BEIJING, May 11 (Xinhua) — regarding the topic of salary system reform in public hospitals, Liang Wannian, the full-time deputy director of the medical reform office of the State Council and the director of the Department of Physical reform of the National Health and Family Planning Commission, said on the 11th that to optimize the salary structure of public hospitals, encourage local governments to explore the reform of the annual salary system of public hospital presidents and implement the autonomy of public hospital distribution.
Data map: Li Kaizhi, a male nurse in hemodialysis room of Liuzhou Workers Hospital, Guangxi, is preparing for hemodialysis for patients. Zhu Liurong photo
Today, the National Health and Planning Commission held a press conference on special topics in May. At the meeting, a reporter asked that after the change of hospital income structure, it may provide a good opportunity for the reform of salary system. Are there any specific measures to improve the income of medical staff? Cost control is the key work this year. The Development Foundation of the eastern, central and western regions is different. Will it cause some obstacles to the next step of improving the ability of the western region? Cost control should promote graded diagnosis and treatment, and strict cost control may be required for tertiary hospitals. Third-level hospitals should also improve the patient structure and treat more difficult and complicated diseases. Is it contradictory to the cost control?
In this regard, Liang Wannian, the full-time deputy director of the medical reform office of the State Council and the director of the system reform department of the National Health and Family Planning Commission, said that one of the key tasks of the salary system reform is to make a pilot of the salary system reform. The 18th CPC National Congress, the third and fifth plenary sessions of the 18th CPC Central Committee all explicitly proposed to study and establish a salary system for public hospitals that adapt to the characteristics of the industry. At the beginning of this year, the Guiding Opinions on carrying out the pilot work of salary system reform in public hospitals were issued, it is clearly required that a certain number of cities should be selected for the pilot reform of salary system in the pilot provinces of comprehensive medical reform and other non-pilot provinces respectively. For example, in 11 pilot provinces of comprehensive medical reform, 3 cities are selected for each province, and in other provinces, except Tibet, one city is selected for each province to pilot the salary reform of public hospitals and explore experience. Then, through about one year’s pilot, we will summarize the experience of the pilot areas in time and begin to formulate guidance documents for the salary system of the medical and health industry.
He pointed out that there are several key contents in the reform of salary system.
— Optimize the salary structure of public hospitals, how to effectively according to the functional positioning and job responsibility requirements according to the situation of different public hospitals, including the situation of different positions in a public hospital, establish a scientific reasonable payment structure, which is to be explored in pilot areas.
— To reasonably determine the salary level of public hospitals. At present, the salary level of public hospitals is approved according to the unified regulations of general public institutions. However, public hospitals, or medical and health industries, have many characteristics, such as the long training cycle of talents, the labor intensity is high, the occupational risk is high, and the industry of life-long learning is also required. So how to reflect the characteristics of this industry? How to implement the “two permits” in all regions, especially in the pilot areas, in combination with the actual situation needs to make breakthroughs in the pilot areas and reasonably determine the salary level of public hospitals. The total amount has gone up, the income structure has become more scientific and reasonable, and the incentive effect of the salary system on medical personnel has come out.
-Local governments can be encouraged to explore the reform of the annual salary system of presidents of public hospitals. Now, some places in Fujian, Jiangsu, Shanghai, etc. have already done it, and some places are preparing to do it. The president manages the hospital on behalf of the government, and the salary is directly allocated by the finance, which has nothing to do with the hospital income. However, the government should conduct strict assessment on the president, and the results of the assessment should be linked to the approved general salary level of the hospital, and use this mechanism to let the president return to his role of managing the hospital on behalf of the government. There are still some places where the annual salary system is implemented for medical personnel. For example, Sanming in Fujian province implements the target annual salary system for medical personnel, but the target annual salary system should also strengthen the assessment, and there is a work-based system for assessment. In these aspects, we also encourage pilot areas to explore experience in various ways.
— To implement the distribution autonomy of public hospitals. Once the total salary is clear, how to distribute, how to reflect the inclination to front-line personnel, how to reflect the workload, work quality and the satisfaction of ordinary people, how to completely cut off the income and medicines of medical personnel, to check the problem of direct income linkage, public hospitals need to be given full autonomy. Public hospitals should formulate performance distribution methods according to the situation and avoid “big pot of rice”. Strict assessment should be carried out. It is strictly forbidden to issue income-generating indicators to departments and medical personnel. The income of medical personnel should not be linked to the business income of drugs, sanitary materials, large-scale inspections, tests, etc.
