work reports of the member units of the district public hospital reform and the two hospitals, and discussed individual issues. The investigation is hereby notified as follows:

I. Measures taken and results achieved

(1) Strengthen organizational leadership and formulate implementation plans. The district government has set up a leading group for comprehensive reform of public hospitals, with the leaders in charge as the team leader and the main heads of development and reform, organization, finance, people's society, health planning and other departments as members, to comprehensively coordinate all forces and promote the reform work as a whole. The implementation plan of comprehensive reform of district-level public hospitals in China was formulated.

The objectives and main tasks of the reform have been clarified, and a series of supporting schemes have been formulated, such as the Implementation Plan for Comprehensive Reform of Public Hospitals in Bazhou District and the Implementation Measures for Government Compensation for Comprehensive Reform of Public Hospitals in Bazhou District, which have laid a solid institutional foundation for promoting medical reform.

(2) Strengthen hospital management and improve service level. In order to standardize the purchase and supply of drugs and medical consumables, the district government and relevant departments strictly implement centralized online bidding and unified distribution of drugs and high-value medical consumables, which reduces the purchase price of drugs and medical consumables. Through the reform of hospital personnel distribution, management and incentive system, the mechanism of recruiting, managing and employing people has been deepened and the structure of personnel team has been optimized.

Since XX, * * * has introduced 5 graduate students, 62 full-time undergraduate graduates and 30 nursing staff. Performance appraisal has been strengthened, with service quality, quantity and patient satisfaction as the core, and the assessment results as the basis of income distribution. Four hospitals above the second level in the whole region have signed two-way referral agreements with 45 primary medical and health institutions respectively, and according to the referral procedures and standards, some initial diagnosis, two-way referral and graded diagnosis and treatment have been done.

(3) The reform was carried out in an orderly manner and achieved initial results. At present, there are two district-level medical institutions in our district. Among them, the District People's Hospital is a third-class first-class Chinese medicine hospital with 499 beds and 485 employees. The Second People's Hospital is a second-class general hospital with 400 beds and 307 employees.

This reform in our district was fully launched on June 10 and 1 day of XX. According to the Notice of Sichuan Provincial Development and Reform Commission and other five departments on Printing and Distributing the Measures for Cancelling the Compensation for Drug Additions in County-level Public Hospitals in Sichuan Province (No.937 of Sichuan Development and Reform Price [XX]), two public hospitals in our district (District People's Hospital and Second People's Hospital) officially cancelled the drug addition (except Chinese herbal pieces) from the date of start-up.

Compensation was made by implementing financial subsidies, adjusting the price of medical services and strengthening the cost management of public hospitals. According to the survey, the average price of drugs dropped by 15% after the district-level public hospitals implemented zero-difference sales of drugs. According to the requirements, the drug addition of two public hospitals will be cancelled, and the price charges of five medical services will be increased at the same time (that is, the outpatient and emergency consultation fees will be increased in 6 yuan).

The hospitalization expenses and the nursing expenses of Grade I, II and II were increased to 9 yuan respectively) and included in the payment scope of the medical insurance pooling fund to compensate for the cancellation of the 70% reduction in drug addition. In XX, the district finance has allocated the subsidy fund1001.16000 yuan to pay 20% of the compensation investment, cancel the special funds such as reducing the drug addition and ensuring the funds for retirees, on-the-job personnel and public health services.

Medical insurance institutions also signed medical service agreements with two public hospitals, which guaranteed and promoted medical reform. Through the initial implementation of various reform measures, medical reform has achieved certain results. According to statistics, first, the cost of medication for patients has dropped. In XX, the total drug sales of District People's Hospital reached 583 1 10,000 yuan, accounting for 37. 14% of the total medical expenses, down 39% from the previous year.

The total drug sales of the Second People's Hospital of District reached18.99 million yuan, accounting for 34% of the total medical expenses, down 25% from the previous year. Second, the hospital income structure has been improved. The total income of the two hospitals in XX is 233.76 million yuan, of which patients pay 72.79 million yuan, accounting for 25% of the total income. Except for Chinese herbal pieces, the sales amount was 68.09 million yuan, accounting for 3.765438+04% of medical income; Inspection income was 66.77 million yuan, down 2% from the previous year.

Third, the structure of the medical team has been gradually optimized. At present, there are 2 1 1 licensed (assistant) doctors in the two public hospitals, including 39 with postgraduate education or above and senior professional titles, which are 8% and 6% higher than last year respectively.

