Reform Task of Guiding Opinions of Shaanxi Provincial People's Government on Promoting Comprehensive Reform of County-level Public Hospitals

(a) to formulate the development plan of county-level public hospitals. The county-level government shall, under the guidance of regional health planning, according to the existing medical resources and local social and economic development, and in accordance with the principle of "revitalizing the stock, controlling the increment, optimizing the structure and dynamic management", formulate the planning for the establishment of medical institutions (including non-public hospitals). Focus on running 1 general hospital, 1 traditional Chinese medicine hospital and 1 maternal and child health hospital, and define their corresponding scale and establishment.

(2) Defining the functional orientation of county-level public hospitals. County-level public hospitals are the leaders of county-level medical and health centers and rural tertiary medical and health service networks, which mainly undertake the diagnosis and treatment of common and frequently-occurring diseases of county residents, the treatment of severe patients, the initial diagnosis and referral of difficult diseases, the popularization and application of medical technology, the training and technical guidance of health personnel in primary medical institutions such as township hospitals, and the medical treatment of natural disasters and public health emergencies.

(3) Cancel the drug addition and reform the compensation mechanism.

1? Reform the mechanism of supplementing medicine with medicine. On the basis of government investment and adjustment of medical service charges, the drug addition policy will be cancelled and zero-difference sales will be implemented. According to the principle of "how much to cancel and how much to compensate", the provincial, municipal and county governments will give full subsidies in proportion to the reasonable income reduced by the cancellation of drug addition in hospitals.

2? Fully implement the "three unifications" management of centralized drug procurement in county-level public hospitals. Drugs in the catalogue must be purchased, distributed and settled online through the county-level drug purchase and settlement center; Give priority to the allocation and use of essential drugs, increase the proportion of essential drugs, and gradually realize the full allocation and use of essential drugs; Carry out provincial public bidding and centralized procurement of medical consumables.

3? Reasonably adjust the price of medical services. According to the principle of total quantity control and structural adjustment, the prices of drugs and high-value medical consumables will be reduced. The inspection and treatment prices of large-scale medical equipment purchased by the government are set at the cost excluding equipment depreciation, and the prices of medical services such as medical treatment fees, nursing fees and surgery fees that reflect the value of technical services are appropriately increased, so that medical institutions can obtain reasonable compensation by providing quality services. The price adjustment should follow the principle of reducing the total medical fee and reducing the burden on patients, and be linked with the medical insurance payment policy.

4? Reform the payment method of medical insurance. Explore the establishment of negotiation and consultation mechanisms and risk sharing mechanisms between medical insurance agencies and medical institutions. Gradually implement medical insurance payment methods such as total prepayment and disease-based payment, and promote the formation of a third-party fee control mechanism. Increase the proportion of reimbursement, realize the immediate settlement of expenses, and timely implement the municipal-level co-ordination of urban medical insurance and joint treatment funds. Urban medical insurance institutions should allocate necessary working capital for county-level public hospitals.

5? Implement the financial input policy. The county-level government is the organizer of county-level public hospitals and should guarantee the basic salary and daily operating expenses of hospital staff. The specific guarantee ratio is determined according to the level of county economic development and hospital revenue and expenditure. The degree of protection should fully reflect the public welfare nature of the hospital and ensure the normal operation of the hospital. Hospital capital construction and large-scale equipment purchase, key specialty development, retirees' expenses in line with state regulations, policy losses, first aid, disaster relief, support and other public service funds in grass-roots units should be fully guaranteed; The historical debts of the hospital are uniformly packaged and stripped, and the government repays them year by year. Gradually establish a stable growth mechanism of financial subsidies, the growth rate is not lower than the growth rate of recurrent financial expenditure. Provincial and municipal governments give appropriate financial support according to the economic development of counties.

(D) Establish a modern hospital management system.

