1. The implementation of the essential medicine system brings new problems and suggestions.

There is a mismatch between the medication habits of grassroots doctors and the masses and the varieties and specifications of essential medicines.

Primary medical institutions in our county now use 505 essential drugs as required. Since the provincial bidding is for one standard and one product, and some drugs are not distributed in place, it is difficult to fully guarantee the supply of drugs. Some primary medical and health institutions sometimes experience short-term drug shortages.

, the reflection is relatively large.

Work suggestions: First, increase the training on the use of essential drugs for grassroots clinicians, and gradually establish medication habits that adapt to the essential drug system.

Carry out supervision and inspection on the standardized use of essential drugs, promote the rational use of essential drugs, and change clinical medication habits.

At the same time, we will increase the publicity of essential medicines to the masses so that they can fully understand and accept them.

The second is to strengthen the supervision of the implementation of essential drugs, conduct regular inventory and publicity of essential drugs in township health centers and village clinics, and investigate and deal with medical prescriptions.

Strictly supervise the implementation of essential medicines in each village clinic. If any violations are found, in addition to refunding overcharges or arbitrary charges and confiscating the purchased medicines, a fine of 3-5 times the amount of the overcharged or purchased amount will be imposed.

If he violates discipline again for the second time, his qualifications for engaging in public health services, implementing the basic drug system, and reimbursing outpatient accounts of the New Rural Cooperative Medical Care System can be cancelled, so as to form a working mechanism for strict management and heavy penalties.

Third, enterprises should strengthen the management of distribution links and establish integrity files for distribution enterprises. Once problems such as incomplete or untimely supply of essential drugs occur, corresponding sanctions should be imposed based on the liability for breach of contract of essential drugs purchase and sale contracts, depending on the severity of the case.

The fourth is to appropriately increase the varieties and specifications of essential drugs and the drug manufacturers that have won bids.

2. Problems and suggestions in the performance pay system of township health centers.

First, the performance management and assessment mechanism is imperfect.

To "assess tasks, determine revenue and expenditure, and provide performance appraisal subsidies" to township health centers.

This mechanism shows that government departments can accurately and reasonably evaluate and verify the task volume and completion status of township health centers.

This assessment mechanism has a high degree of compatibility with the characteristics of basic public health services, but a low degree of compatibility with basic medical services, and the incentives are obviously inefficient.

Second, there is a lack of incentive mechanism for township health centers.

According to the provisions of the "Performance Salary", regardless of the amount of service completed, the township health center can receive 60%-70% of the total performance salary, but it cannot receive any other reward income higher than the total performance salary. This kind of trust

The low-limit-high policy shows low incentives for township health centers and equates the high professional skills and high risk levels of medical personnel to those of other public institutions and industries.

Third, there is a lack of incentive mechanism for health personnel in township health centers.

Although the document requires "to give full play to the incentive-oriented role of performance-based salary distribution, the allocation of internal performance-based salary should be tilted towards public health services and clinical front-line." However, 30-40% of the product salary is not enough to widen the reward gap and mobilize

The enthusiasm of the business backbone.

Doctors do not have clear economic benefits and work tasks. Their work pressure is reduced and their work enthusiasm is reduced. Some grassroots medical institutions are unwilling to admit patients. As a result, some diseases that can be treated in local health centers are spent by ordinary people.

Money goes to higher-level hospitals for treatment, causing overcrowding in large hospitals. This conflicts with the original policy of promoting patients to go to primary medical and health institutions for treatment. The service level and capacity of primary health centers have also been weakened, which has aggravated the problem to a certain extent.

The problem of "medical treatment is difficult and expensive".

Work suggestion: Establish and improve the performance management assessment system of township health centers as soon as possible.

It is necessary to establish a performance appraisal system with service quantity, service quality and mass satisfaction as the core, fully embodying the principle of distribution according to work and more reward for more work.

At the same time, medical tasks should be reasonably determined and a mechanism should be implemented in which performance-based wages are guaranteed to be basic wages with no upper limit.

For clinical business, basic wages must be determined and paid while maintaining operations, and performance wages must be paid in excess of the amount for those who over-fulfill tasks.

Regarding the assessment of basic public health services, it is necessary to link public health funds to the assessment results. Based on the assessment scores, the assessment results of each grassroots medical and health unit are divided into four grades: excellent, qualified, basically qualified, and unqualified, and the funding subsidies are respectively

It will be distributed according to the approved standard subsidy + award funds, the approved standard subsidy, the approved standard subsidy × 90%, and the approved standard subsidy × 80%.

3. Problems and suggestions in the equalization of public health services.

First, the service capabilities of primary medical institutions are weak.

Due to limitations in service facilities, medical equipment, and technical strength of primary medical and health institutions, the public service functions that some primary medical and health institutions should undertake are not fully in place, affecting the effective development of services.

Second, some medical institutions and medical staff have the awareness that they emphasize clinical practice and neglect public health, resulting in a low level of emphasis on public health work.

At the same time, grassroots medical and health institutions use special public health funds for personnel and public expenditures, resulting in insufficient funding for public health services and affecting the development of work.

Work suggestions: First, improve the infrastructure and equipment of primary medical institutions, improve medical conditions, and enhance public health service capabilities.

Further increase efforts in talent training and introduction to improve the overall quality of the public health talent pool.

The second is to establish and improve the public health service evaluation system. The public's satisfaction with public health services should be used as a criterion for assessing performance. Satisfaction should be evaluated by service recipients, and basic public health services should be improved.

The efficiency and quality of health services must be strictly guarded against fraud.

The third is to strengthen supervision and supervision.

Conduct comprehensive inspections on the implementation of public health work in each unit every quarter to strengthen work guidance.