A few days ago，The General Office of the Central Committee of the Communist Party of China、The General Office of the State Council reposted the "Several Opinions of the State Council's Leading Group for Deepening the Reform of the Medical and Health System on Further Promoting and Deepening the Reform of the Reform of the Medical and Health System (hereinafter referred to as" Opinions ")，and issue notifications，Requires and regional departments to implement it carefully in accordance with the actual situation。"Opinions" proposed，Establish a new mechanism for running a public hospital，All public hospitals cancel drug bonus。Establish a modern hospital management system，Performance assessment of public hospitals，Assessment results and hospital fiscal subsidies、Medical Insurance Pay、Total performance salary and dean's salary、Appointment and removal、Reward and punishment and other hooks，Establish an incentive constraint mechanism。

 

  Key points

 

  Operating mechanism

 

  All public hospitals cancel drug bonus

 

  "Opinions" Requirements，Break the medicine to supplement medicine，Establish and improve a new mechanism for running a new public hospital。

 

  Actively and steadily promote the reform of the price of medical services，Make sure the public hospital is benign operation、Medical Insurance Fund to withdraw、Under the premise that the burden of the masses will not increase the overall，Control according to the total amount、Structural adjustment、There are ascending and downward、Gradual requirements，Classification guidance streamlined the comparison relationship between medical institutions and medical service projects。All public hospitals cancel drug bonus，Coordinated consideration of compensation policies determined by the local government，Precise measurement price adjustment level，Simultaneous adjustment of medical services price。Through standardized diagnosis and treatment behavior、Reduce the space of drugs and consumable costs，Dynamic adjustment of medical services price。Price adjustment should focus on improving the diagnosis and treatment of the technical labor value of medical personnel、Surgery、Nursing、Price of medical projects such as rehabilitation and Chinese medicine，Reduce the price of inspection and inspection of large medical equipment，Pay with medical insurance、Hierarchical diagnosis and treatment、Cost control and other policies to connect with each other。Through comprehensive policy，Gradually increase medical service income (excluding medicine、Consumption、Check、Test income) The proportion of total income in the hospital，Establish a new mechanism for running a public hospital。

 

  Medical Insurance Role

 

  The incentive restraint mechanism for the residual retention

 

  Opinions point out，Give play to the basic role of medical insurance，Strengthen external restrictions on medical services，Strengthen the management function of the Medical Insurance Office。

 

  Comprehensive promotion of payment methods reform。Gradually reduce payment by project，Improve the total control of medical insurance payment，Promotion My stake betting appstake betting appis mainly based on disease -based payment，Pay at the first person、Pay for daily fees、Total payment method combined with a variety of payment methods combined with a composite payment method，Encourage the implementation of group paid methods for diagnosis of disease diagnosis，Gradually reforming medical insurance payment methods cover all medical institutions and medical services。A conditional areas can be managed with points and budget management、Payment according to disease species and other combination，Promoting orderly competition between medical institutions and reasonable allocation of resources。Establishing balance retaining、Incentive restraint mechanism for reasonable overcome sharing，Stimulation of standardized behavior of medical institutions、Endogenous power to control costs。

 

  Innovative basic medical insurance service mode。According to the principle of separation of management office，Promoting the professionalization of medical insurance agencies。Under the premise of ensuring the security and effective supervision of the fund，Entrust social forces such as qualified commercial insurance institutions in the form of government purchase services to participate in the basic medical insurance office service，In undertaking urban and rural residents' serious illness insurance，Introduction to the competition mechanism，Improve the efficiency and quality of management services for medical insurance office。Encourage the development of commercial health insurance。

 

  Management System

 

  Performance assessment Linking dean salary, appointment and removal

 

  "Opinions" Requirements，Promoting political affairs separation、Separation of Management Office，Establish a modern hospital management system。

 

  ​​Implement the autonomy of the operation and management of public hospitals。Change government functions，Administrative departments at all levels have transformed from direct management of public hospitals to industry management，Strengthen policy and regulations、Industry Plan、Standard specifications and regulatory duties。Improve the legal person governance structure of public hospitals，Implement internal personnel management、Institutional settings、Responsibility performed、Deputy job recommendation、Middle -level cadres' appointment and removal、Annual budget execution and other autonomy。Improve the internal decision -making and restriction mechanism of public hospitals，Strengthen the public public offer，Give full play to the functions of the staff congress，Strengthen democratic management。

 

  Performance assessment of public hospitals。Establish a public welfare -oriented assessment and evaluation system，Highlight function positioning、Responsibility performed、Social satisfaction、Cost control、Operating performance、Financial Management and other indicators。Regularly organize public hospital performance assessment and the dean's annual and term target responsibility assessment。Assessment results and hospital fiscal subsidies、Medical Insurance Pay、Total performance salary and dean's salary、Appointment and removal、Reward and punishment and other hooks，Establish an incentive constraint mechanism。

