Model report on medical reform 1
In order to thoroughly implement the spirit of the CPC Central Committee and the State Council on deepening the reform of medical and health system, further strengthen the construction of rural primary medical and health institutions, improve the primary medical and health service system, scientifically optimize the allocation of resources, fully understand and master the current situation of primary medical reform in * * county, and promote the healthy development of primary health work, the author conducted field research in Dongping, Yaoshan, Baihetan and other township (town) hospitals and some village clinics. Through watching, listening, checking and visiting, we can deeply understand the development status of primary health care, listen to the opinions and suggestions of primary medical institutions and the masses, and put forward opinions and suggestions on related work.
I. Basic information
(A) the status quo of primary health teams
There are 2 1 1 primary medical institutions in the county, including 9 township hospitals and 9 village clinics. There are 773 employees in the county health system (405 in county-level medical and health institutions and 368 in township hospitals), and 52 employees/person (269 in county-level medical and health institutions and 252 in township hospitals). Township health centers have 240 health technicians and workers 12; Eight people have bachelor degree, junior college degree 16 1 person, and 83 people have technical secondary school education or below; Senior title 1, intermediate title 16, junior title 52. There are only 0.89 health professionals per thousand people in rural areas, which is far below the average level of the whole city (2. 14) and the whole province (3.8). There are 426 rural doctors in the county. Among them, junior college education 1 person, technical secondary school and similar technical secondary school education 3 1 1 person, 78 people with short-term training and 36 people with junior high school education.
(ii) Infrastructure construction
Six township hospitals in the county 19 are equipped with ambulances, nine township hospitals are equipped with color Doppler ultrasound, Zhongzhai, Lead Factory, Jintang and Yaoshan are also equipped with biochemical analyzers and other medical equipment, and six township hospitals are equipped with X-ray machines. A few hospitals are equipped with appropriate Chinese medicine equipment and can provide appropriate Chinese medicine technical services; The village clinic is equipped with simple equipment such as sphygmomanometer, thermometer and stethoscope.
Second, the development of grassroots health work
(1) The reform of the medical and health system was comprehensively promoted.
Since the start of medical reform in June, 20xx, the county people's government has attached great importance to it, and set up a leading group for deepening the reform of medical and health system in * * county to formulate medical reform policies, study and formulate relevant supporting measures and methods, decompose and refine the objectives and tasks of medical reform, and promote the medical reform in the county as a whole.
1. The national essential drug system was successfully implemented.
20xx June, the county 19 township (town) health centers and 19 1 village clinics began to fully implement the national essential drug system. All township hospitals and village clinics are equipped with and use national essential drugs, and zero-difference sales are implemented. Medical institutions directly under the county level are equipped with and use national essential drugs in proportion. The national essential drugs used by medical institutions at the county, township and village levels are uniformly purchased and distributed online by the provincial centralized drug purchasing platform, and the government organizes medical institutions to equip and use essential drugs to achieve full coverage.
2. The level of equalization of public health services has been continuously improved.
* * In the first half of the year, the county established 5744 13 electronic health records of urban and rural residents, with a filing rate of 97.3%; A total of 596 health education publicity columns were set up, 83 health education publicity and consultation activities were carried out, 326 health education knowledge lectures were held, and 310.8 million health education publicity materials were distributed; Accumulate 0? 6-year-old children managed 37376 person-times, and newborns visited 1.9 1.4 person-times; A total of 2,079 prenatal examinations and 65,438+0,873 postpartum visits were conducted. A total of 46,478 person-times of health management were carried out for the elderly over 65 years old; A total of 35,740 people (including 27,754 hypertensive patients and 7,986 diabetic patients) received chronic disease management. A total of 738 cases of severe mental illness/kloc-0 were managed.