1? Explore the establishment of hospital board of directors and other forms of corporate governance structure. The members of the Council include representatives of government-run medical subjects, hospital staff, customers, experts and scholars. The Council is responsible for approving the hospital development plan and financial budget and final accounts; Drafting and amending major business and articles of association; Selection and assessment of the dean; Supervise the operation of the hospital and other duties.

2. Establish the appointment system of the dean. Clarify the qualifications of the president and vice president, select the president and vice president by means of open selection and social recruitment, and examine and approve them according to the cadre management authority, and then be appointed by the Council. Implement the tenure system of principals and vice principals and target responsibility system management.

3? Implement the dean responsibility system. The dean is fully responsible for the operation and management of the hospital. Scientific and democratic procedures for deliberation and decision-making should be established within the hospital. Major decisions, project investment, the use of large amounts of funds, the appointment and removal of middle-level and above personnel, etc., must go through democratic deliberation and be reported to the Council for approval.

4? Improve the internal management system. Around the new hospital management structure, improve the hospital internal decision-making, operation management, asset management, medical risk early warning and other systems. Gradually form an operational management mechanism that is compatible with decision-making, implementation and supervision.

5. Control medical expenses. Through single disease payment and clinical pathway management, medical expenses are controlled within a reasonable range, and a management model with cost and quality control as the core is established. Strengthen performance appraisal, and take controlling medical expenses, quantity of medical services, improving medical quality and service efficiency, and social satisfaction as the main quantitative assessment indicators. Strictly implement the hospital financial accounting system, explore the implementation of the chief accountant system, and implement internal and external audits.

(5) Reform the personnel distribution system.

1? Approved staffing. According to the regional health planning and medical service demand, the county-level government determines the scale of county-level public hospitals and reports it to the municipal government for approval. The staffing is approved according to the ratio of beds to personnel of 1: 1.5, and the professional and technical personnel such as doctors and nurses shall not be less than 85% of the total staffing. Among them, the number of clinical nurses is not less than 0.4 per bed. Explore the implementation of the county-level public hospital filing system and gradually establish a dynamic adjustment mechanism.

2? Deepen the reform of personnel system. County-level public hospitals independently determine posts within the scope of preparation scale and post category. We will fully implement the post employment system, insist on competitive recruitment for posts, post allocation, ability to enter and leave, ability to go up and down, and contract management, and gradually change identity management into post management. Take various ways to properly resettle the unemployed and non-medical professionals.

3? Implement the post performance salary system. The salary income of medical staff should be linked to the assessment results of technical level, quality, quantity, cost control and patient satisfaction of medical services, so as to achieve more work, excellent performance and equal pay for equal work. Income distribution inclines to the front line of clinic. By increasing the proportion of hospital staff expenditure to business expenditure, the hospital can balance its income and expenditure, and a certain proportion can be used to improve the treatment of medical staff and ensure the income of medical staff to increase year by year.

(6) Improve the service capacity of county-level public hospitals.

1? Accelerate the standardization construction of county hospitals. According to the regional health planning and medical service demand, counties should formulate or revise the construction plan of public hospitals in a timely manner. For public hospitals whose business premises cannot meet the needs of the masses, new construction, expansion and reconstruction projects can be started in a planned way. During the "Twelfth Five-Year Plan" period, at least 1 hospital in each county reached the second-class level. In the process of standardization construction, we will focus on improving the county emergency service system and building key specialties such as fever clinic, intestinal disease clinic, obstetrics, pediatrics, pathology, intensive care, hemodialysis and newborn.

2? Strengthen the informatization construction of county-level public hospitals. According to unified standards, make full use of existing resources, integrate existing information platforms, and build a county-level hospital management and service information system with electronic medical records as the core. Connecting with the information systems of medical insurance agencies and primary medical and health institutions, and gradually realizing interconnection; Strengthen the construction of telemedicine information system and gradually realize remote consultation, remote (pathological) diagnosis and remote education; Establish a county medical and health service information network based on residents' health records, gradually implement residents' health cards, and effectively use residents' health records.

