Sample of Songjiang of Shanghai of the comprehensive medical reform The next focal point arouses medical worker's enthusiasm

Sample of Songjiang of Shanghai of the comprehensive medical reform The next focal point arouses medical worker's enthusiasm
Sample of Songjiang of Shanghai of the comprehensive medical reform The next focal point arouses medical worker's enthusiasm
The pilot city of comprehensive health care reform of first of Mao PeiYun China, come from the Songjiang District of Shanghai of 2005. Through the exploration and practising of nearly four years, the expert of Ministry of Public Health thinks, Songjiang district basically realized the goal of hygiene reform, "the system is offered the lifelike experience to serve basic health care that ' everybody enjoyed '. " But paid the high cost in reform. Health care reform as the synthesis " Eldest son " ,In 2005, the trivial finance of Songjiang took out 30 million yuan as starting the fund of medical reform. And one, increase progressively by 10% every year in input to the hygiene that year. Shortly before National Day, at the forum that Songjiang district deepen the hygiene reform, Songjiang trivial eldest grandson JianPing said, public hospital reform while solving public beneficially, must reform original the intersection of performance and the intersection of examination and way of hook of serving and charging etc., should emphasize the implementation of government's financial fund and improve the medical worker enthusiasm even more. After going on in the past 4 years, how will the comprehensive medical reform of Songjiang last? Most old beneficiary seem in new secretary of Bang town the whole forest Pu, health care reform peasants are the oldest beneficiary. " peasants are most afraid of falling ill, expensive medical fee, force their young disease to tow, serious disease,etc. (die) . " The whole Lin Pu is the indigenous people in Songjiang, have deep feeling for this. For this reason, two grades of governments in the district Town furnish funds of 25 million yuan, set up and is used mainly in the serious disease mutual fund of badly off peasant caused by hospitalization cost expenditure of large volume and cover the basic medical guarantee network of urban and rural residents. From 2007, adopt the government to " it is single to bury " in Songjiang Method,woman, man over 60 over it is for 55 of countryside,carry on by a physical examinations free every year; To the medical insurance of the peasants of male 55 year old woman, 60 year old, it is single to bury by the finance of district town second; The medical insurance of the household enjoying the 5 guarantees, disabled person is buried by Department of Civil Affairs singly; The medical insurance of the disadvantaged groups is all buried by the government singly. The whole forest Pu say now, Songjiang peasant spend 180 every year only, buy cooperative medical insurance, can enjoy three kinds of treatment of medical insurance. Namely: One grade of basic medical security systems in the town, door emergency calls seen in every year, the expenses are in under 5000 yuan, submit an expense account fully. District level the intersection of serious disease and the intersection of risk and security system, use for, compensate, in hospital hospitalization cost and special the intersection of disease and the intersection of door and the intersection of emergency call and hospitalization cost pay the intersection of volume and person of more than 10,000 yuans exceeded for itself wipe out, specially. Enjoy the medical insurance of 60,000 yuan in one year; The badly off peasants caused by hospitalization cost expenditure of large volume, enjoy the insurance of 60,000 yuan in one year. Sun JianPing reveals, the basic medical security system in Songjiang is protected to the urban worker's basic medical insurance (city of the urban on-the-job worker) , to the basic medical insurance (occupy and protect) of urban residents' urban residents , the basic medical insurance (town of peasants' little urban residents is protected to the urban lost territory) With directing against four parts of rural cooperative medical service of the agricultural population, realize basic medical treatment ensures covering completely at present. Talent and public medical care resource equal to take materials, reveal, at present, national 80% of the medical resources centre in the big city, among them 30% concentrate on the large hospital again. While seeing the doctor, people all run to the large hospital, countrymen run to the town. No exception in Songjiang. "Phenomenon that changing ' large hospital the overstaffed, small hospital, there are very few callers ', must implement talent and public the intersection of medical care and equality of resource take. " Ren XiangYang, vice head of district of district in Songjiang says. For this reason, Songjiang, the community health station, rural clinic, as the agency of the community health Center, manage in unison. The purpose is: Make the intersection of the superior and the subordinate and hospital really connect each other, facilitate