3. The medical and health service system has reached a new level.
First, the infrastructure construction of medical institutions has been steadily advanced. Dongping, Chongxi, Laodian and other hospital business buildings have been put into use. * * The newly approved five township hospitals (Hongshan, Zu Mao, Furnace House, Xindian and Mashu) started construction in May this year and are currently under construction. Second, the compensation policies of primary medical and health institutions have been effectively implemented. In * *, two documents, the Implementation Opinions of the People's Government of * * County on Establishing and Perfecting the Compensation Mechanism of Primary Medical and Health Institutions (Qiao [* *] No.9) and the Notice of the Office of the People's Government of * * County on Printing and Distributing the Implementation Plan of Separate Revenue and Expenditure Management of Primary Medical and Health Institutions (Qiao [* *] No.3), were formulated and issued, and the compensation mechanism of primary medical institutions was established, mainly through implementation? Two lines of revenue and expenditure? Management, to all township hospitals in the county to implement full financial allocation, to implement financial subsidies for rural doctors, to ensure that the monthly subsidy for rural doctors is not lower than that of 400 yuan, to build a solid primary health care service network.
(2) The key health work has been carried out steadily.
1. Disease prevention and control work was carried out in an orderly manner.
In the first half of * * year, through taking effective prevention and control measures, the prevention and control of major infectious diseases achieved remarkable results. First, six vaccine campaigns were carried out, and the vaccination rates of five vaccines (hepatitis B, BCG, polio, whooping cough, leprosy and measles) were all above 95%. By increasing the vaccination rate, the occurrence of target infectious diseases was effectively prevented. Second, strengthen the management of epidemic situation, further standardize the reporting of infectious diseases, and further curb the phenomenon of underreporting and misreporting; The third is to do a good job in tuberculosis prevention and treatment. In the first half of * * year, 53 cases of active pulmonary tuberculosis/kloc-0 were newly discovered, including 54 cases of smear positive, 87 cases of smear negative and 2 cases of severe smear negative/kloc-0, all of which have been brought under centralized management.
2. Maternal and child health care has developed steadily.
In * * years, it signed the responsibility book for health work objectives with township hospitals, collected the responsibility money for prevention and protection, and earnestly strengthened the management of maternal and child health care. At the same time? Reduce or eliminate? This project is a pioneer in strengthening maternal health care services. First, further reduce maternal mortality and infant mortality, and strive to improve the rate of hospital delivery of pregnant women. In the first half of the year, there were 3,053 hospital deliveries in the county, with a hospital delivery rate of 95.4%. The second is to organize implementation? Maternal and child health care program? . By June 30th, * * had completed 2,894 premarital checkups, and screened newborns for hereditary metabolic diseases 1804, with a screening rate of 58.2%, hearing screening 1937, with a screening rate of 62.5%, children health management of 43,903 and maternal health management of 3 198.
(3) The new rural cooperative medical system runs smoothly.
In * * * county, the financing standard of the new rural cooperative medical system is 380 yuan per person, in which farmers pay 60 yuan per capita, and the central and provincial governments support 320 yuan. The number of people participating in the new rural cooperative medical system in the county is 503,300, with a participation rate of 98.57%. The implementation plan of the new rural cooperative medical system has been adjusted and supplemented: First, supplementary insurance for serious illness has been added. The second is to improve the hospitalization capping line. The maximum amount of accumulated hospitalization compensation for participants in the whole year was raised to 380,000 yuan. Third, the new rural cooperative medical system is organically combined with medical assistance for serious illness and medical assistance for poverty, and the civil affairs department is jointly carried out with the county civil affairs bureau and the people's social security bureau? One stop? Medical assistance has effectively reduced the medical burden of the majority of participants.
Three. Difficulties and problems
(A) the construction of grassroots health talent team lags behind.