3? Improve the service ability of traditional Chinese medicine. In view of major local diseases, we should make active use of local Chinese medicine resources, give full play to the characteristics and advantages of Chinese medicine, improve the level of syndrome differentiation and treatment, strengthen the support and guidance for grassroots medical and health institutions, and promote Chinese medicine to enter grassroots rural areas to prevent and treat diseases for the masses. Strengthen the construction of traditional Chinese medicine service capacity in county hospitals and implement the investment tilt policy of traditional Chinese medicine hospitals.

4? Implement measures to benefit the people and facilitate the people. County-level public hospitals should optimize medical procedures, extend outpatient hours, carry out peak-shifting services and diagnose and treat in different periods; Improve the referral appointment and two-way referral system; Popularize high-quality nursing service, implement nursing responsibility system and improve service attitude and quality; Extensive use of appropriate technologies; Implement mutual recognition of inspection results of medical institutions at the same level; Improve the patient complaint handling mechanism and strengthen the communication between doctors and patients; Intensify the propaganda of frequently-occurring diseases, infectious diseases and chronic diseases, health education, tobacco control and public health, guide the masses to develop healthy living habits and reduce the occurrence of diseases.

(seven) to strengthen the construction of county medical and health personnel.

1? Increase the introduction of talents. The government provides funds and policy support to attract senior and intermediate technical talents, academic leaders and medical college graduates to work in county-level hospitals for a long time. During the "Twelfth Five-Year Plan" period, the proportion of professional and technical personnel at or above the undergraduate level in county-level public hospitals should reach over 30%. The introduction of health technicians with senior professional titles and bachelor degree or above in county-level public hospitals is not limited by staffing. Adjust the policy of professional title evaluation of primary medical staff, and increase the proportion of senior professional titles and technical personnel.

2? Establish and improve the standardized training system for residents and strengthen the construction of training bases. New residents in county-level public hospitals must undergo standardized training. Training costs are shared by provincial and municipal governments.

3? Strengthen personnel training. Implementation of county-level backbone physician training plan, each county to participate in the training of not less than 10, the province's annual training 1000; Explore the establishment of a targeted training system for in-service graduate students in county-level public hospitals. Every year, the province selects about 50 doctors from county-level public hospitals to participate in in-service postgraduate education; The county government supports public hospitals to send a certain number of medical staff to tertiary hospitals in cities for further study every year. Cities can use 3 to 5 years to train medical staff in county-level hospitals in rotation.

4? Implement the integrated management and counterpart support system of county and township medical institutions. Actively carry out the integrated management of counties and towns, promote the sinking of high-quality medical resources at the grassroots level, and gradually form a pattern of first diagnosis, graded medical care and two-way referral at the grassroots level. Continue to do a good job in supporting county-level hospitals in municipal hospitals. Conditional city hospitals can take various effective forms, such as hosting and sending management teams to support county hospitals. At the same time, strictly implement the provision that urban doctors should serve in rural areas for 1 year before being promoted to the title of attending physician or deputy chief physician, implement the system of long-term resident doctors in urban hospitals supporting county-level hospitals, and improve the management level and service capacity of county-level public hospitals.

(8) Improve the supervision mechanism of county-level public hospitals.

1? Strengthen the supervision of the health sector. Supervise the quality and safety of medical services in county-level public hospitals in strict accordance with relevant laws and regulations, strengthen the supervision of financial management such as budget, revenue and expenditure, assets and costs, and monitor and manage the growth of medical expenses in county-level hospitals.

2? Give full play to the guidance, supervision and restriction of medical insurance institutions. Real-time monitoring was strengthened by using indicators such as drug preparation rate, utilization rate, self-funded drug control rate, drug proportion, average cost, hospitalization rate and average length of stay, and the results were linked to fund payment.

3? Strengthen price supervision and inspection. All relevant departments should strengthen cooperation and linkage, and intensify the investigation and punishment of illegal acts. Establish a credit system and medical personnel assessment files. Implement a fair and transparent method for evaluating people's satisfaction and strengthen social supervision.