Guideline for public pilot reforms

To implement the "Opinions of the CPC Central Committee and State Council on Deepening the Reform of the Medical and Health Care System" (Zhongfa [2009] No. 6) and the State Council's "Nearly Key Implementation Plan of the Medical and Health System Reform (2009-2011)" (No. 12 [2009] of the State Council [2009]) ), guide local governments to do a good job in the pilot reform of public hospitals and formulate this guidance.

I. Guiding Principles and Basic Principles

(I) Guiding Ideology

Adhere to the public-welfare nature of public hospitals, put people's health rights and interests at the top of the list, separate administrative affairs, separate administration from management, separate medicine, profitability, and non-profit separation, promote system and mechanism innovation, mobilize the enthusiasm of medical personnel, and improve public hospitals. Operating efficiency, and strive to make the people look good. In accordance with the requirements of “moderate scale, optimal structure, rational distribution, quality improvement, and sustainable development”, we must adhere to the principle of equal emphasis on Chinese and Western medicine, coordinate the allocation of medical resources between urban and rural areas and between regions, promote the healthy development of public hospitals, and meet the basic medical services of the people. Demand has effectively alleviated the problem of expensive and difficult medical services for the general public.

(b) Basic principles

Adhere to the unification of fairness and efficiency, government-led integration and the use of market mechanisms; adhere to the dominant position of public hospitals, encourage diversified medical services, promote the coordinated development of hospitals of different ownership and business nature; adhere to the combination of development, reform and management, and improve the service system ,Innovate the institutional mechanisms, strengthen internal management; Adhere to the overall design, orderly advancement, key breakthroughs, systematic review; Adhere to the central to determine the direction and principles of reform, based on China's national conditions, encourage local emancipation of the mind, adjust measures to local conditions, and boldly explore and innovate.

Second, the overall objectives, main tasks and implementation steps of the pilot

(III) Overall objectives

To build a public hospital service system with clear goals, reasonable layout, appropriate scale, optimized structure, clear tiers, complete functions, and efficient public hospitals. Explore the establishment of a division of labor and collaboration mechanism with the primary health care service system, and accelerate the formation of a diversified medical service structure. Comparing the scientific and standardized public hospital management system, compensation mechanism, operating mechanism and supervision mechanism, strengthening the internal management of public hospitals, and encouraging public hospitals to effectively perform public service functions, providing the public with safe, effective, convenient, and inexpensive medical and health services. Form the overall thinking and major policy measures for the reform of public hospitals, and lay the foundation for comprehensively promoting the reform of public hospitals.

(IV) Major tasks

- Strengthen regional health planning. Rationally determine the function, quantity and scale of public hospitals, optimize the structure and layout, and improve the service system.

-- Reforming the public hospital management system. Exploring the effective forms of separation of government affairs and management and administration, establishment of a coordinated, unified, and efficient public hospital management system, scientific definition of the rights and responsibilities of public hospital owners and managers, exploration of the establishment of a hospital legal person governance structure, and promotion of professionalization of hospital administrators. Specialized construction.

-- Reforming the compensation mechanism for public hospitals. Exploring specific ways to realize the separation of medicines, changing the over-reliance on the sales revenue of medical institutions to maintain the operation, gradually eliminating the drug addition policy, rationally adjusting the prices of medical services, improving the basic medical insurance payment methods, and implementing the financial subsidy policies. Implement the Chinese medicine support policy.

-- Reforming the operating mechanism of public hospitals. Deepen the reform of the public hospital’s personnel system and income distribution system, improve the economic operation and financial management system of public hospitals; strengthen the internal management of public hospitals, implement various hospital management systems, formulate disease treatment protocols and promote implementation, accelerate the advancement of information construction, and ensure medical services Quality, improve service efficiency, control medical expenses, facilitate the people to seek medical treatment.

-- Sound public hospital regulatory mechanisms. Implementation of hospital information disclosure, improvement of public hospital performance appraisal system, and strengthening of medical safety quality and economic operation supervision.

- Form a diversified pattern of running a doctor. Encourage, support and guide social capital to enter the field of medical services, improve the policy system, create a fair environment for the operation of non-public medical and health institutions, guide, encourage and support the development of non-public medical and health institutions, and promote mutual cooperation between different ownership medical and health institutions And orderly competition to meet the needs of people at different levels of medical services.