First, the staffing of township hospitals is seriously inadequate, and the medical service capacity cannot keep up with the people's demand for medical services. 19 There are 368 township hospitals, and now there are only 252 people, which makes the medical equipment and inspection equipment equipped in some township hospitals unattended and idle for a long time, resulting in disorderly waste of health resources and seriously affecting the improvement of medical quality and service ability. There are 1 18 temporary staff in township hospitals throughout the county, accounting for 46.8% of the regular staff. Although the prominent contradiction of the shortage of health personnel has been alleviated in a short time, it has also increased the economic burden of employers. Second, there is a shortage of professional and technical personnel. At present, there are only 240 health professionals in township hospitals. Due to the shortage of medical staff at the grassroots level, the phenomenon that doctors do not distinguish between doctors and nurses and doctors practice beyond the scope is serious, which leads to the low medical service ability and the difficulty for the masses to see a doctor has not been alleviated. Third, the structure of technical titles is unreasonable, the composition of academic qualifications is low, and there are many people without titles. As of June this year, there are 1 person, accounting for 0.04%, 12, accounting for 5%, 5 1 person, accounting for 2 1.2%, of which only 16. Only 64 people hold the qualification certificate, and 187 people have not obtained the qualification certificate, accounting for 77.9%. Most medical staff do not have qualification certificates, and there are legal risks. People with low professional titles and no professional titles have become the main force of primary health work. Fourth, the training of talents is not enough. Due to the serious shortage of personnel in township hospitals, it is difficult to send personnel to participate in the training of general practitioners and business backbones, and it is difficult to improve medical technology. Fifth, the aging of village doctors and the shrinking of the team will inevitably lead to the fault of village medical staff if the appropriate personnel cannot be replenished in time.
(B) talent introduction policies and mechanisms are not perfect.
First, because the talent introduction policy and incentive policy have not been effectively implemented, the threshold for talent introduction is high, the working environment of township hospitals is relatively difficult, and there is little room for professional exhibition (the latest investment investigation report of 20 16) and business promotion, most medical college graduates are unwilling to work in township hospitals, and the recruitment indicators are often not fully implemented. Some graduates quit after applying. Second, professionals? Can't recruit? 、? Can't stay? The loss of personnel with technical expertise is serious, and a few newly recruited health technicians have short post experience time and slow professional ability improvement. Third, the enthusiasm of the existing medical staff is not high, the treatment of grassroots village doctors is low, there is no social security, the team is unstable, and the problem of making friends by fault is becoming increasingly prominent.
(3) Policies and measures related to medical reform need to be improved and perfected.
Since the reform in 20xx, although some supporting policies for medical reform have been formulated, it is still not in place to deepen the implementation of comprehensive supporting reforms for medical reform. For example, the post appointment system, income distribution system, performance appraisal system, and management measures for the use of basic public health service funds are still not perfect, which leads to the low enthusiasm of grassroots medical staff to participate in medical reform. How to ensure the sustained, healthy and orderly development of hospitals, how to better mobilize the enthusiasm of medical staff, and how to provide more convenient, fast and cheap medical and health services for the masses need further follow-up and improvement.
(D) The ability of primary medical and health services is not strong.
First, the infrastructure and equipment construction of primary medical institutions is lagging behind, making it difficult to carry out effective medical and health services, which is not suitable for the current development of health work and the people's demand for medical services. Most township hospitals have been built for a long time, and their planning layout and functional settings are unreasonable, and some even become dangerous buildings. There are still 13 clinics in the county without business premises. In terms of equipment construction, most township hospitals are not equipped with X-ray machines, B-ultrasound machines and biochemical analyzers, and some towns that have been equipped have been aging and damaged due to long-term unmanned operation and improper management and maintenance. Second, the quality of medical care still needs to be improved and the medical order needs to be standardized. The medical staff's service consciousness is not strong, the service quality is not high, and the phenomenon of patient outflow is serious; Medical disputes occur from time to time, which is difficult to handle; There are many illegal medical practitioners in rural areas, so it is difficult to manage and crack down on illegal medical practice. Village-level health service capacity is weak, people's opinions are big, and satisfaction is low.
(E) There are weak links in the construction of medical ethics.
First, a small number of health technicians lack professionalism, professionalism and responsibility, and their service attitude is poor; Second, the service consciousness is weak, and there is a lack of communication with patients; Third, driven by economic interests, a few health technicians regard the pursuit of economic interests as the highest principle; Fourth, the medical ethics education and management of medical staff are not in place. These problems lead to the delay of some patients' illness and lack of timely and effective treatment, and even lead to medical disputes or accidents, which seriously damages the social image of the medical and health industry.
