Development Research Center of the State Council: better public welfare is the starting point of public hospital reform

Source: China development portal Author: Zhou Bing 2015-09-14 "Research on reform and development mode of public hospitals in China" jointly conducted by experts from development research center of the State Council and other institutions, lasted for one year, ushering in the closing moment On September 13, the research team held a results conference in Beijing, believing that the reform of public hospitals in China must be accelerated to serve the health and well-being of the people The research group pointed out that better realization of public welfare is the basic starting point of public hospital reform, the key is to reasonably divide the boundary between public welfare and market, and more effectively allocate medical resources through effective cooperation between the government and market According to the "China People's livelihood index" of the development and research center of the State Council, the total cost of health in 2014 rose too fast, with an average annual growth rate of 18.4% in the past four years, far higher than the growth rate of residents' income At the same time, the proportion of reimbursement for hospitalization expenses was low, only about 40% The "difficult" and "expensive" problems still plagued the patients The report points out that the reasons for the above problems are that the reform of public hospitals is not in place and the allocation of medical resources is not reasonable It is suggested that the government purchase services to provide basic public medical services, so as to better enable public hospitals to participate in the market mechanism The overall reform has achieved remarkable results, but the problem is still in the "Research on the reform and development mode of public hospitals in China" project, which is jointly organized by the resource and Environment Research Institute of the development research center of the State Council and the culture and media of the State Research Institute The members and consultants of the research group are from the development research center of the State Council, the national health and Family Planning Commission, the Ministry of finance, the Ministry of science and technology and some universities The reform of public hospitals is one of the important contents of deepening the reform of medical and health system It is also the most arduous and concerned task in the medical reform It plays a key role in realizing the goal of medical reform in an all-round way, even directly related to the overall situation of medical reform The research group believes that in recent years, with the deepening of the reform of the medical and health system, the reform of public hospitals in China is speeding up, and some pilot cities have carried out reform and exploration, with remarkable results First, the public welfare function of public hospitals is increasingly clear Public hospitals re emphasize social benefits and social responsibility The perspective of hospital management is no longer limited to the medical institutions, but has changed from simply considering the development of the hospital itself to paying more attention to the overall interests of the people Second, the management system of public hospitals has been gradually improved At present, China's public hospitals have begun to transform from affiliated institutions of health administrative departments to independent legal persons operating independently In the past, the hospital's leadership and management system was transformed into the president's responsibility system The president, as the legal representative, is fully responsible for the operation of the hospital Basically, the president has the responsibility and the right in operation and management Some hospitals have begun to try to standardize the management of hospital legal persons Reform Third, a diversified pattern of running medicine is taking shape The government gradually liberalized the access conditions for running medical services, vigorously encouraged, supported and guided social capital to develop medical and health services, and presented a diversified pattern of investors Fourth, the layout of public hospital service system has improved Community health institutions are being strengthened, which has promoted the balanced development of medical services between cities The medical service network throughout urban and rural areas has basically formed, and the layout has improved Fifth, the operation mechanism of public hospitals has been continuously improved The incentive mechanism for medical staff has been initially established, the efficiency of hospital operation has been greatly improved, the reform of personnel system has been deepened, a scientific and effective employee performance evaluation system has been established, and the compensation mechanism of "medical separation" is being explored and established Sixthly, the service capacity and level of public hospitals have been continuously improved The medical level and facilities of large-scale urban hospitals in developed areas are close to or up to the level of developed countries The medical conditions of central and western regions and grass-roots hospitals have also improved significantly The quality of medical services has been improved day by day, and the professional ability of doctors has been improved significantly However, the reform of public hospitals in China still faces a series of problems According to the research group, from the perspective of the functional division of public hospitals, the public welfare and operational nature of public hospitals are not distinguished in terms of personnel and property, which directly leads to the serious profit seeking trend of public hospitals As a result, there is a bad phenomenon of induced consumption, pursuit of drug plus income and kickback, "medical supplement with drugs" has evolved into "medical support with drugs" From the perspective of hospital management autonomy, due to the existence of government property rights, health administrative departments run hospitals and manage hospitals, and hospitals lack management autonomy and flexibility From the perspective of medical resource allocation, the allocation of high-quality medical resources is too much concentrated in large cities, and the small and medium-sized cities are obviously insufficient Relevant data shows that the first and second tier cities have about 70% of the health resources, while the small and medium-sized cities and rural areas only have about 30% of the health resources From the perspective of incentive and restraint mechanism, the design of internal incentive mechanism in public hospitals in China is often one-sided, arbitrary and unscientific The managers and employees lack reasonable market-oriented incentive value, which always restricts the full potential of hospital employees In addition, the distribution supervision mechanism, assessment mechanism and moral restraint mechanism need to be further improved Generally speaking, the reform of public hospitals in China is at a critical moment Since the implementation of the new round of medical reform, the coverage has been greatly improved, but the effect of the reform of the medical and health system is not obvious to the masses, and even the phenomenon of "difficult to see a doctor, expensive to see a doctor" is further intensified in some places, and the task of reform is still very arduous The research group of "Research on the reform and development mode of public hospitals in China" conducted in-depth research in China, and selected Suqian maternity hospital