(e) Implementation steps

In 2009, according to the requirements of the “Working Arrangements for the Five Key Reforms of the Medicine and Health System in 2009” (Guoban Letters [2009] No. 75) of the General Office of the State Council, all provinces, autonomous regions, and municipalities have already selected 1 to 2 cities (municipalities) as their respective requirements. Public hospital reform pilot city. Within the scope of pilot cities, the country has selected 16 representative cities as pilot cities for the reform of public hospitals guided by the state.

In 2010, it began to promote pilot reform of public hospitals. Strengthen the investigation and supervision of pilot cities, timely study and solve existing problems, strengthen information exchange and guide training, and conduct assessments in due course. We continued to summarize the experience of pilot reforms in public hospitals, improve the general ideas and major policy measures for reform of public hospitals, and gradually promote the reform of public hospitals throughout the country.

Third, the main content of the pilot

(6) Improve the service system of public hospitals

Strengthen the planning and regulation of public hospitals. The provincial people's government formulates health resource allocation standards and organizes the preparation of regional health plans and regional medical institution setting plans. Rationally determine the functional positioning of various types of public hospitals at all levels. The health administrative (including Chinese medicine management) departments at or above the municipal level in districts shall, in accordance with their respective responsibilities, study and formulate the plans and plans for the establishment of public hospitals in accordance with the regional health planning and the planning requirements for the establishment of regional medical institutions. On the basis of this, the types, quantities, scales, layouts, structures, and configuration standards of large-scale medical equipment for all types of public hospitals at all levels are clearly defined. Make full use of and optimize the allocation of existing medical and health resources. Newly added health resources must meet the regional health plan. For some public hospitals, there may be planned, step-by-step relocation, integration, transformation, restructuring, etc., to promote the optimization of the layout of public hospitals.

Establish a division of labor and collaboration mechanism between public hospitals, public hospitals, and urban and rural primary health care institutions. At the city level, some secondary hospitals should be transformed into community health service agencies according to regional health plans. Public hospitals promote the development of primary health care institutions through various means such as technical support, personnel training, and management guidance, so that public hospital reforms can be closely coordinated with and promote the improvement of the primary health care system. Establish a division of labor and cooperation mechanism between public hospitals and primary health care institutions, implement graded medical care, and conduct two-way referral. While clarifying the functional positioning of public hospitals at grade two and above, and focusing on improving the service capabilities and levels of primary health care institutions, we should also make use of price and basic medical care. Ensure the guidance and regulation of payment policies, and guide the general medical treatment to sink to the grassroots level. In areas with favorable conditions, hospitals can promote the rational allocation of medical resources through cooperation, trusteeship, and restructuring. Develop extended services such as elderly care and rehabilitation, and gradually realize the separation of acute and chronic diseases.

Focus on strengthening the capacity building of county-level hospitals and implementing counterpart support for urban and rural hospitals. Promote the standardization of county-level hospitals and improve the business housing and equipment conditions for county-level hospitals. We will improve the counterpart support system for urban and rural hospitals, strengthen the construction of a contingent of qualified personnel in various forms and channels, and gradually improve the quality and ability of the staff in county-level hospitals.

(7) Reforming the Public Hospital Management System

Clear government agencies at all levels to hold public hospital duties. The central and provincial people’s governments are responsible for organizing state-level or provincial-level medical centers that undertake the functions of diagnosis and treatment of critical illnesses, medical research, and teaching; the county (city, district)-level people’s governments are mainly responsible for the holding of county-level public hospitals; other public hospitals are It is organized by the municipal people's government.

Actively explore the effective form of separate management. In accordance with the principle of separation of medical service supervision functions and medical institutions to organize functions, the localized management of the government health and other departments, state-owned enterprises and institutions affiliated hospitals is promoted, and the unified management of public hospitals is gradually realized. In areas where conditions permit, special agencies can be set up to be responsible for the asset management, financial supervision, and the appointment of key persons in charge of public hospitals, and to establish a coordinated, unified, and efficient public hospital management system. The relevant government departments formulate and implement policies and measures for the development, construction, staffing, government investment, medical price, and income distribution of public hospitals set up according to their responsibilities in order to provide conditions for public hospitals to perform public service functions. Health and education administrative departments must actively study the reform of the management system of college affiliated hospitals.