(6) It is difficult to supervise the new rural cooperative medical fund.
The first is the lack and deficiency of management system. The new rural cooperative medical system has no legislative support, the supervision mechanism has not been further established and improved, the supervision and management functions are not centralized, and the powers and responsibilities are not unified. Second, there are more patients and fewer management institutions, and the audit and settlement business is huge. Third, some medical institutions abuse drugs and use drugs irrationally. It has increased the burden on the masses to see a doctor, and also increased the burden on the new rural cooperative medical fund. Fourth, the supervision of village clinics is weak. Due to the large number and wide coverage of village clinics, it is extremely difficult to implement effective supervision.
(7) The system of essential drugs needs to be further improved.
The price of essential drugs is high and the distribution is not timely; Some drugs have been purchased many times because of their low prices and low dosage, but the distribution company said that they were out of stock and could not be delivered; Due to the different medication habits of different regions and doctors, the national and provincial essential drug lists can not fully meet the people's medication needs, and some commonly used drugs with good curative effect and people's dependence have not won the bid; Some drugs that won the bid on the Internet have great side effects, which have aroused people's opinions, and the medical services of township hospitals have also been affected to varying degrees.
Four. Comments and suggestions
(a) to strengthen the construction of grassroots health personnel.
First, in view of the fact that township hospitals in the county are seriously short of staff, speed up the establishment and improvement of the talent introduction mechanism. Simplify the procedures for talent introduction, appropriately lower the standards for talent introduction, and implement? Selection of employers and audit by personnel department? Access mechanism; Introduce preferential policies for talent introduction, and suggest giving preferential treatment in terms of salary and promotion of professional titles. , make people willing to come and stay; The second is to increase training. To carry out continuing medical education, support primary medical staff to participate in education to improve their academic qualifications, improve their ability and quality, and improve the level of medical services and academic qualifications; Do a good job in the training of grassroots public health personnel and the education of rural doctors' academic qualifications, and implement the education and training plan for rural doctors; Implement linked assistance measures, increase the counterpart assistance of health talents, and improve the ability of primary health care services.
(2) Improve relevant supporting policies for medical reform.
First, strengthen government responsibility and improve the input mechanism. Rural public health and basic medical services have the characteristics of public goods, and should be regarded as important public services of the government, adhere to the principle of public welfare, and establish a multi-input mechanism based on government investment. Adjust the focus of financial support to support public health, preventive health care, personnel training and infrastructure construction in township hospitals and village clinics. The second is to establish and improve a scientific and reasonable interest-oriented and performance appraisal mechanism, and tilt preferential policies to important front-line positions and people with outstanding contributions. The third is to standardize the drug procurement and distribution mechanism, strengthen the assessment and supervision of drug distribution enterprises, urge them to distribute drugs in time, efficiently and in full, improve the service quality of distribution enterprises, and meet the people's drug demand. The fourth is to establish a medical liability insurance system. Carry out medical liability insurance, establish a medical liability insurance system that combines risk transfer and dispute handling in line with the risk characteristics of medical practice in * * county, establish and improve the social sharing mechanism of medical risks, and adopt various channels and means to effectively resolve contradictions and disputes between doctors and patients. Fifth, strengthen the management of village doctors. Actively promote the integrated management of rural health, establish and improve the training and assessment system for rural doctors, and strengthen the management, training and assessment of rural doctors in strict accordance with the requirements of the Regulations on the Administration of Rural Doctors.
Sixth, establish and improve the normalization mechanism to crack down on illegal medical practice. County-level health supervision stations and township health supervision stations should earnestly perform their duties and intensify unannounced visits and supervision and law enforcement; In view of the characteristics that illegal medical practice is concealed and difficult to obtain evidence, we should vigorously publicize the dangers of illegal medical practice, actively collect clues, carry out normalization work, resolutely crack down on all kinds of illegal medical practices that endanger people's health, and standardize medical order.
(3) Efforts should be made to improve grass-roots service capabilities.