 

  remuneration reform

 

  Hospitals with overtime overtime are given tilt

 

  "Opinions" proposed，Establish a personnel salary system that is in line with the characteristics of the industry，Mobilize the enthusiasm of medical staff。

 

  Establish a flexible use of human mechanisms。Innovative public hospital preparation management method，Improve the management measures，Actively explore the pilot management reform of public hospital preparation and management。In the local area, there is an existing total amount，Determine the total number of public hospitals，Gradually implement the filing system，Carry out management reform in some large and medium -sized cities three -level public hospitals，Pilot management pilot management pilot。Simplified recruitment procedures for professional and technical personnel，Professional and technical personnel or high -level talents who are scarce in the hospital can be recruited by the hospital stake betting appin accordance Stake Sports Bettingwith regulations。Increase the grassroots medical and health institutions、Advanced job ratio，Greed up the career development space of medical personnel。

 

  Promoting the reform of the salary system。Place can be combined with actual，Make reasonable determination of public hospital salary levels in accordance with relevant regulations，Gradually increase the proportion of business expenditures in business expenditure。More labor outside working hours、High -level medical talents gather、Public welfare target tasks are heavy、Public medical institutions that develop family doctors' contract services，Tilt when the total performance salary is approved。Strengthen long -term incentives for medical staff，Establish a public welfare -oriented performance assessment mechanism，Salary achieves moderate growth on the basis of maintaining the existing level。Public medical institutions independently allocate performance salary based on the total performance salary approved by the approved performance salary。Total salary verification and personal performance salary distribution is not with medicines of medical institutions、Consumption、Large -scale medical examination and other business income linked，Salary distribution reflects the technical content of the post、Risk、Contribution, etc.，It is strictly forbidden to set up a creation index for medical staff。Grass -roots medical and health institutions can extract the employee welfare fund and award fund。

 

  Expert Interpretation

 

   & ldquo; Three Medical & RDQUO;

 

  Medical insurance is deepening medical reform，Promoting medical treatment、Medical Insurance、Pharmaceutical & ldquo; Three Medical & RDQUO; Links has an important basic role。full -time deputy director of the medical reform office of the State Council、Director of the Reform Director of the National Health and Family Planning Commission System Reform Liang Wannian pointed out，Supervision and Management of the Medical Insurance Fund、Medical service price negotiation、Pharmaceutical consumables joint procurement and settlement、Medical Service Behavior Supervision、The construction of the medical insurance information system is integrated together，Exercise uniformly from an institution，It is conducive to achieving overall management of basic medical insurance funds，It is conducive to the centralized payment function of medical insurance for purchasing drugs，Reduced the price of drugs through linked and prices，It is also conducive to strengthening the supervision and restraint of hospitals and doctors、Standardized service behavior。In particular, it is conducive to promoting the formation of medical insurance and medical reform policies for synergy，Accelerate the construction of a big health。

 

  Liang Wannian said，All public hospitals cancel drug bonus，Coordinated consideration of compensation policies determined by the local government，Precise measurement price adjustment level，Simultaneous adjustment of medical services price。Through standardized diagnosis and treatment behavior，Reduce the space of drugs and consumable costs，Dynamic adjustment of medical services price。

 

  For the reform of the salary system proposed by the Opinions，Liang Wannian said，The place can be combined with actual，Make reasonable determination of public hospital salary levels in accordance with relevant regulations，Gradually increase the proportion of business expenditures in business expenditure。

 

  Under the premise of uneven distribution of high -quality medical resources，It is necessary to coordinate the promotion of hierarchical diagnosis and treatment and family doctor signing services，It is necessary to ensure that patients can see well，It is necessary to resolve & ldquo;，The dilemma of the small hospital Menkeelo & rdquo;。Liang Wannian said，Can guide residents or families while signing with the family doctor team，Volunteer choosing a second -level hospital、A third -level hospital，Establishing & ldquo; 1+1+1 & rdquo; combined signing service mode，Signing residents can choose any medical institution in the signing portfolio，If you go to the group, you must refer it by a family doctor。

 

  Experience in various places

 

  Shanghai Jiangsu Public Hospital's reform performance tilted towards front -line positions

 

