Paying attention to the income stability and effective incentives of medical personnel can be tilted towards medical personnel who are urgently needed by the masses and have a shortage of talents or who have been sent to the countryside in the internal salary distribution.
Recently, the Fujian Provincial Health Commission, the Provincial Party Committee, the Provincial Development and Reform Commission and other nine departments jointly issued the "Implementation Plan on Further Promoting the Construction of a Compact County Medical and Health Community" (hereinafter referred to as the "Implementation Plan") to further promote the construction of a close county medical and health community in the province, emphasizing that by the end of 2025, all county medical communities will meet the national close evaluation standards.
By the end of 2027, the operation mechanism of the county-level medical community management system in the province will be further consolidated, the three-level coordination of counties and villages will be more efficient, the county-level disease prevention and treatment and health management capabilities, and the county-level use efficiency of the medical insurance fund will be significantly improved, and the people's sense of gain will be further enhanced.
The "Implementation Plan" promotes the experience of Sanming according to local conditions, absorbs the practical experience of the construction of the medical community in Fujian Province, consolidates the county-level medical community that has been established in all counties (cities), clarifies the main objectives, main tasks and safeguard measures to further promote the construction of the county-level medical community, and further refines the external management, internal operation, improvement of services, and support policies of the county-level medical community, forming 17 key tasks in 4 aspects.
How to further improve the management system of county-level medical community?
The "Implementation Plan" further improves the management system of the county-level medical community from four aspects.
The first is to improve the promotion mechanism
Establish a promotion mechanism led by the county-level party committee, led by the government, and participated by various departments, with the county-level party committee or government leader serving as the convener, and the daily work of the promotion mechanism undertaken by the county-level health administrative department, improving support policies, implementing regulatory responsibilities, and consolidating the management and service responsibilities of county-level medical communities leading hospitals.
The second is to improve the layout of the county-level medical community
Consolidate the established county-level medical community and support the establishment of county-level medical community in municipal districts, and encourage and guide social forces to run medical institutions to join county-level medical community. Encourage county-level traditional Chinese medicine hospitals with conditions to take the lead in establishing county-level medical communities, and clarify that the legal personality and institution names of each member unit within the county-level medical community remain unchanged in principle.
The third is to establish county-level medical and prevention coordination
Establish and improve coordination mechanisms such as service integration and resource information sharing between county-level medical communities and professional public health institutions, and county-level public health professional institutions are responsible for technical guidance, operational training, supervision and inspection of county-level public health services, and explore effective forms of participation in the management and services of county-level medical communities.
Fourth, strengthen urban-rural linkage and rural integration
In terms of urban support for rural areas, the tertiary hospitals and the county-level medical community should be promoted through expert dispatch, specialist co-construction, clinical teaching, remote collaboration, scientific research and project collaboration, etc., and the urban public tertiary hospitals that carry out assistance should send at least 3 or more experts to the county-level medical community to provide guidance in medical treatment, pharmacy, nursing, management, etc. all year round.
In terms of counties and townships, the leading hospitals of the county-level medical community are required to send clinical and management talents to townships (streets) all year round through the forms of "branch package hospitals", joint wards, training and guidance, and county-level medical tours, so as to ensure that each township health center (community health service center) has at least one attending physician or above in the leading hospital to serve all year round.
What are the specific requirements for standardizing the internal operation and management of county-level medical communities?
The "Implementation Plan" puts forward specific requirements for standardizing the internal operation and management of county-level medical communities from four aspects.
The first is to improve the internal decision-making mechanism
Strengthen the construction of the party organization of the county-level medical community, implement the president responsibility system under the leadership of the party committee, and the team members of the county-level health administrative department can concurrently serve as the secretary of the party organization of the county-level medical community, and give play to the leading role of the party committee in setting the direction, managing the overall situation, making decisions, promoting reform, and ensuring implementation.
The second is to strengthen performance appraisal
The health administrative departments of districted cities or county-level cities are required to organize relevant departments to formulate annual task objectives and performance appraisal indicators of the county-level medical community, and carry out performance appraisal every year, and the assessment results are linked to the appointment and dismissal, salary, rewards and punishments of the main person in charge of the county-level medical community leading hospital, as well as the subsidy for public health services, the payment of medical insurance funds, and the approval of the total amount of performance wages. It is necessary to establish an internal assessment and incentive mechanism guided by the sinking of resources, and the assessment indicators are inclined to the sinking of resources, the dispatch of medical patrols, the signing of family doctors, and cost control. It is required to formulate a distribution plan for the retained income of the medical insurance fund and performance wages in each member unit, and clarify the distribution ratio of the retained income of the medical insurance fund in the member units.
The third is to strengthen internal unified management
Relying on the leading hospitals, three major management centers of the county-level medical community, including human resources, finance, and medical insurance, have been established. Coordinate the management of human resources at the county level, promote the rational flow of personnel, give priority to ensuring the employment needs of primary medical and health institutions, and ensure that grassroots general practitioners, traditional Chinese medicine physicians, public health physicians, pharmacists, etc. are in place as required.
Fourth, strengthen service quality management
Relying on the leading hospitals, two management centers for medical quality control and drugs (consumables) have been established. It is required to unify the rules and regulations and technical specifications, personnel training, quality control and other standards within the county-level medical community, strengthen the medical quality and safety management of the county-level medical community, improve the workflow and standards such as ward rounds, medical case management, prescription reviews, and inter-agency referrals, and strengthen the monitoring and evaluation of the quality of inspection and disease diagnosis. Formulate a unified drug catalogue within the county-level medical community, implement unified procurement and distribution, and pay for goods in a unified manner. Establish a drug shortage registration and distribution system, and promote the free flow of medical insurance prescriptions within the county-level medical community.
What are the measures to improve the overall medical and health service capacity of the county?
