After the three-step process, it is generally possible to complete the task of changing the cage. A sign of a core, now the income structure of public hospital, the medicines and chemical reagents, supplies the materialized mainly income probably account for between 60% and 70%, truly reflect the labor value of technology of medical income is about 30%. If through this reform, in the framework of total revenue remains unchanged, or on the premise of normal growth, the income structure of the internal adjustment, which in turn can make drugs and consumables should be decreased to less than 50% of overall income accounted. Now some earlier reform region, such as fujian sanming drug proportion has been below 30%, and reflect the labor price income proportion by the past around 30% to 50% or even 60% now. This structure adjust, the hospital total income only on the basis of limited increase in inflation, the value of its earnings to increase, big part, can, in turn, to establish salary system in accordance with industry characteristics and job characteristics, to fully arouse the enthusiasm of the medical staff, so it really made it through this reform, make the operation of the hospital was not affected, make sustainable medical insurance fund, make people whole medical burden does not increase, and the hospital income a benign orbit.
Keep health net reporter: thousands of drug supply problems happened in guangdong province last week, I want to ask is what are the safeguards for drug shortage in 2017 the government? thank you
Liang:
The issue of supply protection for medicines has been an important task for healthcare reform. We are talking about the five institutions of health reform, one of which is the construction of a supply guarantee system for medicines. Recently, the state has issued about some advice to perfect the pharmaceutical production circulation use policy reform, puts forward new requirements for drug supply security, including the existing problems and put forward some concrete measures of reform, reform the key task in 2017, also put it as a very important one of the 56 task requirements across departments in accordance with the responsibility to accelerate reform.
Drug supply problems in the supply of security system is a key ring, the core problem is the guarantee drug can satisfy the demand, and to timely, ensure the quality at the same time. The relevant documents are clearly defined. Our country is larger, the type is much also, drug use is manufacturer, distribution enterprise also is more, our suppliers at the same time, the medical and health service system, we have a number of hospitals, including the number of clinics, clinics, can say is the most of the world. A system of supply and demand that is so large, and how to work together effectively, is actually a plan, and it will be better adjusted for reform.
In the area of supply, the key question is how to protect the medicines that are short of medicines and are vulnerable to shortages. Recently, the state health and family planning commission jointly with relevant departments to specifically study the problem of shortage of medicine supply security, the central deep reorganization also dedicated to the document has carried on the review meeting, this file will be printed and distributed in the near future. In fact, we in the drug supply security, must be to create a shortage of medicine supply security includes coping mechanisms, from how to find what kind of medicine is shortage, found that after carefully analyse the causes of it, for warning. After warning, according to its properties of graded response, including the classification, analyze the reason which is the productive result in shortage, which is the shortage of the cause of the price, what may be the reason for the seasonal shortages, which is the shortage of raw material supply problem. After analyzing the various causes, different ways of dealing with it are taken according to its scope and extent. So in general, must put the shortage of medicine supply security as an important task of the reform of this year, to ensure that we can ensure the timely supply of ordinary use.
China Radio International: we have noticed that this year's government work report offered to full implementation of public hospital reform, the abolition of all requires that all public hospital drug addition. We'd like to know what the requirements are.
Liang:
Fully opened the public hospital reform, all the abolition of all public hospital drug addition, it is a YingRenWu health reform in 2017, is this year premier li keqiang have put forward clear requirements in the middle of the government work report. As I said before, at the end of 2015, all county-level public hospitals had already pushed through the comprehensive reform of public hospitals, and of course the reform was progressing steadily. By the end of 2016, there have been 200 pilot cities in the country with comprehensive reform of urban public hospitals, and the remaining 138 cities, and this year we will implement comprehensive reforms. Among this year's health reform tasks has been clear about the two points: one is July 31 of this year, all the cities must be out of the city public hospital comprehensive reform of the implementation of the scheme. All across the country, the second September 30, urban public hospitals will cancel the drug addition (except traditional Chinese medicine yinpian), now we are in accordance with the schedule to advance.
Recently, the national health and family planning commission, ministry of finance, public sector, human resources, social security, the national development and reform commission, the state bureau of traditional Chinese medicine, health care do seven departments under the state council jointly issued a national guard restructuring hair [2017] 22 file, for the abolition of all opened the reform of public hospitals and drug addition to specific requirements are put forward. There are a lot of quantitative rules in this 22, and I will give you a brief introduction of what are the quantitative and hard requirements of the comprehensive reform.