Fourth, the number of people seeking medical treatment has gradually increased. In XX, the number of inpatients in two hospitals reached 26,502, an increase of 5.42% over the previous year.

Second, the main problems

(A) Hospital operating pressure is increasing year by year. First, there is great pressure to prepare for the exam. With the gradual implementation of the medical reform policy, the continuous expansion of medical insurance coverage and the gradual increase of service population, the requirements of setting up personnel according to beds and personnel can no longer meet the actual needs of society for medical care, resulting in many management systems not being deeply promoted: Second, the employment pressure is great.

Public hospitals in our district recruit some contract workers. Although they have corresponding qualifications, they are under great economic burden and management pressure due to staffing restrictions. Third, the economic pressure is great. Due to the expansion of hospital operation scale and infrastructure construction, there are many debts (District People's Hospital debt 1.2 1.2806 million yuan, Second People's Hospital debt 24.3 million yuan).

(2) The pressure of economic compensation is increasing year by year. After the cancellation of the drug addition policy, the compensation of district hospitals will be changed from three channels of service charges, drug addition income and government subsidies to two channels of service charges and government subsidies, and compensation will be made by adjusting the price of medical technology services and increasing government investment.

Through investigation, although the debts of two public hospitals in our district are locked, they are still unable to repay their debts due to special reasons of the local economy. Although the financial subsidies to public hospitals have increased year by year, they still cannot meet the growing demand of the total business of the two hospitals. Considering the natural growth of drug revenue, urban and rural medical insurance and public health services, the financial pressure is even greater.

(3) The pressure brought by the social expectation of reform is increasing year by year. The reform of public hospitals is oriented to public welfare. Only by making great achievements in the reform of system and mechanism can people feel the benefits brought by the reform, while the reform of public hospitals requires top-level design, and the top-down comprehensive reform has not been carried out in depth.

The related supporting reforms such as management system, establishment management, medical insurance payment system, distribution system and drug procurement have not been substantially promoted, and the establishment of a unified and efficient public hospital management system with "separation of management and administration and openness of government affairs" needs in-depth exploration and practice. The total resources of public hospitals in our district are small and unevenly distributed.

There are few high-quality resources, and the District People's Hospital has not yet been put into operation. In addition, most people are used to flocking to urban hospitals for medical treatment, and the problems of difficult and expensive medical treatment have not been effectively solved.

Third, some suggestions.

(a) to further improve and perfect the financial input mechanism. The government should play a leading role and earnestly implement the government's responsibility for public services such as infrastructure, equipment investment, personnel training and public health tasks in public hospitals.

(two) to further strengthen the supervision of medical insurance funds. Further explore the reform of medical insurance payment methods and formulate relevant supporting systems, strengthen the supervision of designated medical institutions, and strictly investigate and deal with medical insurance violations. District-level public hospitals should adhere to reasonable inspection, reasonable treatment, rational drug use and reasonable charges, and standardize medical service behavior.

(3) Further strengthen the management of district-level public hospitals. The district public hospital management committee should perform the supervisory function and comprehensively supervise the construction, operation and development of the hospital. Strengthen the assessment of hospital target management, further establish and optimize the target responsibility system and hospital grade evaluation system of hospital presidents, and optimize the internal management of hospitals.

Deepen the reform of personnel system, and gradually establish and implement a diversified incentive mechanism for performance wage distribution; Actively explore the establishment of filing management system and dynamic adjustment mechanism to stimulate the vitality of public hospital reform.

Extended data:

The Office of the Leading Group for Performance Appraisal of Tertiary Public Hospitals in National Health Commission recently commissioned the National Health Commission Doctor-Patient Experience Research Base of Peking University People's Hospital to conduct on-site verification of the satisfaction survey results of nearly 200 tertiary public hospitals in 22 provinces and cities across the country. Patient satisfaction is one of the important contents of performance evaluation of tertiary public hospitals.

The way to obtain patient satisfaction data is to post WeChat QR codes in public areas of hospitals, and the medical management center platform of the National Health and Family Planning Commission is responsible for collecting satisfaction evaluation of patients and hospital employees. The advantage of this method is that a large amount of information can be collected quickly, but whether the data has "moisture" needs further verification through online and offline combination.

People's Health Network-On-site verification of public hospital satisfaction survey started