Public hospital reform, Beijing ushered in a new stage of the process. Window on the Web site of Beijing Municipal Government capital on March 16, in recent days, the Beijing Municipal Government issued the Beijing Municipal integrated public hospital reform programme (Beijing Government issued (2016), 10th, hereinafter referred to as the implementation of the programme). Beijing is the first batch of pilot reform of public hospitals in the city, early in the summary on the basis of the outcome of the reform, programme for the implementation of the next phase of public hospital reform in General, reform of basic principles, objectives, priorities and safeguard measures, and strive to make breakthroughs in key areas and key links, release reform dividend.
, The implementation programme is a top level design
For the Council of the implementation of the guidance relating to the comprehensive reform pilot city public hospital (the State Office (2015), 38th), research development for the implementation of the programme. Programme for the implementation of proposed public welfare nature of public hospitals and the main role into full play, effective implementation of Government-run medical responsibility; deepen the reform of payment and to play its key role to establish scientific and reasonable compensation mechanism adjust and optimize the structure of medical service system, the first to establish a nationwide basic medical and health system and hospital management system, to promote the city's medical and health system to develop in depth. Focus on promoting "2323" comprehensive reform: namely, continue to run separate the pharmaceutical separation, continue to deepen, in the Medicare regulation, price adjustment mechanism, financial investment system reform breakthrough, continue to promote reform of the remuneration system and grading system of diagnosis and treatment, give play to talent training, development and information technology support.
Second, the implementation of the programme for established five objectives
By 2017, the public hospitals in the city achieved five objectives:
1. scientific and reasonable compensation mechanism was established. Mechanism to break with medicine, medical service prices gradually straighten out, health care payment reform breakthrough difference financial investment policy to further improve. Unreasonable increase medical costs under control, growth in total health expenditures coordinated with gross domestic product growth in the region.
2. grading diagnosis and treatment systems promote. Medical service system in the different levels and the different types of public hospital functions clearer and improved the medical order, city-level hospitals general out-patient attendances in health institutions gradually reduce the proportion of the total visits, grassroots first diagnosis, two-way referral, acute or slow-cure clinic, and the linkage of grading model constructed.
3. industry characteristics of remuneration system prototype. Preparation of the personnel system is more reasonable, employment mechanism more flexible and stimulating a more active and effective mechanism of income distribution, medical technology and service value reasonably reflects.
4. modern hospital management system was established. Localization, medical management system of industry-wide capital of the more perfect, more robust evaluation and supervision system of public hospitals, Government medical orderly with social forces.
5. patient satisfaction be improved. Medical treatment more standardized, more fairness and basic medical services, medical environment safer and more orderly. Burden of medical costs to maintain a reasonable level of personal health spending as a share of total health expenditure remained at 20% per cent. The satisfaction of patients and medical staff in public hospitals gradually. Meng jianzhu say with a clear conscience any instructions
Third, the programme for the implementation of five 20 specific tasks
(A) governance system: a multidimensional construct new system of governance in public hospitals.
Modern hospital management system, decentralization of public hospitals in the areas of personnel and distribution, operation autonomy, promote public hospitals return to public welfare, improving operational efficiency, promoting the establishment of new system of public hospital. Stressed government functions of change, clear Government on public hospital of led, and guarantees, and management, and supervision four items responsibility connotation, advance full industry, and territorial of management; strengthened performance assessment and industry evaluation, developed to public for oriented of industry evaluation standard, perfect public hospital performance assessment system, financial compensation and performance assessment linked, promote public hospital improve service efficiency; stressed perfect multi regulatory mechanism, strengthened medical service regulatory functions, strengthening hospital information public, advance medical institutions and doctor credit system construction, Improve third party professional agencies participate in the evaluation mechanisms; explore hospital corporate governance mechanism, through a variety of forms to explore the establishment of corporate governance structure and governance; strengthening budgetary management in public hospitals, advance public hospital cost accounting and cost control.
(B) the operating mechanism: breaking mechanism play combination with medicine, promoting the setting up of new mechanisms.
Focusing on restructuring, interest mechanism, construct new mechanism of public welfare-oriented running. "Make room, adjusting the structure": cancel the drug add and implement Sun purchase, make room for separate medicine and medical service price adjustment. Advance three to collaborative: collaborative pharmaceutical separate reform, reform of the price reform of medical service and drug purchases the Sun. Break "to medicine medical" mechanism, introduced city public hospital medicine separate implementation programme, completed chemical drug and biological products of Sun procurement, started proprietary Chinese medicines Sun procurement and high value medical with supplies Sun procurement; perfect financial input mechanism, increased financial funds input efforts, more to infectious diseases, and psychiatric, bear public task more heavy of medical institutions be tilt, strengthened financial grants and performance assessment results linked, perfect government purchase service mechanism; perfect medicine price regulation mechanism, Straighten out medical service project of price relationship, reduced large medical with equipment check treatment price, improve surgery, and nursing, reflected medical personnel technology labor value of medical service price, gradually established classification management, and dynamic adjustment, and multi participation of price formed mechanism; strengthened Medicare paid regulation mechanism, strengthening Medicare Fund payments budget and fine of management, established to by disease species paid mainly, by head paid, and by service unit paid supplement of composite type paid way, The city-wide disease diagnosis related groups (DRGs) payment reform, play all kinds of medical insurance regulatory guidance and supervision role.