One is the issue of charge. How to effectively control the unreasonable growth of medical expense of public hospitals, put forward clear requirements, is asking the country to all public hospitals of the total medical expenses to control the average growth rate under 10%. At the same time, we require the various provinces and cities to the increase in the cost index based on the actual decomposition to each of the cities, and then each cities to increase in the cost index decomposition to each medical institutions, the requirement of each medical institutions around the country, every place of cost growth ranking. Our country will also monitor, rank and report on the situation in different parts of the country. I am here to explain that we control the total cost growth has increased, the past is likely to be concerned about time we all office visit, the growth of the hospitalization expenses, but this time we transition to this area is the total cost you no more than 10% compared with that of last year. But the various medical institutions, may be some medical institutions do this a more patient, also have the needs of the development of, it can rise higher, but some can be lower, the decomposition by local, total amount control in 10%. Now we do grading diagnosis and treatment, for example, we may be hope grassroots medical institutions growth of medical expenses, and some big hospital medical costs increase must be down, overall assurance at the regional balance of below 10%. So central to the province, the province to decompose indicators according to different situations, according to the situation of different hospitals across to decompose indicators, we make a total requirement is 10%, this requirement just about all costs than in the past to further put forward the requirement of cost control.
Second, the comprehensive reform of public hospitals was carried out in addition to the total elimination of drugs. The national health and family planning commission (NHFPC) has 44 hospitals in 11 cities, with six directly under the state administration of traditional Chinese medicine. Us to the 50 committee belongs to the pipe, directly affiliated hospitals and put forward the request, must all take part in this year of public hospital reform, in accordance with the relevant local public hospital reform policy, including price, medical insurance, compensation, and so on policy to push through reforms. This year, Shanghai, tianjin has completed the reform, the reform in Beijing, state development planning commission committee belongs to who 11, the state bureau of traditional Chinese medicine directly under six, a total of 17 hospitals all participated in the Beijing's comprehensive reform. The management of the commission and the direct management hospital must be able to do well in the leading role.
Third, the requirements of the pilot cities for comprehensive reform of public hospitals in the first four cities were made. There were 17 pilot cities in 2010, including Shanghai, Beijing, shenzhen, luoyang and so on. By 2014, it expanded to 34 pilot cities, expanding to 100 pilot cities in 2015 and the fourth in 2016, with 200 pilot cities. We also made specific requirements for the pilot cities in the first four batches of urban public hospitals. For example, by the end of 2017, the first four batches of 200 pilot cities of public hospital medicine accounted (excluding Chinese medicine yinpian) to control at about 30%, medical income one hundred yuan income (excluding pharmaceuticals) in the consumption of health materials to reduce under $20. The proportion of drugs is the control of unreasonable drug use, the cost of 100 yuan medical income is the cost of controlling the unreasonable use of high-value consumables. In addition, the reform of the payment method was carried out, and the first four batches of 200 pilot cities paid for the reform, and the number of patients paid by the disease was not less than 100. Also has asked for information, which requires at least 60% of the basic-level medical institutions and the superior hospital established remote medical information system, implementing information unicom, for medical couplet body construction, telemedicine, counterpart support to provide information. At the same time, more than 20 percent of public hospital outpatient visits will be made in the pilot cities that require reform.
Four is the reform of public hospitals at the county level have all opened in 2015, but the reform is on the road, not saying to complete the reform, the reform of public hospitals at the county level that has been opened, we in the two, and puts forward some specific demands. For example, the reform of the payment method requires that this year be fully advanced in the form of complex payment methods, which are paid mainly by disease and by multiple payment methods. The core problem is to significantly reduce now pay by project to pay after make payment, change it to bed according to macro-reforms, capitation payment, according to pay, including the DRGs. In addition, we should further optimize the fee structure of county-level public hospitals, make the proportion of drug consumables fall further, and the price of labor technology will increase further. So do more to change birds in the cage.
In order to further promote the reform of public hospitals at the county level, country in 4 provinces and cities, also is the first comprehensive reform pilot provinces, anhui, jiangsu, fujian, the qinghai are chosen as a county as a demonstration county of the reform of public hospitals at the county level comprehensive, like anhui tianchang, qinghai, fujian city.when this mutual aid, as well as jiangsu qidong, these four counties and cities is a demonstration of reform of public hospitals at the county level. This year we have demands provinces also should make demonstration, each province should have a national demonstration, in wider range, to strengthen the demonstration leading role.