the masses, make common disease, frequently-occurring disease can get valid making a diagnosis and giving treatment in the area. Meanwhile, encourage the service of medical organization, expert, medical worker to sink to the community. It is reported, it has three routes that district level hospital personnel sink in the community: The district level hospital cures skill personnel and hangs and arranges flowing; Serve as the chief community's doctor or complete group's captain; It takes half a year in community service before promoting professional title. Have already appointed over 60 district level hospitals and cured skill personnel and sunk in the community at present. XiangYang Ren say frankly at present, Songjiang income of medical worker make the difference because of the identity, involve different funds source channels, incomes are different to some extent too. In the pilot project of the medical reform, Songjiang makes great efforts to narrow different authorized personnels' income gap. He says, for example, in the village clinic, the rural doctor is not worked out by an undertaking, whether identities or villagers. But Songjiang district took the lead in solving the rural doctor's social security problem in 2007, meanwhile, improve the rural doctor's treatment year by year, increase by about 10% every year. Will also implement the district level pool of the rural doctor's treatment in 2008. This measure, steady rural doctor's team, has established the foundation for the medical reform. Set up in the medical centre of the district " The medical network service department of the community " ,It is another light spot of the medical reform of Songjiang. Pass " medical network service department of the community " Long-distance video hold a consultation,last Songjiang citizen (be included not living by the patients of remote area) Do not go out of the community, can get the making a diagnosis and giving treatment of the district level hospital expert. The statistics show, in 2008, the central hospital of Songjiang district will amount to 7101 persons receiving the patient of network hospital. In order to encourage citizens to see the doctor and seek medical advice at the gate of home, give play to the role of lever of the mechanism of the expenses in Songjiang, pull open cooperative medical insurance, get up pairs of standard and wipe out proportion to community and two, tertiary hospital. The concrete method is: Adjust the compensation proportions of different rank medical organizations progressively, door emergency call wipe out proportion as the intersection of village and 80% clinic, 70% community health Center, district level 60% hospital, tertiary hospital 50% in the personal account. Meanwhile, reduce the intersection of community and the intersection of hygiene and service organization, seek medical advice expense. Issue " improve peasant, seek medical advice the intersection of issue and ten major measure " 2005, stipulate village clinic exempt from registration fee, make a diagnosis fee and pay a home visit fee, in 2007, reduce or remit the emergency call of the door and examine and check the fee to the community health Center. The statistics reveal, patient above the Songjiang district 75%, would like to see the doctor in the medical organization of the community. 2008, community, and the intersection of organization and person who go to a doctor account for above the the whole district 90% already under the community. A difference rate and a difference rate of basic medicines of basic medicines is the opera involving much singing and action of the medical reform of Songjiang. A sincere introduction of chief of health bureau of Songjiang district, only force down the medicine price, could make it become reality expensively any more to see the doctor. Want, realize basic the intersection of medicines and zero rate (low to stock a low producing, a addition) difference ,Its primary problem is: Who comes to bear the fee of difference produced by this? Public director of medical organization administrative center Zhu GenMing in Songjiang district is a chief leading cadre of this job, he says, the initial imagination is: Medical insurance, hospital and patient three sides bear together. This scheme is rejected while referring to standing meeting of district government to talk about. Sun JianPing emphasizes, since the one that should solve ordinary people sees the doctor expensively, implement a difference rate of basic medicines, the difference expenses produced by this, should be born by the district finance Take on. Under Sun Jian's flat proposition, the district finance allocates special funds of 10 million yuan every year, used in a difference rate of basic medicines to replenish. From the will it be November 2007, Songjiang set up basic the intersection of medicines and catalogue, district of Songjiang, implement a difference rate to the whole the intersection of district and public basic medicines of medical organization. After implementing the basic medicines catalogue of Songjiang district, every average form prescribed medicine