(C) the remuneration system: innovative staffing management, improve the pay distribution method and dynamic adjustment mechanism.
Let medical staff gradually flowing to establish medical industry characteristics of remuneration system and dynamic adjustment mechanism, mobilize the enthusiasm of staff. To explore the implementation of medical personnel are not included in the staffing management, building can be hired and demotion of employment mechanism; improve public hospitals approved for the total amount of pay-for-performance approach to reasonable medical staff salary, wage distribution gives priority to first-line clinical, key positions and others inclined, explore wage agreement wages, project and so on.
(D) on the health care system: push classification system of diagnosis and treatment, promote orderly treatment.
Optimizing layout and structure of public hospitals, improve the classification system of diagnosis and treatment, with emphasis on orderly treatment order, increase the overall utilization of resources, optimize the pattern of medical service and medical attention. Established medical resources distribution reasonable of service system, developed regional medical health service system, and medical institutions set, related planning, stress Center City medical resources, upgrade city administrative Deputy Center of overall medical service capacity; established medical service Division collaboration of pattern, promoted public hospital and grass-roots synchronization reform, building grass-roots first diagnosis, and two-way referral, and urgent slow points rule, and upper and lower linkage of grading clinic mode, promote quality medical resources sinking, advance basic medical health service equal of ; Established Beijing Jin JI medical health collaborative development of pattern, guide in Beijing medical institutions through cooperation do medical, and specialist collaboration, and technology support, form, and Jin JI between medical institutions carried out cooperation; established social do medical and public hospital ordered competition of pattern, in medical field carried out franchise, and delegate management, Government and social capital cooperation (PPP) pilot, advance public hospital property system reform.
(V) play three training and development and information technology support.
In personnel training, development and information, and to highlight the characteristics of capital and resources. Perfect talent training system, promoted talent training to socialization training mode of change, strengthening backbone doctor team construction and shortage talent of training, perfect integrated Chinese and Western medicine differences of of talent training and evaluation system, exploration implementation nurse standardized training system, strengthening public hospital Dean professional training; perfect subject development and technology results into mechanism, consolidation this city focus subject, and specialist in both at home and abroad of influence and academic status, established public hospital technology results into and industrialization mechanism, construction "capital into medical center" ; Speed up capital construction of medical information, regional population health information system, establishment of standardized electronic health records and medical records database and promote mutual recognition of medical examination results to Exchange in the city, promote the "Internet +", the establishment of public hospital reform data monitoring platform.
Programme for the implementation of subsequent to the issuance of each sector against requires task decomposition, refined arrangements. Municipal Government will strengthen mechanisms to move forward to strengthen the monitoring, evaluation, supervision of the implementation of reform, ensuring that it achieved the expected results.
Four, the main feature of the reform
1. adhere to the policy of linkage, combination. Promoting the reform of medical, health care, medicine collaborative linkage.
2. adhere to classification reform, the implementation of diversity policies. Function orientation of urban public hospitals, give full play to its provision of basic medical services, acute and critically ill and the backbone role of disease, including diagnosis and treatment. Proceeding from reality, for different regions, different levels and different types of public hospitals in Medicare payments, price adjustment, financial investment, performance evaluation of the reform of discriminatory policies.
3. focus, grab the key, insist on breakthrough. In medicine separately, price reform, Medicare pay for diagnosis and treatment, grading, remuneration and other key areas of reform breakthrough and establish real institutional mechanism in the capital. Deepening the reform of payment and to play its key role to establish scientific and reasonable compensation mechanism.
4. push synchronization of public hospital reform in the administrative area of the city. All three levels within the administrative area of the city, two-stage, first into the scope of the reform of public hospitals. Planning, industry regulation, pricing, access health care, medicine separately and the drugs they purchase, third-party evaluation of reform policies are applicable to all public hospitals. Management system, financial investment, the remuneration, performance appraisal and other aspects of the reform policies applicable to municipal, belonged to public hospitals, national ministries, the army, the armed police forces, public institutions, State-owned enterprises in Beijing hospitals may refer to the implementation, in accordance with the requirements of the national and military-related, guaranteed by its competent authorities establish specific rules and policies are implemented.
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