In addition, the reform of public hospitals in the city, we also require the provinces to choose corresponding cities to do demonstration of urban reform of public hospitals, countries on the basis of this, will select some cities as a national demonstration city public hospital reform, the goal is to play a leading role, demonstration play both the central and local governments. At the same time, encourage local bold exploration innovation, to overcome some obstacles of institutional reform and policy bottleneck, really let us reform as soon as possible in the broader benefit ordinary people.
Thank you.
County health reporter: China Liang Wannian priests, on May 5, 2017 health priorities, we put this task to communicate with the county hospital, dean of the most concerned about is how the 70 task from the policy text to carry out some of the action to the hospital. Conference just now before you begin, you also say that interprets the 2017 reform the work carries out "the implementation of the" two words, I want to ask is, how do we ensure that all the key tasks has been fully implemented effectively?
Liang:
In 2017, as the year of deepening the reform of the medical and health care system, it is an emphasis on how to make the task real and effective. Because of the ultimate goal of reform, we should make people feel better and improve the health of the people. So the document is well written, the task is deployed more, if it can't be done, maybe it's a piece of paper. So this is the theme of this year.
In order to do a good job in the health of the CPC central committee and the state council has always attached great importance to deepen the reform work, xi jinping, general secretary of deliberation by the session chaired a deep restructuring reform many times major policy files, listen to the health report, of major reform issues in policy decisions. Premier li keqiang has paid a lot of attention to the work of healthcare reform and has held regular meetings of the state council to study and deploy healthcare reform. Reform leading group leader liu yandong deputy prime minister personally leading health reform, many times to local in-depth research, dozens of health under the state council leading group meeting coordinated reform. The central committee of the party and the state council have all taken the implementation as an important requirement for advancing health reform.
In order to effectively implement all key tasks, we are the first to strengthen organizational leadership. My last year, the state united forward reform leading group of the state council on further promoting the deepening medical and health system reform of experience, several opinions on how to strengthen the reform of organization and leadership, strengthen the leadership system and propulsion mechanism, this paper introduced some place good practice. In 2017, the task of deepening reform of the health care law is clearly intended to promote the leadership of the leading group of leading party and political leaders of all regions. Up to now, 26 provinces have been led by the party committees and (or) the government's chief responsible for the health care leadership group. There are also places such as fujian, where health care, health care and medicine are run by a single leader, which is more conducive to the promotion of the three-doctor linkage.
The second is to emphasize the implementation of the division of labor. Reform tasks this year is different with previous years, written in the form of a pull dry article divided it into two large, first speak 14 files, out this year to lead the department is who must, when complete, clear request. The following are 56 key tasks, with clear requirements for the lead department, the participation department and the deadline for completion, which can be tracked, assessed, and accountable. Reform of the state council at the same time also in accordance with the reform of the state council leading group office request, build system of account, quarterly, semi-annual, annual monitoring, monitoring results timely notification and relevant departments around the country, press to complete the task.
The third is the emphasis on departmental synergy. Because healthcare reform is a comprehensive reform project, it is hard to push any sector alone. Unit to carry forward the reform leading group members of their respective advantages and major issues to study together, important policy must work in consultation with key experience to cultivate together, everybody to form resultant force. At the same time, we should give full play to the initiative of the central and local governments, and let local governments combine their own practice with bold innovation.
Fourth, we must grasp the supervision and supervision of the inspectors. From the central reform to the state council to the health care leadership group, the key tasks of the reform will be supervised and supervised every year. Reform leading group of the various departments, the health care priorities on the content of the supervision of the department, such as the national health and family planning commission, set up a committee leadership contact provincial system reform, each committee leadership for three to four links, each link province sent the corresponding health care experts, state development planning commission of a few cadres to the casing in the coordination, guidance and supervise the local implementation of the key reform tasks. The financial, social, and reform departments also have some concrete measures to ensure that the task of reform is being done.
The fifth is to focus on research. Once the task of health reform is clear, it will be implemented, but in the process of implementation, there may be new conditions and new problems. So how do you know if these problems exist in a timely fashion, and what are the reasons? Then work with the relevant departments and places to solve the problem. Issue, therefore, to strengthen guidance, to strengthen investigation and study, the new problems and new situations, collectively and timely research countermeasure, to solve, this is an important methodology of reform to promote.
