Notice on printing and distributing the key points of deepening the reform of medical and health system in Shanghai in 2015

Source: Shanghai development and Reform Commission, 2015-2-26, Shanghai development and reform medical reform [2015] No 2, member units of the leading group of medical reform of Shanghai: key points of deepening the reform of medical and health system in 2015, reviewed at the plenary meeting of the leading group of medical reform of Shanghai on January 6, 2015, and approved by the municipal government, are hereby printed and distributed Please implement them carefully Shanghai Leading Group Office of medical and health system reform (seal of Shanghai development and Reform Commission) February 16, 2015 key points of deepening the reform of the medical and health system of Shanghai in 2015 The final year of the plan is also the key year to implement the spirit of the third and fourth plenary sessions of the 18th CPC Central Committee and comprehensively deepen reform Two thousand and fifteen In order to deepen the reform of the medical and health system in this city, we should continue to adhere to the basic path of overall arrangement, highlighting the key points and advancing in order, increase the work intensity, strengthen overall coordination, adhere to the guidance of the major problems reflected by the masses, and promote the construction of the hierarchical diagnosis and treatment system, the reform of the separation of medicine and medicine, the reform of the personnel salary distribution system, the comprehensive reform of community health services, and the elderly Focusing on the construction of medical and nursing service system, we will further promote the linkage of medical treatment, medical insurance and medical treatment, and comprehensively promote relevant special reforms Now we propose the key work of deepening medical reform in 2015: first, we will formulate the 13th five year plan for deepening medical and health system reform, thoroughly implement the overall requirements of the national and municipal medical reform, and work out a new round of national medical reform 2020 Based on the in-depth evaluation and summary of the effectiveness of deepening the reform of the medical and health system during the 12th Five Year Plan period, the existing problems and the situation faced were analyzed, and the 13th five year plan for deepening the reform of the medical and health system in Shanghai was prepared and completed 2016-2020 was proposed In, the main objectives and key tasks of deepening the reform of the medical and health system in the city guided the work of deepening the reform of the medical and health system during the 13th five year plan The planning work should focus on reform and innovation, adhere to problem orientation, reflect the characteristics of the times and correctly grasp the relationship between the government and the market, strive to make the planning deeper and more practical, and enhance the operability of the planning According to the node requirements for the preparation of the 13th five year plan of the city, the first draft of the 13th five year plan for medical reform will be formed by the end of March 2015 and submitted to the office of the 13th five year plan leading group, and the draft of the 13th five year plan for medical reform will be formed by the end of September, and completed by the end of December The connection between the outline of the master plan, the 13th five year plan for deepening the reform of the medical and health system, and the 13th five year plan for the development and reform of the city's health and family planning (leading department: Municipal Medical Reform Office, cooperating Department: member units of municipal medical reform leading group) II Coordinate and promote five key reforms Strengthen the top-level design, take promoting the construction of hierarchical diagnosis and treatment system and the separate reform of medicine as the key, deepen the reform of personnel salary distribution system and the comprehensive reform of community health service as the basis, accelerate the construction of elderly medical and nursing service system as the support, step by step promote the pilot, summarize the experience in time, and lay a good foundation for building a basic medical and health system covering urban and rural residents Foundation 1 Promote the construction of hierarchical diagnosis and treatment system The first is to strengthen the contracted services of family doctors Give priority to meeting the signing needs of the elderly over 60 years old and residents with chronic diseases To explore the signing of contracts between residents and "1 + 1 + 1" medical institutions (1 family doctor of community health service center, 1 District Hospital, 1 Municipal Hospital) Second, strengthen the health management of family doctors to the contracted residents Based on the electronic health records, family doctors should regularly assess the health of the contracted residents, manage the contracted residents by categories and provide targeted services Third, establish an orderly diagnosis and treatment order under the family doctor system Endow the family doctors with certain health resources, guide the contracted residents to give priority to the use of family doctors' diagnosis and treatment services, and gradually realize the designated treatment and the first diagnosis in the community by giving priority to the contracted residents, smooth two-way referral, long prescription for patients with chronic diseases, ensuring the continuity of therapeutic drugs after referral, medical insurance and price concessions Fourth, increase the support of medical insurance to family doctor system Explore the establishment of medical insurance cost management and evaluation mechanism based on contracted services, and strengthen the responsibility of family doctors to manage contracted residents' medical insurance costs Fifth, improve the working mechanism of secondary and tertiary hospitals to support grassroots communities 2、 Third level hospitals should reserve a certain number of expert numbers, designate departments or special personnel to connect with family doctors' referral services, and establish green referral channels for referral patients, so as to increase the support for basic medical institutions In 2015, some districts and counties were selected to carry out pilot projects (leading departments: Municipal Health and Family Planning Commission, municipal medical insurance office, Shenkang hospital development center, supporting departments: Municipal Finance Bureau, Municipal Price Bureau) 2 Steadily promote the reform of medical separation First, on the basis of the implementation of the pilot work of "volume procurement" in 2014, according to the pilot situation, timely identify problems, study and expand the scope of pilot varieties, and further enlarge the policy effect of "volume procurement" The second is to learn from the general practice of GPO, select some varieties and self funded drugs that are not subject to centralized bidding within the scope of medical insurance catalog, and promote the reform of drug group procurement mode and medicine separation The third-party drug group purchasing organization (GPO) is explored to give full play to the market advantages GPO is entrusted by medical institutions to establish a joint negotiation mechanism, optimize the drug supply chain, reduce the virtual high space of drug purchase price, and reduce