It is worth mentioning that the "Implementation Opinions" clearly mentioned at the beginning of the document: "Promote the leading comrades of local party committees and governments or a leading comrade to be the leader of the medical reform leading group and give full play to the overall coordination role of the medical reform leading group. The standing committees of party committees of all provinces (autonomous regions and municipalities) study medical reform at least once a year 1 time. 」
Xu Zhiluan, one of the core members of the medical reform leading group at the start of Sanming medical reform, once said that the commendable feature of Sanming medical reform lies in the strong leadership and strong support of previous party committees and governments, which not only fully trusted the medical reform leading group, but also fully authorized the medical reform leading group at some key nodes of the reform.
20 12 Before the start of Sanming medical reform, Zhan Jifu, then vice mayor of Sanming City, asked Deng Benyuan, then mayor, for the corresponding management rights: to change the situation that medical treatment, medical insurance and medicine were under the jurisdiction of different vice mayors and were in charge of medical reform by himself.
As a result, the decision-making power of Sanming medical reform moved from the previous municipal government executive meeting and the Standing Committee of the Municipal Party Committee to the municipal medical reform leading group.
Adjusting salary structure: giving full play to the function of salary guarantee
The reform of salary system in public hospitals has been mentioned again.
Article 7 of the Implementation Opinions mentions that it is necessary to implement the Guiding Opinions on Deepening the Reform of Salary System in Public Hospitals (Ministry of Human Resources and Social Security Fa [2021] No.52) and comprehensively deepen the reform of salary system in public hospitals.
It is required that "all localities should reasonably increase the total wages of public hospitals and reasonably determine the proportion of personnel expenses in the business expenses of public hospitals according to the requirements of" two permits "according to hospitals of different levels and different natures, after deducting costs from medical service income in that year and withdrawing various funds according to regulations. Promote public hospitals to reasonably determine the internal salary structure, pay attention to the stable income of medical staff, and give full play to the guarantee function of salary. 」
It is worth mentioning that Xu Shuqiang, director of the Department of System Reform of National Health Commission, pointed out that the proportion of fixed part in public hospitals should be gradually increased, and strive to reach about 50% by the end of the Tenth Five-Year Plan and 60% by the end of the Tenth Five-Year Plan.
(Click to view the previous report: One of the pilot tasks of high-quality development of public hospitals: fixed salary accounts for 60%)
In addition to adjusting the salary structure, the form of salary is also mentioned in the Implementation Opinions.
Article 20 of the "Implementation Opinions" clearly states: "Encourage all localities to explore and deepen the reform of the salary system in public hospitals in light of the actual situation, and explore salary forms such as annual salary system, post salary system, agreed salary system and project salary, gradually establish a salary system that reflects post responsibilities and knowledge value, and give full play to the effective incentive function of the salary system. Encourage and support local exploration of wage distribution policies that are conducive to mobilizing the enthusiasm of primary medical and health institutions. Give full consideration to the characteristics of Chinese medicine service and promote the reform of salary system in the field of Chinese medicine in combination with reality. 」
Regarding the implementation of the annual salary system and post salary system, Sanming's latest exploration scheme is the total annual salary, including the total basic annual salary and the total performance annual salary:
The basic annual salary approved standard is:
The chief physician's basic annual salary is 300,000.
The basic annual salary of deputy chief physician is 250,000.
The basic annual salary of attending physician is 200,000 yuan,
The basic annual salary of residents is 6.5438+0.5 million yuan;
The basic annual salary of technicians and pharmacists is 80% of the basic annual salary of doctors at the same level;
The basic annual salary of nurses is approved by 70% of the basic annual salary of doctors at the same level;
The basic annual salary of administrative logistics personnel is approved by 40% of the average basic annual salary of doctors;
The basic annual salary of village health clinic staff is 654.38+10,000 yuan.
When verifying the total annual performance salary, the total annual performance salary of public medical institutions shall be extracted according to 10% of medical service income, and linked to the annual performance appraisal results of the secretary (dean) and chief accountant.