The "Implementation Plan" further improves the overall service capacity of the county-level medical community from five aspects.
The first is to improve the sharing of resources and services
Improve the county's six major resource sharing centers, including medical examination, medical imaging, electrocardiogram diagnosis, pathological diagnosis, disinfection supply, and remote consultation, and coordinate the establishment of five major clinical service centers in the county, including tumor prevention and treatment, chronic disease management, minimally invasive intervention, anesthesia and pain diagnosis and treatment, and intensive care, so as to improve the efficiency of resource allocation and use, and enhance service capabilities. Establish a county-level medical community information and data management center to promote the application of artificial intelligence-assisted diagnosis technology.
The second is to improve the service capacity of traditional Chinese medicine
Coordinate the county-level traditional Chinese medicine service resources, and accelerate the construction of "two specialties and one center" in county-level traditional Chinese medicine hospitals, shared traditional Chinese medicine pharmacies and traditional Chinese medicine distribution service projects. Strengthen the training of medical knowledge and skills at the grassroots level and the promotion of appropriate technology, and guide the grassroots to strengthen the construction of "Chinese medicine halls" and "Chinese medicine pavilions".
The third is to improve the capacity to respond to major epidemics and medical emergencies
It is required to improve the monitoring and early warning mechanism for infectious diseases in the county-level medical community, rely on the leading hospitals to establish a county-level emergency system covering urban and rural areas, strengthen the construction of primary medical emergency response teams, and improve the mechanism for the treatment of major epidemics at different levels and levels.
Fourth, expand the contracted service of family doctors
County-level general hospitals should set up general medicine departments, using primary medical and health institutions as a platform and relying on the village (community) grid to expand and implement contracted services for the general population and key populations. In the county-level medical community, the higher-level hospitals reserve more than 20% of the resources in terms of expert number sources, inpatient beds, and appointment examinations to give priority to ensuring patient referrals.
Fifth, innovate a new model of medical and prevention integration
Rely on the lead hospital to set up a health management center, improve the list of public health responsibilities of the county-level medical community, clarify the basic public health service responsibilities of the lead hospital, primary medical and health institutions, and professional public health institutions, and coordinate the use of medical insurance funds and public health service funds, so as to realize the effective connection of public health services and medical services.
What are the supporting policies for improving the construction of county-level medical community?
In terms of investment guarantee, operating costs such as personnel expenses and operating expenses are compensated through service charges and government subsidies, and at the same time, the new financial health expenditure is appropriately tilted towards primary medical and health institutions. Provincial-level finance subsidizes primary medical and health institutions through funds such as basic public health services, subsidies for the basic drug system, personnel funding guarantees for township health centers, and rewards for health technicians. Funds for the exploration of basic public health services are managed by the county-level medical community and the leading hospitals. The budgeted investment will increase support for eligible projects within the county-level medical community, and explore the establishment of a long-term mechanism for provincial-level subsidies for the construction of county-level medical communities.
In terms of personnel establishment, it is proposed to give more autonomy to the county-level medical community in terms of establishment and use, personnel recruitment, personnel arrangement, performance appraisal, and professional title evaluation.
The establishment and use of public medical and health institutions within the county-level medical community shall be managed by the filing system, and the leading hospital shall study and propose a plan for the preparation and use of the demand, which shall be submitted to the county-level health department for review and implementation, and shall be implemented after the establishment department of the institution at the same level has been put on the record. The county-level medical community promotes the "county management and township use" of health technicians in township health centers, and the "township hires village use" of rural doctors, appropriately increases the proportion of middle and senior professional and technical positions at the grassroots level, and the practicing (assistant) physicians in village clinics under integrated management can participate in the evaluation of professional titles.
In terms of salary, the implementation of the "two allows" requirements, reasonable determination of the internal salary structure, pay attention to the income stability and effective incentives of medical staff, can be in the internal salary distribution to the masses urgently needed and talent shortage professional or sinking to the countryside medical staff. Coordinate and balance the level of performance-based wages at the county and township levels, and reasonably regulate and control the income gap between all levels and types of medical and health institutions. Promote the implementation of an annual salary system for the heads of medical and health institutions within the county-level medical community.
In terms of medical insurance policy support, the first is to improve the medical insurance payment policy. Improve the mechanism of "lump sum lump sum, surplus retention, and reasonable overexpenditure sharing" of the county-level medical community, include the surplus funds in the medical service income of medical institutions, clarify the reasonable overexpenditure sharing boundary, and strengthen the assessment of the growth rate of medical expenses, the proportion of medical insurance reimbursement, the rate of primary medical treatment, the proportion of fund expenditure in the county, and the proportion of medical insurance funds of primary medical and health institutions in the county. Strengthen the internal supervision responsibility for the use of the medical insurance fund of the county-level medical community, and appropriately tilt the total budget of the county-level medical community led by the traditional Chinese medicine medical institution.
The second is to strengthen the coordination of medical security policies. When all localities are required to implement dynamic adjustment of medical service prices, they should coordinate and support the development of rural medical and health institutions, and for medical service projects with a high degree of homogeneity such as dressing changes, injections, infusions, and blood collection, the specific scope can be clarified, and the same price in the same city at the county level can be gradually implemented. Reasonably adjust the general diagnosis and treatment fees of village clinics, and connect them with the overall planning capacity of the medical insurance fund and the patient's affordability. The medical insurance reimbursement catalogue has added suitable health services in rural areas such as traditional Chinese medicine rehabilitation treatment and palliative care, simplified the application process, and gradually increased the proportion of service income of rural medical and health institutions.
Source: Huayi.com (Reprinted for sharing only, the copyright belongs to the original author.) If there is an error or infringement of the source, please contact us, we will correct and delete it in time, thank you! ）
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