   & ldquo; expensive & stake sports betting apprdquo;Stake Sports Betting。The reporter learned，In the reform of public hospitals in Sanming City, Fujian Province，Established a scientific compensation mechanism，All public hospitals cancel drug bonus，Purchase by drug limits through drugs、Strictly control the water of the prescription right of physicians and the use of squeezing drug consumables in the use of squeezing drugs。For the field of drug circulation as the basic link of drug prices，Sanming City's implementation of public hospital drug procurement & ldquo; two -vote & rdquo;，That is, the manufacturer will issue an invoice to a circulating enterprise，Circulation enterprises to issue an invoice at a medical institution。Drug production enterprises are responsible for distribution，Implement a unified distribution in the entire area。Adjust the price of medical services at the same time，Medical Insurance Simultaneous follow -up。

 

  Big Hospital & ldquo; No. 1 difficult to find & rdquo;，Small Clinic Men Keeloque，The characteristics of the grassroots people seeing a doctor for a long time & ldquo; the characteristics of unequal hot and cold & rdquo;。To promote the first consultation of the grassroots at the grassroots level，Shanghai Starting Pilot & LDQUO; 1+1+1 & RDQUO; Signing Service Combination，That is, the residents are based on a contract with a family doctor，Select another district level、A city -level hospital for treatment。Signing residents can choose any medical institution in the signing portfolio，If you need to go to the group, you must refer it by a family doctor，Implement & ldquo; hard binding & rdquo;。

 

  Jiangsu Province forms a provincial medical group with two three three hospitals as the core，Hospitals above the second level of urban areas、Specialist Hospital and Community Health Service Agency，Formed a longitudinal integrated medical group，Establish a community health management center，Medical Group to give full play to the advantages of the core hospital，Start management assistance with community health service agencies、Technical cooperation、Division of doctors and personnel training。

 

  Low salary、Mission weight、Risk high，Professional ecological environment pressure of first -line medical staff。In order to take care of efficiency and fairness during the assessment，Jiangsu Provincial Public Hospital when formulating the internal performance salary issuance project of the unit，Establishing job allowance、Life subsidy、Scientific Research Allowance、Medical and Health Occupation Order、Late overtime subsidy、Duty subsidy、Night Class subsidy and other items。When the specific distribution，Focus on clinical first -line、Key positions、Business backbone、High risk and contribution and other medical personnel are inclined。

 

  In addition，In terms of the performance assessment of the dean，Shanghai is satisfied with society、Effective management、Asset operation、Development continues、Employee Satisfaction, including five target dimensions, select 23 evaluation indicators，Assessment results are directly used as an important basis for the dean's annual performance rewards and punishments。

 

  Medical reform results

 

  Basic medical insurance coverage rate 95%covers more than 1.3 billion people

 

  "Opinions" released yesterday pointed out，A new round of medical reform has made significant progress and obvious results。It is mainly manifested in: the national medical insurance system is basically established，Basic medical insurance participation rates are stable at more than 95%，Covering more than 1.3 billion people，2016 urban and rural residents' medical insurance financial subsidy standards reached 420 yuan per capita，Urban and rural residents' serious illness insurance pushed open，A significant improvement of the guarantee level。Comprehensive reform of public hospitals continues to expand and deepen，1977 counties (cities) nationwide pushed the comprehensive stake betting appreform stake betting appof county -level public hospitals，Pilot cities of comprehensive reform of public hospitals expand to 200，The scientific management system and operating mechanism are being formed。The grass -roots medical and health service system is continuously improved，Basically realized the health center of the countryside、Village Village has a toilet，Service capabilities have improved significantly。The degree of equalization of basic public health services has increased significantly，Implement 45 national basic public health service projects in 12 categories，Cover the entire process of residents，benefit hundreds of millions of people。

 

  The drug supply guarantee system is further improved，Implement the national basic drug system，Promoting open and transparent public medical institutions Pharmaceutical provincial online centralized procurement，Gradually establish a market -oriented drug price formation mechanism。The construction of a hierarchical diagnosis and treatment system is accelerated，More than half of the county (city) nationwide carried out the first diagnosis of the grassroots at the grassroots level，The consultation rate in the county reaches 80%or more。Personal hygiene expenditure in total health expenses continued to decline，from 40.4%in 2008 to less than 30%; the basic medical and health services have significantly improved，80%of residents can reach medical institutions in 15 minutes; the health level of the people is significantly improved，Per capita life span reaches 76.34 years，1.51 years old than in 2010，People's health level is generally better than the average level of countries in high -income countries，Getting higher health performance with less investment。

 

  Opinions point out，Practice proof，Deepen the reform direction of the reform of the medical and health system correct、The path is clear、The measures are strong，Reform results are widely benefited to the people，Solution to see a doctor for medical treatment、Improve the health quality of the people、Maintain social fairness and justice、Promoting economic and social development has played an important role。