It is worth noting that in the implementation of the six major engineering action plans to promote medical reform in Sanming City, the annual salary basis no longer distinguishes hospital grades, and the basic annual salary is all approved according to the titles of medical staff.
(Click to view previous reports: blockbuster exclusive! National medical reform to see Sanming! "Six Major Projects" Boost Sanming Medical Reform! )
The "Implementation Opinions" explicitly encourages qualified places to learn from Sanming's practice, reform and improve the assessment method of total wages of public hospitals, calculate the total wages of hospitals based on medical service income (excluding drugs, consumables, inspection and laboratory income), implement the target annual salary system for all employees, improve the performance appraisal system with integral system, informationization and openness, and safeguard the public welfare of public hospitals.
Expand the scope of centralized mining
The balance of the medical insurance fund for centralized procurement of pharmaceutical consumables shall be retained.
Articles 3 and 4 of the "Implementation Opinions" respectively mentioned the issues of expanding the scope of centralized procurement and retaining the balance of medical insurance fund for centralized procurement of pharmaceutical consumables.
Article 3 points out that "the centralized procurement of pharmaceutical consumables organized by the state should be normalized and institutionalized, and the scope of procurement should be gradually expanded, and efforts should be made to purchase more than 300 generic drugs by the end of 2022. By the end of the Tenth Five-Year Plan period, the number of generic names of drugs purchased by the state and provincial organizations in each province should exceed 500. Strengthen the procurement and inventory management of medical institutions to meet the requirements of centralized procurement with quantity. 」
At present, the first five national collections have covered 2 18 varieties (common names). Article 3 of the "Implementation Opinions" points out that "the number of generic drugs purchased will exceed 300 by the end of 2022", which means that nearly 100 drug varieties will be adopted by the state one after another.
In order to promote the smooth implementation of centralized procurement of drugs, encourage medical institutions to give priority to purchasing and using selected drugs, and encourage and mobilize medical institutions and doctors to participate in centralized procurement, Article 4 of the Implementation Opinions clearly puts forward: "Implement the policy of retaining the balance of medical insurance fund for centralized procurement of pharmaceutical consumables organized by the state. 」
It is worth noting that in the Opinions on Promoting the Normalization and Institutionalization of Centralized Drug Purchase issued by the General Office of the State Council in 20021year1October, the health department noticed the "national procurement" that had been carried out before in the generic name of drugs, and on this basis, it was put forward that "the joint procurement of drugs with different generic names but similar indications or functions should be carried out with centralized procurement".
This means that while expanding the scope of centralized mining, the competition for drugs or drugs is more intense and needs further follow-up.
Establish a dynamic monitoring system of medical service price
Article 5 of the "Implementation Opinions" proposes that before the end of June 2022, all provinces should issue relevant documents to establish a dynamic adjustment mechanism for medical service prices, scientifically set the starting conditions, trigger standards and constraints for medical service price adjustment, and stabilize price adjustment expectations; The medical service price items that meet the requirements will be included in the scope of medical insurance payment in time.
Article 6 proposes to strengthen the price monitoring and evaluation of public hospitals, accelerate the establishment of a monitoring system for the price, cost, expenses, income distribution and reform and operation of medical services in public medical institutions, and provide a basis for the dynamic adjustment of medical service prices.
16 proposes to optimize the management of new medical service price items, select some provinces to formulate measures for the management of new medical service price items, simplify the application process of new medical service price items, speed up the acceptance and review progress, clarify the processing time limit, and promote the innovative development and clinical application of medical technology; Explore and improve the price items of medical services.
Combining the above three items, the future medical service price will focus on the dynamic adjustment of service price, scientific evaluation, timely monitoring and project optimization. This puts higher demands on hospital administrators, and special attention should be paid to the quality and standardization of services.