Regarding the impact of cost control on tertiary hospitals and the central and western regions, Liang Wannian said that from the national level, he proposed that all regions are mainly at the provincial level and in the control of medical expenses of the entire public hospitals, the average growth rate this year cannot exceed 10%, which is a requirement for the provincial level. There are many imbalances among the eastern, central and western parts of our country, including the imbalance of medical resources, the imbalance of development, the imbalance of technology mastered and so on, which must be admitted. But on the other hand, the demand of the eastern region and the demand of the common people in the central and western regions are unbalanced. Considering multiple factors such as supplier, demander, technology and medical insurance fund, including the bearing capacity of common people, an index of less than 10% is proposed, which is calculated and carefully studied, it is also a period of practice, including reference to international experience. The international control level of the total medical expenses is generally compatible with the growth level of GDP and the growth level of per capita disposable income of residents. Therefore, it should not hinder the development of medical and hygienical undertakings in the central and western regions, especially the western regions, and affect the benefits of the common people because of the general cost control target requirements for the provinces.
As for the problem of cost control in tertiary hospitals, he pointed out that among the 70 medical reform tasks, there is a very important direction, that is, to change the entire medical and health service system from a single different type in the past, hospitals of different levels fight alone and compete in disorder, and gradually integrate to form an integrated service system with mutual coordination and cooperation with each other with functional orientation as the core. Therefore, this year, we have put forward clear objectives, requirements and tasks for graded diagnosis and treatment, the construction of medical association, including the functional orientation of the hospital. The purpose is to build an integrated service system, let all levels and types of hospitals return to their own functional positioning. Tertiary hospitals play an important role in China’s medical and health service system and are a very important leader in the development of medical and health service system to some extent. However, the reform of tertiary hospitals is not to hinder its development, but to promote its more effective, scientific and efficient development.
He also said that a very important purpose of this reform is to make the allocation of health resources, especially medical resources, from the inverted triangle in the past to the positive triangle. Now many medical resources, especially high-quality medical resources are in big cities and hospitals. High-quality resources are on the top, and it is bound that ordinary people must follow the resources when they seek medical treatment. Therefore, to solve most common and frequently-occurring diseases of ordinary people at the grassroots level, it is necessary to promote the flow of high-quality medical resources through and down.
— Increment. It is necessary to focus on increasing the quality resources at the grassroots level. Therefore, in the task, strengthen the training of general practitioners, standardized training of resident doctors, training of talents in short supply, etc., including the special posts of general practitioners at the grassroots level.
— Existing resources, existing resources, do everything possible to make it flow below. Therefore, a very important purpose of the construction of medical association is to strengthen the grass-roots level. A very important means is to flow the high-quality resources of large hospitals to the grass-roots level through the construction of medical association. The development of large hospitals is necessary, but large hospitals cannot develop blindly. They must return to the functional orientation, which is necessary for large hospitals to control costs. However, in the control cost of the whole system, the grass-roots level has developed rapidly, and patients in large hospitals gradually go to the grass-roots level for treatment. The total cost of the grass-roots level is bound to increase. If it is a reasonable increase, it is true that patients come back from the big hospital, which is particularly welcome. The reform is the result that needs this.
He further pointed out that while decreasing, while increasing, one day, an orderly positive triangle medical and health service system will be formed, that is, 80%, 90% of the common diseases are first diagnosed at the grassroots level, which will achieve the goal of reform. The ultimate beneficiaries are two, one is the common people, the door to see a doctor, is the cheapest and most comfortable. The second is that the whole medical and health system is more convenient, scientific and reasonable. This should be the direction of reform.
3177
zhongxin.com, May 11, regarding the topic of salary system reform in public hospitals, Liang Wannian, the full-time deputy director of the medical reform office of the State Council and the director of the Department of Physical reform of the National Health and Family Planning Commission, said on the 11th that to optimize the salary structure of public hospitals, encourage local exploration of public hospitals