as the reform sample to dissect and summarize its reform practice At the issue achievement conference, Suqian City introduced their reform practice Suqian City is one of the earliest cities to explore the reform of public hospitals, and Suqian maternity hospital is also one of the first public hospitals to carry out reform and innovation Suqian maternity hospital has carried out effective exploration in five mechanisms of "government management mechanism, division of labor and cooperation mechanism, financing and construction mechanism, product supply mechanism and hospital operation mechanism", and innovated and formed a set of relatively mature, graftable and replicable "public hospital reform" mode, namely“ Scientific supervision by the government, close cooperation between the public and the private, diversified medical services by the society, purchase of public services and modern corporate governance " The innovation and development of Suqian maternity hospital ended the history of Suqian City as a prefecture level city without maternal and child health care hospital, and accumulated valuable experience for promoting the reform of public hospitals in other regions of China Some suggestions on deepening the reform of China's public hospitals the research group put forward some suggestions on deepening the reform of China's public hospitals on the basis of in-depth study of the current situation of China's public hospitals, in-depth dissection of reform samples, and a large number of collection and analysis of international experience First, we should make clear the reform direction of "ensuring the basic level, strengthening the basic level, and building the mechanism" of public hospitals "Basic protection" is mainly reflected in the provision of basic services On the basis of basic medical insurance, according to the principle of cost-benefit, we should make a catalogue of basic medical services for medical institutions at all levels, and encourage public hospitals to take the lead in using appropriate technologies by economic means, which will not only help to control the total cost, but also change the medical model Therefore, it is necessary to establish an independent performance evaluation system of medical services, which is also a significant trend in the current medical reform in developed countries "Strengthening the basic level" should be expanded to county hospitals County Hospital is the network base of public hospital system and the leader of grass-roots level With large and medium-sized public hospitals as the leader, county hospitals and township hospitals as the network base, integrate public hospital resources, establish an intensive and integrated public hospital system, and accelerate the establishment of an orderly medical treatment system The key to "building mechanism" is the reform of compensation mechanism and the incentive mechanism for medical staff On the basis of canceling the medical supplement, improving the compensation mechanism, taking the performance and quality as the standard, strengthening the assessment and evaluation of public hospitals, establishing the assessment and evaluation, mass appraisal, hospital rating, information disclosure and other systems, promoting the transformation of public hospitals from cost promoters to cost controllers, from income generation oriented competition to performance-oriented competition, and from extensive management To fine management We should reasonably improve the legitimate income of medical personnel, mobilize the enthusiasm of medical personnel through competition and performance management, ensure the professional environment of doctors, and stabilize the ranks of medical personnel at all levels Second, we should make clear the property right nature of public hospitals and improve the management system of public hospitals The first is to clarify the nature of non operating state-owned assets of public hospitals We will promote the state to enact the law on public institutions, the law on non profit organizations, or the law on corporate associations, the law on public hospitals, the regulations on the administration of public hospitals, and the regulations on the administration of non profit hospitals, which stipulate the planning, financial and personnel management of non-profit hospitals, and clearly determine the government's resource layout, regional health planning, fixed asset investment, and major assets in public hospitals Disposal, daily financial management, distribution of operating earnings and other aspects are binding; further clarify and strengthen the content of public hospital industry management The second is to establish a modern hospital system of "accurate objectives, implementation of property rights, consistent responsibilities and rights, scientific management, strong supervision and transparent operation" Establish the property right management system of public hospitals, define the institutions that perform the responsibilities of investors and responsible persons on behalf of the government; establish the appointment system of the chief accountant of public hospitals, the examination and approval system of revenue and expenditure budget, the approval system of construction projects, the performance appraisal system of hospitals and presidents, the information disclosure system of public hospitals, the social supervision system of public hospitals, the inspection system of public hospitals, the system of dispatched supervisors, and the audit features The system of appointing personnel, implementing the audit function of audit department to public hospitals, and improving the data collection and release mechanism of public hospitals Third, improve the financial management of public hospitals Establish a national public hospital foundation On the basis of strict financial revenue and expenditure of public hospitals, we will gradually integrate government financial investment, social capital donation and medical insurance fund into the fund management of public hospitals, and control the total budget of public hospitals When social capital invests in and shares in public hospitals, it should adopt the way of donation to the foundation After donation, it should not interfere with the operation of the public hospitals, nor ask for the asset income from the public hospitals, while enjoying the returns such as tax credit and honorary title According to the regional health plan and the wishes of donors, the state gives priority to the use of public hospital funds for the development of grass-roots and central and western public hospitals The foundation of public hospitals should be supervised by the people's Congress, the government and the masses, so that the information is completely open and the revenue and expenditure are clear Third, we need to implement the government's responsibility for running hospitals and increase investment and supervision First, further increase government investment Adjust the income structure of the hospital, from indirect investment to direct investment, and from "supplement" to "supplement people" We will further promote governments at all levels to increase investment in public hospitals and reduce hospital drug and inspection revenues In particular, governments at and above the county level should increase financial transfer payments to support the reform of county and township level public hospitals In the short term, we can reduce the prices and expenses of drugs and inspections by adjusting the income structure of hospitals, appropriately increasing the prices and expenses of services Second, we should make overall use of government funds, better play the role of government investment, and change