the total cost of drug supply In 2015, pilot projects were carried out in four new suburban hospitals and mature districts and counties Third, we should gradually implement the policy of canceling drug markup, cut off the drug interest chain and curb the "drug corruption" by increasing the price of a batch of medical services, improving the compensation mechanism and other comprehensive measures (leading departments: Municipal Health and Family Planning Commission, municipal medical insurance office, Municipal Price Bureau, cooperating departments: Municipal Finance Bureau, municipal food and drug administration, Shenkang hospital development center) 3 Deepen the reform of personnel compensation distribution system First, we will further improve the standards for the establishment of public hospitals, scientifically and reasonably verify the staffing of public medical institutions, improve the personnel management system with the employment system and post management as the main content, optimize the personnel structure, and strengthen the strength of medical personnel Second, under the overall framework of the performance-based pay reform of the state and the city, we will explore and study the reform policies of the pay system that reflect the characteristics of the health industry, establish the income distribution mechanism of medical personnel based on performance appraisal, adjust the internal distribution mode, and further reflect the technical service value of medical personnel In 2015, pilot projects were carried out in public hospitals and community health service centers that are ready for reform (leading departments: Municipal Health and Family Planning Commission, municipal human resources and Social Security Bureau, Municipal Finance Bureau, supporting departments: municipal medical insurance office, municipal development and Reform Commission, Municipal Price Bureau, municipal editorial office, Shenkang hospital development center) 4 Deepen the comprehensive reform of community health services We will promote the implementation of the guiding opinions on further promoting the comprehensive reform and development of community health services in this city and eight supporting documents, select 20-30 community health service centers as the first batch of pilot projects, steadily promote the pilot projects, timely track and evaluate them, and ensure the implementation results Through the system design and mechanism adjustment of community health service, we will consolidate and improve the network base of community health service, and build the community health service center as a platform for the government to perform basic public service functions and protect the basic health rights and interests of residents (leading department: Municipal Health and Family Planning Commission, cooperating Department: Municipal Human Resources and Social Security Bureau, municipal medical insurance office, Municipal Finance Bureau, Municipal Price Bureau, municipal editorial office, Shenkang hospital development center) 5 Accelerate the construction of elderly medical and nursing service system The first is to speed up the development of the elderly medical and nursing service system and promote the construction of the leading elderly medical center in Shanghai through the combination of government guidance and market mechanism Second, give full play to the positive role of market mechanism in the construction of elderly medical and nursing service system, encourage social capital to participate in the construction of elderly medical and nursing service system, and expand the supply of resources Third, we should strengthen the integration of medical and nursing services and resources, and establish an orderly connection mechanism for elderly care, elderly care and elderly care services Fourth, we will step up the adjustment of existing resources and gradually turn the treatment beds in the community health service center into medical and nursing beds for the elderly The fifth is to carry out mid-term evaluation, modify and improve policy measures, and expand the scope of the pilot Sixthly, we should continue to promote the establishment of nursing stations and other nursing institutions, strengthen the establishment and cultivation of nursing teams and the skill training of nursing staff (leading departments: Municipal Health and Family Planning Commission, municipal medical insurance office, supporting departments: Municipal Development and Reform Commission, municipal human resources and Social Security Bureau, Municipal Price Bureau, Municipal Finance Bureau, Municipal Civil Affairs Bureau, Shenkang hospital development center) 3 Further promote relevant special reforms 1 Promote the reform of public hospital system and mechanism by layers We will continue to promote the reform of the city's public hospital system and mechanism at the level of District, county and city hospitals First, according to the requirements of 13 operational guidelines for the reform of public medical institutions in districts and counties, strengthen supervision and guidance, and promote the establishment of a new mechanism for the management and operation of public medical institutions in districts and counties Second, we will continue to deepen the pilot reform of four new suburban hospitals, timely adjust and improve reform policies such as the management system, government input compensation mechanism, operation mechanism, evaluation and supervision mechanism, and explore the establishment of a target model and evaluation index system for the reform of public hospitals The third is to summarize the successful experience that can be replicated and popularized in the system and mechanism reform pilot of four new hospitals in time, and timely push forward some reform measures that have achieved good results in general and municipal hospitals; at the same time, continue to deepen the general reform of municipal public hospitals, and promote the "transformation of mode, structure and mechanism" of municipal hospitals (leading departments: Municipal Health and Family Planning Commission, Shenkang hospital development center, supporting departments: Municipal Human Resources and Social Security Bureau, municipal medical insurance office, Municipal Finance Bureau, Municipal Price Bureau) 2 Improve the government compensation mechanism of public hospitals The first is to summarize the pilot experience of implementing comprehensive budget management system in four new suburban hospitals and explore the promotion in some municipal hospitals We will further deepen the overall budget management of public hospitals, strictly enforce budget implementation, strengthen budget constraints, and strengthen financial management and accounting Second, we should strengthen the management of public hospital financial project expenditure, improve the evaluation and demonstration mechanism of project expenditure and the way of financial subsidies, and improve the efficiency of financial funds Third, actively study the financial compensation scheme after the transition period of four new institutes, and deepen the pilot of comprehensive reform of four new institutes Fourth, consolidate the economic operation and internal management foundation of public hospitals, focus on the establishment and improvement of cost management and internal control system, strengthen cost accounting and cost control by means of information technology, and solidly promote the scientific refinement of public hospitals