price is reduced by 4.5 yuan, it is about 10 million yuans that can save medical expense expenditure in the whole year. Reflect public service " implement public the intersection of medical organization and two lines of revenue and expenditure, make the intersection of health care and commercialization, market-based to change into public beneficial to serve of system, establish the public service properties of the medical organization and make a reservation fundamentally. " As far back as 2005, Sun JianPing proposed the public hospital reforms the system in the course and keeps the factor in check. From September, cleared up the existing bank accounts of 20 affiliated public medical organizations in Songjiang in the same year, unified the norm in setting-up " The income " With " expenditure " Two accounts (all economy of the medical organization " The income " All submit to the national treasury; Salary, bonus and every expenditure of the medical worker include in budget management, all by the government " It is single to bury " ),Its core is: Personal income of the worker and the hospital, department business income " Pair breaks off relations " . Since the reform, the district finance successively set aside 50 million yuan, so as to ensure the medical organization was public beneficialing and smooth implementation of budget management of two lines of revenue and expenditure. In order to avoid appearing" Mess, poor efficiency " In the question, September of the same year, made the medical performance of health organ and examined and assessed the method in Songjiang, the in-house income distribution system of medical treatment of coordinated reform, have set up many departments and supervised and commented on the mechanism, professional quality evaluation mechanism, decent practice supervisor to appraise the mechanism. In the new performance is examined, 50% are the working efficiency, 30% are social satisfaction and masses' satisfaction, 20% give consideration to quality and cost, get in touch after cutting off medical worker's income and medicines, directness of checking income. One is said sincerely: "The hospital turned from the heavy economy in the past to heavy quality, the major indicator which examined the medical worker was no longer a business income, but use medicine rationally, check rationally, treat rationally, transfer from one hospital to another rationally. " Zhu GenMing tells reporters, in " accuse of one to improve four times " (control the intersection of clinic and times of expenses, the intersection of control and average the intersection of bed and day expenses, the intersection of control and average number, the rate of subsequent visit controlled in hospital in hospital, raise working efficiency) Examination index system under,medical treatment is in-house operating mechanism, service mode, service content and doctor behavior last changes obvious. These changes, have not merely improved feasibility and fairness of the hygiene service, have also reduced residents' hospitalization cost. The reporter knows, before the medical reform, the hospitalization cost of the whole district increased at an annual average of about 18% each time. Behind the reform, the whole the intersection of district and the intersection of door and emergency call times of expense drop by 12.8%, decreasing amplitude is obvious. In 2007, the clinic of hospital of Shanghai is average expenses once are the medical fee of 177 yuan, that year, Songjiang was 117.2 yuan; In 2008, Songjiang is 123.5 yuan. In the past four years, Songjiang has lightened masses' expenditure of more than 120 million yuan of hospitalization cost through the medical reform. The medical reform way is endless from 2007, participate in drafting to the hygiene policy committee member of Committee of Experts Rao KeQin of Ministry of Public Health of the new medical reform scheme, begin to track that pays close attention to the medical reform of Songjiang. He says: "The hygiene reform in Songjiang, so long as maintain the statusquo, 5 years later, report and material taken out can still walk in front of the whole country. " "Difficult point with three major generality of medical reform carried on at present. First, what a service of facing basic medical treatment and public health; Second, how is the public hospital through coming back public beneficially, set up intact operating mechanism; Third, how set up one effectual review and mechanism to supervise hospital. " One is said sincerely. At the forum that Songjiang district held a few days ago studies and carries out " new medical reform scheme ", Sun JianPing says, the public hospital reform mainly solves two things: Health care is public beneficial and after settlement is public beneficial, the medical worker enthusiasm. "Solve the public beneficial problem, further deepen reform on how to arouse medical worker's enthusiasm next during the reform of the first wheel in Songjiang. Form the salary to want from skill, the bonus is to the benign operation mechanism of serving and wanting.


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