The sixth is to do good publicity. That includes two levels, one level is to let the ordinary people and medical workers can really understand the reform policy, the reform of the basic goals, paths and methods, really understand the reforms, support, especially for medical workers to participate in the reform, really become the main force of reform. The second level, the reform of the participants, including the reform of the designers, practitioners, especially of hospital management, must be familiar with the reform strategy, path, specific methods and so on, to conduct a comprehensive training, and participate in the reform of departments at all levels and specific staff to be able to understand the policies of reform, it is very important. Finally, a good atmosphere for reform, reform, reform and understanding of reform was formed by the reform of the whole society, the reform of the medical staff and the reform of the reformers.
Finally, we need to promote experience. Reform is a complex thing that cannot happen overnight. In the process of reform, there will still be problems. The confidence of the reform must be firm, however, because of the CPC central committee and state council made the decision to deploy, we a few years ago it has been proved that the reform of the health reform direction is correct, the path is clear, the measures are effective, the effect is remarkable. So how to further boost the reformers and the broad masses of the people to deepen the reform of the confidence and determination, or want to some good practices and experience in the publicity, make less detours around, dry example, demonstration, on the basis of the typical demonstration leads at the same time, allow yourself to be integrated with the actual, can carry on the reform and explore creative, create more experience. In so many ways, the work of deepening reform in all areas of health care will go from bonsai to garden, from one side to the region and the whole country.
These are some of the important measures and strategies that we have taken to achieve this year's health reform. thank you
Host:
Time relations, one last question.
Health reporter: this question is the director of liang. As you mentioned earlier, when the hospital's income structure changes, it may give us a good opportunity to reform our compensation system. Is there any concrete measures to improve the income of health workers and motivate them to participate in the reform? There is also a question, as you mentioned earlier this year, the cost of control is the focus of the work, and the 10% index is also implemented in all areas. There have a problem, to the east in the central and western regions, because of their development, the basis of the charged fee will be for the west to improve the ability to produce some obstacle next? In addition, you mentioned fee to promote grading diagnosis and treatment, which is for primary or encourage them to develop, for tertiary hospitals may be held to strict control. The 3rd level hospital also wants to improve the patient structure, the more treatment is the difficulty of the disease, this is an oxymoron to charge of charge, is it? Please answer it.
Liang:
I will answer the question of the reform of the compensation system first, and one of the key tasks is to do a trial of the reform of the compensation system. The congress of the 18th national congress of the communist party of China, the third plenary session of the 18th CPC central committee and the fifth plenary session of the communist party of China (CPC), made clear the plan to study the compensation system for public hospitals that will accommodate the characteristics of the industry. Earlier this year, human resources and social security ministry, the ministry of finance, the state health and family planning commission, the state administration of traditional Chinese medicine four departments jointly issued a "about salary system reform of public hospitals will be carried out pilot work guidance", clear requirements in other comprehensive reform pilot provinces and other provinces have to pay for a certain number of city selected respectively pilot reform of the system. 11 comprehensive reform pilot province for example, each province to choose three city, other provinces except Tibet, each province to choose a city, the system of public hospital compensation reform, to explore the experience. Then, through a year or so of trial, the experience in the pilot area is summarized in time, and the guiding document of the remuneration system for medical and health industry is set up.
Salary system reform there are several key content, the first is the optimization of the structure of public hospital compensation, how to according to the situation of different public hospitals, including in the case of a public hospital internal different jobs, effectively according to the function orientation and responsibility requirements, establish a scientific and reasonable salary structure, it is pilot areas to explore.
The second is to properly determine the level of pay in public hospitals. Now the level of public hospital compensation for approval in accordance with the unified general institution is to do, but public hospitals, or the health care industry, there are a lot of its own characteristics, such as personnel training cycle is long, the intensity of labor is big, high professional risk, but also realistic of lifelong learning, etc. How do you characterize this industry? Especially in pilot areas around how to combine the actual, to implement the "two allowed", needs to have breakthrough in pilot areas, reasonable compensation for public hospital level. In total, the income structure is more scientific and reasonable, and the incentives for health workers are coming out.