(8) Reforming corporate governance mechanisms in public hospitals

Identify the main body of the government for medical treatment, scientifically define the rights and responsibilities of owners and managers; explore and establish various forms of corporate governance structure of public hospitals with the board of directors as the core, clarify responsibilities in major issues, and formulate decisions, implement and supervise each other Checks and balances the power operation mechanism. We will implement the status of an independent legal person in public hospitals, strengthen specific operational management functions and responsibilities, and increase the vitality of public hospitals.

Formulate the management system for deputy directors of public hospitals, selection and appointment, and promote professional and professional construction. Establish a public hospital performance evaluation management system with public welfare as the core, and explore the establishment of incentive and restraint mechanisms for hospital chiefs.

(9) Reforming the Internal Operation Mechanism of Public Hospitals

Improve the internal decision-making mechanism of the hospital. Perfect the president's responsibility system. In accordance with the provisions of corporate governance structure to perform management responsibilities, major decisions, the appointment and dismissal of important cadres, major project investment, the use of large amounts of funds must be discussed collectively by the hospital leadership team and submitted for approval and implementation according to management authority and stipulated procedures. Implementation of the court affairs was open to promote democratic management. Improve the hospital's organizational structure, rules and regulations and job responsibilities, and promote the institutionalization, standardization, and modernization of hospital management.

Improve the hospital financial accounting management system. Strict budget management and income and expenditure management, strengthening cost accounting and control. Actively promote the reform of the hospital's financial system and accounting system, rigorously manage financial centralized and unified management, strengthen asset management, establish and improve internal control, and implement internal and external auditing systems. Explore the implementation of the chief accountant system in large public hospitals.

Deepen the reform of the personnel system in public hospitals and improve the distribution incentive mechanism. Scientifically and rationally verify the staffing of public hospitals. We will establish and improve a personnel management system that focuses on the employment system and post management system. With professional technical ability, work performance and medical ethics as the main evaluation criteria, improve the qualification system for professional titles of health professionals. Rationally determine the level of medical personnel treatment, improve personnel performance appraisal system, the implementation of post-performance wage system, embody the characteristics of medical staff, fully mobilize the enthusiasm of medical staff. Explore ways to implement and regulate the practice of registered physicians in multiple locations to guide the rational flow of medical personnel.

(10) Reforming the Compensation Mechanism for Public Hospitals

Promoting the separation of medicines, reforming the mechanism of drug supplementation and gradually changing the compensation for public hospitals from the three channels of service fees, drug addition revenue, and government subsidies to service fees and government subsidies. The service charges and government subsidies are rationally determined by various localities in accordance with the relevant national regulations, taking into account such factors as the positioning of the hospital's functions, the affordability of the medical security fund, the local financial capacity, the income level of urban and rural residents, and the affordability of price adjustments.

Reasonably adjust the price of medicine and gradually eliminate the policy of drug addition. On the basis of cost accounting, reasonably determine the prices of medical technology services, reduce the price of medicines and large medical equipments for examination and treatment, and strengthen the management of medical consumables prices. Gradually cancel the policy of drug addition, adopting measures such as increasing drug service fees and adjusting some technical service charge standards for public hospitals and reducing their reasonable income, and compensate them through medical insurance fund payment and increasing government investment. The pharmacy service fee is determined in principle according to the cost of pharmacy service and comprehensive consideration of social affordability and other factors, and is included in the scope of basic medical insurance reimbursement. It is also possible to carry out differential price increase pilots for the sale of drugs in hospitals and guide hospitals to use drugs rationally.

Improve the reform of the medical security payment system. We will improve the payment methods for basic medical security expenses, actively explore ways to pay per disease, pay per capita, and total advance payment, and pay in full and timely the expenses that meet the requirements of medical security policies and agreements; implement project management for medical assistance, charitable causes, and Payment system; Perfect supplementary insurance, commercial health insurance, and road transportation insurance payment methods to effectively reduce the burden on people's medical expenses. Under the premise of strengthening government guidance, reasonably determining the guiding price of medical services, and reasonably controlling the total cost of medicines and the average cost of hospitals, it is explored that the hospitals (hospital representatives) and medical insurance agencies negotiate the scope of services, payment methods, and payment standards. Quality of service requirements.

Increase government investment. The government is responsible for the basic construction of public hospitals and the purchase of large-scale equipment, the development of key disciplines, and the retired personnel's expenses and policy-related loss subsidies that meet the requirements of the state. It provides special subsidies for public health tasks undertaken by public hospitals, and guarantees government-designated emergency treatment and disaster relief. Funding for public services such as foreign aid, support for agriculture, support for borders, and support for communities is tilted toward investment policies in Chinese medicine hospitals (ethnic medical hospitals), infectious disease hospitals, occupational disease prevention and treatment centers, mental hospitals, maternity hospitals, and children's hospitals.