Huang Zeng, director of the Medical Service Management Department of the National Medical Insurance Bureau, pointed out that "among the three major medical insurance catalogues, medical service is the most difficult one. 」
The establishment of sensitive index conditions and trigger mechanism can better solve the problems of expected management and price adjustment window, and avoid the situation of "long-term immobility and sudden movement"
This not only avoids the blindness and randomness in the adjustment process, but also prevents the occurrence of "abnormally high or abnormally low prices" through monitoring. The relevant person in charge of the National Medical Insurance Bureau said earlier that the price monitoring and evaluation will expand from the simple observation and discovery function to a certain supervision and management function, providing institutional guarantee for the effectiveness and long-term vitality of the reform.
For public hospitals, on the one hand, the reform of medical service price and dynamic monitoring mechanism is helpful to improve the reasonable income and enthusiasm of medical staff; On the other hand, hospital managers also need to open their eyes and pay attention to medical services with high clinical demand and strong clinical effect.
According to the introduction of the health department, Hunan Province took the lead in establishing a monitoring and evaluation system for the dynamic adjustment of medical service prices in China. The evaluation indicators cover regional social development indicators, medical development indicators and medical insurance operation indicators. According to the difference between the pricing cost and the medical service price, select the medical service items and adjustment range that need to be adjusted, and determine whether and how to adjust the medical service price in this region.
The last year of 200 pilot cities
Article 8 of the "Implementation Opinions" proposes to deepen the reform of medical insurance payment methods, implement multiple compound medical insurance payment methods based on disease types, gradually reduce the proportion of medical insurance fund payment by project, and increase the proportion of medical insurance payment methods such as group payment according to disease diagnosis, payment according to disease types, payment by bed day, and outpatient payment by head. By 2025, the proportion of medical insurance funds grouped by disease diagnosis or paid by disease type will reach 70% of all eligible hospitalization medical insurance funds.
17 proposes to accelerate the reform pilot projects related to disease diagnosis, such as paying by group, total budget of regional integration method and paying by disease points. Before the end of 20021,all pilot cities will enter the actual payment stage, sum up their experience in time and promote it throughout the country. Encourage the exploration of payment methods that meet the characteristics of Chinese medicine services.
Earlier, Huang, director of the Medical Service Management Department of the National Medical Insurance Bureau, introduced at the policy briefing that in 2065438+2009, the National Medical Insurance Bureau launched DRG payment pilots in 30 cities across the country. At present, all 30 pilot cities have entered the simulation operation, and some cities have already started the payment work. In addition, since 2020, 7 1 cities across the country have started the DIP payment pilot. At present, 765,438+0 pilot cities have all completed pre-grouping. So far, there are more than 200 DRG and DIP pilot cities in China, and the actual payment will be made on 202 1.
In other words, 202 1 is the closing year of DRG and DIP pilot, and it is also a crucial year to sum up the pilot experience and promote it to the whole country.
DRG and Dipper have different positions and grouping principles, and each has its own advantages and disadvantages. As a more advanced payment system than the traditional "payment by project", the multi-compound medical insurance payment method based on diseases is helpful to realize the important transformation of "payment by value" in medical insurance.
In this process, it may lead to phenomena and problems such as insufficient application of new technology, insufficient diagnosis and treatment, and insufficient compensation for critically ill patients. In the future, it may be circumvented by establishing a reasonable system.
For example, for innovative technologies that meet clinical needs, first choose "pay by project"; Encourage the attempt of clinical pathway and strengthen the evaluation of medical quality; For truly critical patients, different payment standards are adopted.
For public hospitals, under the background of the reform of medical insurance payment method, the profitable business that once paid by project may become the operating burden of the hospital, so the hospital will be forced to carry out disease cost accounting.
Future public hospitals need to find their own position, not only paying attention to medical efficiency, but also paying attention to operational efficiency.
On the one hand, pay attention to medical quality and technological innovation to achieve a win-win situation of economic and social benefits; On the other hand, inspired by the "surplus retention" of doctors in compact county, we should be good health gatekeepers at the grassroots level.