Third can encourage local dean exploration, dean of the yearly salary reform of public hospitals, fujian, jiangsu, Shanghai, etc., now in some places have already made, in some places are going to do. The dean represents the government to administer the hospital, and the pay is directly disbursed by the government, which has nothing to do with hospital revenue. But the government to the dean to carry on the strict examination, the assessment results to and approved by the hospital total compensation levels, use this mechanism to let dean back to him on behalf of the government to manage the role of the hospital. Also in some places, implement it to the medical personnel, such as fujian sanming, practice is the goal of medical personnel releasing, but the goal it also wants to strengthen the inspection, implement of appraisal system. We also encourage pilot areas to explore experience in a variety of ways.
The fourth is to implement the allocation of autonomy in public hospitals. Total compensation once clear, how to allocate, how to reflect to the first-line staff tilt, how to embody the workload, work quality and people's satisfaction, how to completely cut off directly contacted with the medical staff and drug, check the revenue problem, is the need for public hospital full autonomy, the public hospital performance distribution measures according to the circumstance, should avoid "Commons". To strict examination, forbidden to revenue target required by the department and the medical staff, medical staff income shall not and medicine, health materials, large-scale inspection, testing and other business income.
The second problem is the effect of 10% on the three level hospitals and the impact on the Midwest. Around the first of all, from the national level, we put forward mainly at provincial level, in the whole public hospital medical expense control, the average growth rate no more than 10% this year, this is our request of provincial level. We have done some analysis, our country is very big, there are a lot of imbalance between the eastern, central and western, including the imbalance of health resources, imbalance of development, to master the technology does not balance, etc., it must be admitted. But on the other hand, our needs are unbalanced, the demand in the east and the needs of the people in the Midwest are unbalanced. So we consider the seller, the buyer and technology, the medical insurance fund, including people of multiple factors, put forward an index of less than 10% of the, this is after calculation and careful research, and after a period of practice, including reference to the international experience. The international level of control over the total amount of medical expenses is commensurate with the level of GDP growth and per capita disposable income. So shouldn't be because we put forward for the provinces after the total control target requirements, hindered the pharmaceutical and healthcare industry in the Midwest especially in the west, affects the benefit of people.
For tertiary hospitals of fee problem, in fact, you should feel this year, the 70 health reform task we have a very important point, is the whole of the medical and health service system by the single level of different types, different hospitals fight alone, disorderly competition, gradually integrate, forming a respective coordinated with each other to function as the core of the integrated service system. So this year on construction of couplet of hierarchical diagnosis and treatment, medical, including hospital function orientation, have put forward a clear goals and objectives and tasks, the purpose is to build integrated service system, make all kinds of hospitals at all levels to return to their own function orientation. Tertiary hospitals of medical and health service system in our country, has a pivotal role, to some extent, is the development of medical and health service system is a very important leading the charge. But we are not trying to reform the tertiary hospitals to prevent it from developing, or to promote its more efficient, scientific, and efficient development.
We have a very important purpose of the reform, is to make especially medical resources allocation of health resources by nabla into equilateral triangle in the past, now a lot of medical resources, especially the high quality medical resources, is in a big city and big hospital. High-quality resources in the above, it is bound to when people go to a doctor must follow resources, so want to let common people most of the common disease, frequently-occurring disease in basic solution, to promote high-quality medical resources through flow down. One is the incremental. To focus on increasing basic quality resources, so the task of strengthening the training of general practitioners, resident standardization training, shortage of talents training, etc., including general practitioners, at the grass-roots level. The second is the resources of the stock, the resources that have been made, and the resources that are available, to be able to flow down to the below. So the cure of couplet of building a very important purpose, is stronger at the grass-roots level, an important means, through the construction of couplet of medical, the quality of big hospital resources flow to the grassroots. The development of big hospital is necessary, but big hospital also cannot blindly develop, must return to function position to go up, the control charge of big hospital is necessary. But in the control cost of the whole system, the grass roots grow fast, the big hospital patients gradually come down to the bottom line, the total cost of the grass-roots unit is bound to increase. If it's a reasonable increase, it's true that the patient is coming back from the big hospital, and we're particularly welcome, and that's what our reform needs to be. In decline, while growing, one day, we ordered the formation of medical and health service system of equilateral triangle at the grass-roots level is 80%, 90% of the common diseases is the first option, then we can achieve the goal of reform. The ultimate beneficiary is two, one is the common people, the home is the cheapest and the most comfortable. The second is that the health system is more convenient, more scientific and more rational. This should be the direction of reform.
Thank you.
Host:
Thank you for your introduction and the interaction with the media. Thank you very much.
|