(11) Strengthening Public Hospital Management

Strengthen medical service quality management. Improve and implement hospital management rules and personnel responsibility system, improve the organization of medical quality management, implement guidelines for disease diagnosis and treatment and clinical application of drugs, and standardize clinical inspection, diagnosis, treatment, use of drugs, and introduction of medical devices. Continuously improve the quality of medical care and ensure the safety of patients. Strengthen the construction of key disciplines and personnel, and improve the ability and level of medical services. We must standardize the proportion of all types of public hospitals that use national essential medicines, establish and improve a national basic medicine procurement and supply management system, and promote the priority allocation and rational use of essential medicines in public hospitals. Promote the use of appropriate technologies and essential medicines, gradually implement the mutual recognition of inspection results of medical institutions at the same level and reduce the cost of medical services on the basis of strengthening standards and ensuring quality. Study and formulate disease diagnosis and treatment protocols and promote implementation to promote standardized treatment of diseases.

Improve hospital services. Through the provision of medical services for appointments, the emergency green channel is unimpeded, the service flow is optimized, and measures such as medical treatment are classified according to the conditions of illness to make the patient's waiting time shorter. Establish a patient complaints management mechanism to timely and effectively handle patient complaints and medical disputes, and build a harmonious doctor-patient relationship.

Improve the level of hospital information. With the focus on hospital management and electronic medical records, we will promote the informatization of public hospitals and improve management and service levels. Study and formulate regulations and standards for internal information management in medical institutions, and make full use of available resources to gradually establish interconnection and interoperability mechanisms among hospitals, higher-level hospitals and primary health care service organizations, and hospitals and public health institutions and medical insurance agencies. , Build a convenient and efficient hospital information platform.

(12) Reforming the regulatory mechanism of public hospitals

Implement industry-wide supervision. Strengthen the supervision function of medical services in the health administrative (including Chinese medicine management) department, and establish and improve the supervision mechanism for medical services. All health care institutions, regardless of ownership, investment entity, affiliation, and business nature, are unified planning, unified access, and unified supervision by the health administration (including Chinese medicine management) departments. We will improve the access and withdrawal mechanisms for institutions, personnel, technology, and equipment and implement supervision of the entire industry in accordance with the law.

Strengthen the supervision of the safety and quality of medical services in public hospitals. Fully rely on the existing public hospitals with high technical level and quality management level, establish and improve the national, provincial, city (ground) three-level medical quality and safety control evaluation system and various professional medical quality control evaluation organizations at all levels to strengthen medical care Quality and safety evaluation and control work, continuous improvement of medical service quality. We will improve the management evaluation system for all types of hospitals at all levels and continue to do a good job in evaluating and evaluating hospital management.

Strengthen the operation supervision of public hospitals. Health administrative departments must strengthen the supervision of the functional positioning and development planning of public hospitals. Strictly control the scale, standards, and loan behavior of public hospitals, and strengthen the configuration and management of large-scale medical equipment. To control the scale of special services in public hospitals, the proportion of public hospitals providing special services does not exceed 10% of all medical services. Improve the financial analysis and reporting system and strengthen the financial supervision of public hospitals. Establish and improve public hospital financial auditing and hospital president economic responsibility auditing system.

We will establish a multi-stakeholder supervision system and give full play to the role of all parties in society in the supervision of public hospitals. Comprehensively promote the hospital information disclosure system and accept social supervision. Strengthen the supervision and control functions of medical insurance agencies on medical services, supervise the services provided by medical institutions in accordance with the agreement, and incorporate them into the contents of public hospital assessments and evaluations. Give full play to the role of auditing and supervision of accounting firms and strengthen the role of medical industry associations (societies) in the supervision of self-discipline management in public hospitals. Establish a third-party mediation mechanism for doctor-patient disputes, actively develop medical accidental injury insurance and medical liability insurance, improve the mediation mechanism for medical disputes, and severely crack down on “doctors” behavior.