First, strengthen the infrastructure and equipment construction of primary medical institutions. The existing township hospitals and county finance should implement local financial matching funds to ensure that the projects under construction are completed on schedule; Pay attention to solving the housing shortage and dangerous buildings in some township hospitals, actively strive for construction projects, solve the dilemma of some village clinics without business premises, and strengthen the infrastructure construction of primary medical institutions. The second is to continuously strengthen the construction of medical quality. Further strengthen the management of medical personnel's professional behavior norms, actively promote the standardization of diagnosis and treatment, and conscientiously implement the clinical management rules and regulations, diagnosis and treatment nursing routines and technical operation norms formulated by the state, province and city; The establishment of medical quality assessment system, the implementation of regular medical quality assessment, timely find and solve problems in medical services; Strengthen the dynamic supervision of medical quality, continuously improve medical quality, reduce medical risks and ensure medical safety.
(4) Strengthen the fund supervision of the new rural cooperative medical system.
Further establish and improve the supervision and management system of the new rural cooperative medical system, the operation analysis and risk early warning system of the new rural cooperative medical system fund, and maintain the high-pressure situation of the new rural cooperative medical system fund supervision. Strengthen the supervision of designated medical institutions to ensure the safe use and maximum benefit of the new rural cooperative medical fund; On the basis of the original number of prescriptions approved by the number of service people, we will further explore and verify the number of prescriptions of the new rural cooperative medical system, ensure its scientific rationality, and prevent false prescriptions from taking the new rural cooperative medical system fund.
(5) Vigorously strengthen the construction of medical ethics.
First, carry out in-depth education on medical ethics. Carry out professional ethics education, carry out warning education and case analysis of medical disputes, so that medical staff can consciously establish their sense of responsibility, morality and law, and do their best to do their jobs. The second is to establish and improve rules and regulations and implement institutionalized management. Establish and improve the supervision mechanism of medical ethics, and do a good job of self-supervision and external supervision within the health industry; Constructing medical ethics evaluation system and doing well in medical ethics evaluation activities. Improve the standards and methods of medical ethics evaluation, and judge the behavior and activities of medical personnel or medical institutions according to standards and principles; Establish assessment files and link the assessment results with personal interests as an important basis for annual assessment, evaluation and selection, salary and bonus distribution and promotion.
(six) increase financial input to promote the overall promotion of rural health work.
The first is to promote the construction of disease prevention and control system. Continue to do a good job in monitoring, controlling and handling major infectious diseases and emerging infectious diseases such as AIDS, tuberculosis and viral hepatitis; Implement and expand the national immunization program, consolidate and maintain the coverage rate of rural immunization programs above 90%, and build a strong population immunization barrier; Promote the standardization of vaccination institutions, optimize the working environment and conditions of vaccination, and improve the quality of vaccination services; Adhere to the working idea of government-led, professional and technical institutions supporting and combining prevention and treatment, build a management platform for chronic disease prevention and treatment, and promote the in-depth development of chronic disease work; Improve the construction of rural public health emergency system and improve the ability to deal with major epidemics and public health emergencies. The second is to strengthen maternal and child health care. Is it well executed? Maternal and child health care program? Effectively reduce maternal and infant mortality, attach importance to obstetrics and pediatrics, strengthen maternal and child health care, and improve the basic quality of the birth population. The third is to strengthen food hygiene and safety management. Strengthen food risk monitoring, strengthen the supervision of centralized tableware disinfection enterprises, and actively carry out comprehensive health law enforcement supervision. Strengthen the training of health supervisors, improve the co-management mechanism of health supervision, expand the coverage of grassroots health supervision, and promote the overall improvement of health supervision level. Fourth, attach importance to the improvement of rural environmental sanitation. Focus on strengthening rural environmental sanitation, pay attention to the coordination between departments and towns, establish rural garbage disposal operation mechanism, improve rural garbage disposal facilities and improve processing capacity. Give full play to the participation of the masses, guide the establishment of good health habits, advocate a scientific, civilized and healthy lifestyle, improve rural environmental sanitation and improve the quality of life.