(13) Establishing a standardized training system for residents

Gradually explore the establishment of a standardized training system for resident doctors that meets the growth law of medical talents and adapts to China's national conditions, and regard resident physician training as a necessary link for the training of general practitioners and specialists. Through trials, it explored and improved the institutional model, normative standards, institutional mechanisms, and supporting policies for standardized training of residents, established a standardized insurance funding guarantee mechanism for resident physicians, and improved personnel management mechanisms such as establishment management, job setting, personnel recruitment, and wage security, and other related issues. policy. During the pilot period, the focus was on cultivating specialists in the direction of the county level hospitals, and training general practitioners in the urban and rural primary health care institutions.

(14) Accelerating the development of a diversified medical service

Encourage, support and guide social capital to develop medical and health services, and accelerate the establishment of a medical service system with diversified investment subjects and diversified investment methods. Improve policy measures and encourage social forces to organize non-profit hospitals. In the regional health planning and medical institution planning, it is necessary to leave enough space for non-public hospitals. Non-public hospitals enjoy the same treatment as public hospitals in terms of medical insurance coverage, scientific research projects, job title assessment, and continuing education, and have equal access to service access, supervision and management. The government may adopt public hospitals to undertake public health services and public services by purchasing services. We will implement preferential tax policies for non-profit hospitals and improve tax incentives for profit-making hospitals. Strengthen the supervision of non-public hospitals, guide non-public hospitals to operate in accordance with the law, strengthen management, strict self-discipline, and healthy development. Provincial health administrative departments, in conjunction with relevant departments, determine the scope, conditions, procedures, and supporting policies and measures for the transformation of public hospitals in accordance with regional health plans and regional medical institution setup plans, and actively and steadily convert some public hospitals into non-public hospitals to ensure that they are state-owned The preservation of assets and the legitimate rights and interests of employees. Public hospital restructuring plans must fully seek employee opinions. Allow commercial insurance institutions to participate in restructuring and restructuring of public hospitals.

Fourth, pilot organization leadership

(15) The pilot mechanism

The task of public hospital reform pilots is heavy and difficult, and it is necessary to fully understand the importance, complexity, and arduousness of public hospital reforms, and earnestly strengthen the leadership of public hospital reform pilots. The pilot work shall be under the unified leadership of the State Council's Leading Group for Deepening the Reform of the Medical and Health System (hereinafter referred to as the State Council's Medical Reform Leading Group). The pilot municipal people's government and the local people's government at the local level shall be responsible for the implementation. The Ministry of Health shall organize pilot projects and strengthen the guidance of the pilot cities. Training, evaluation and supervision, and other relevant departments actively support cooperation.

(16) Implementation of the pilot organization

The Pilot City People's Government shall establish a leading agency for pilot work and be responsible for organization, coordination, guidance, and supervision. According to the "Opinions of the Central Committee and the State Council on Deepening the Reform of the Medical and Health System", the State Council's "Planning for the Implementation of the Medical and Health Care System Reform in the Near Future (2009-2011)" and the "Guidance Opinions", full investigation, multi-argumentation, and extensive consultation, Formulate a pilot implementation plan. The implementation plan should be based on the direction and principles determined by the central government. It should strive to refine, actualize, and materialize, highlight key aspects and key links, emphasize innovations in institutional mechanisms, explore in-depth, make bold attempts, strive for breakthroughs, and achieve practical results. The pilot implementation plan was organized and implemented by the provincial medical reform leading group, and reported to the Ministry of Health and the State Council's Medical Reform Leading Group Office for the record. Formulate and implement pilot supporting policies and measures, coordinate and resolve problems arising from the pilot work, and promptly report major issues to the provincial people's governments and relevant state agencies.

(17) Guidance, assessment and supervision of pilot sites

Provincial governments must strengthen guidance and support for pilot cities. Relevant departments of the State Council are responsible for each other and closely cooperate with each other to strengthen the guidance and evaluation of the pilot work, sum up the pilot conditions in a timely manner, improve relevant policies and measures, and promote the pilot work to be carried out actively and steadily.

(18) Creating a good pilot environment

Pilot areas should do a good job in media propaganda, strengthen publicity on the significance, guiding ideology, basic principles, major tasks, and policy measures of public hospital reform pilot work, mobilize the participation of medical personnel in the enthusiasm and initiative of the reform, and strive for the people and the masses. The understanding and support of all sectors of society. The health department and the propaganda department should closely cooperate with each other to strengthen the monitoring and study of public hospital reform pilots, actively guide public opinion, strengthen reform confidence, and reasonably guide social expectations.