Beijing publicizes medical reform measures and reforms the "hard bones"

The reform of public hospitals has been regarded as the most difficult “hard bone” due to the adjustment of the interests of various parties involved. The Beijing Hospital Authority recently announced the public hospital reform measures: pilot drug division; the government appraisal president, social satisfaction will affect the president's "position", etc. These explorations are to standardize medical behaviors and solve the problem of "seeing a doctor to see a doctor". The question is of positive significance.

Pilot "Pharmaceutical Separation" Contains "Big Prescription"

"Government expensive" makes "taking drugs to support medical care". Beijing will continue to promote the reform of public hospitals in Beijing during the "Twelfth Five-Year Plan" period. "Separation of medicines" will be the highlight of this year's medical reform. In accordance with the rhythm of promotion after the pilot, gradually eliminate the “adjustment” of drug addition in public hospitals and reform the mechanism of “taking drugs to support medical care”.

The Beijing Municipal Medical Management Bureau is responsible for the personnel, affairs and asset management of 22 public hospitals in Beijing. Mao Yu, deputy director of the Beijing Municipal Medical Management Bureau, said that this year Beijing will use the two municipal general hospitals as the first "pharmaceutical separation" pilot hospitals, and the two pilot hospitals are developing specific implementation plans.

Zhou Zijun, a professor at the Peking University School of Public Health, said that outpatients do not take medicines from hospitals, but use prescriptions to go to retail pharmacies to purchase medicines. Such "medical separation" is a common practice in many countries. In China, the income of pharmacies has become an important source of income for the normal operation of hospitals. This is "taking drugs to provide medicine." It is seen as a catastrophic illness that causes "expensiveness".

The medical experts pointed out that China’s current policy of 15% drug addition was established in the 1950s. Although it was considered that hospital losses should be supplemented by the state’s financial resources, due to the limited financial resources of the state, it is impossible to give such subsidies to hospitals. This policy has been formulated so that hospitals can increase some of their income by selling medicines to supplement the losses in hospital operations.

Zhang Jian, deputy dean of the Beijing Friendship Hospital, said that the policy of “taking medicine to support medicine” has been formed in history. Currently, the drug plus mark has become the “professional rule” for hospitals. The funding source of public hospitals mainly includes government financial input, medical service income, and drug plus Three aspects of income. After "medical separation", that is, canceling the 15% increase in medicines, there will be no relationship between the hospital's income and the prices and quantities of medicines. That is, how many varieties and how many medicines are used in a hospital has nothing to do with the income of this hospital.

Han Xiaofang, director of the Beijing Municipal Medical Reform Office, said that cancelling 15% of drug additions is only part of the “separation of medicines.” “Separation of medicines” is to turn the original hospital’s three channels of relying on medical expenses, medical service fees, and financial input into relying on medical services. The two parts of cost and financial investment are the adjustment of the income structure and interest mechanism. This change will make the "prescription" and non-standardized use of drugs disappear.

Zhang Jian, deputy dean of the Beijing Friendship Hospital, said that the hospital's drug additions revenue accounted for about 14% to 15% of the total hospital revenue in 2011. If you cancel the drug addition, you hope other aspects of compensation can keep up to ensure the normal operation of the hospital. And healthy development. Similarly, Tian Wei, president of the Beijing Jishuitan Hospital, said that in advancing the “separation of medicines”, he hopes the government will adjust the prices of medical services. The current medical service fee standards do not reflect the labor value of medical personnel.

With the cancellation of drug additions, the price of medical services will also be adjusted. The "12th Five-Year Plan" of Beijing's health just announced clearly stated that it is necessary to establish a reasonable mechanism for the formation of medical prices and adjust the prices of medical services so that they can fully reflect the labor value of medical workers.

The government will give full compensation to hospitals in seven areas, including the basic construction of public hospitals, purchase of large-scale equipment, development of key disciplines, retired personnel costs in line with national regulations, compensation for policy losses, and public health commitments. Tasks, as well as guarantees for government-designated emergency services such as emergency treatment, disaster relief, foreign aid, support for agriculture, support for borders, and support for community services.

"For the sake of prudent consideration of 'separation of medicines', pilots will only be conducted in a small area, but progress will be very rapid. Once the pilots are successful, they will be pushed open immediately," Han Xiaofang said. Mao Yu said that the Hospital Authority will guide and inspect the implementation of the hospital, monitor the dynamic changes of the pilot hospitals after the “drugs are separated,” and coordinate the relevant committees and offices to implement and adjust the supporting policies in a timely manner so as to cancel the goal of “remedying medicine”. In addition, Beijing will start the unified procurement of medicines in municipal hospitals this year, and will purchase certain types of commonly used drugs to further reduce drug prices.

"'Dividing medicine' means that doctors can use technology to serve 'eating'. Simply put, it means that the income of medical staff is linked to their skills, ability, level, job title and working time, instead of being linked to drug additions and 'big prescriptions'. Zhou Zijun said that this is conducive to curbing "big prescriptions" and alleviating the problem of "expensive medical treatment."

Government appraisal president’s social satisfaction influences the president’s “position”

The public’s satisfaction with the hospital may affect the “position” of Beijing’s public hospital chief. The Beijing Municipal Hospital Authority announced on the 9th the new performance appraisal system for public hospitals. Satisfaction from the people is not the most important criterion for evaluating hospital performance. If the hospital's annual performance assessment fails for two consecutive years, the hospital director and secretary of the party committee will be removed from office.

The Beijing Municipal Hospital Authority announced on the 9th the “Measures for Annual Performance Evaluation of Municipal Hospitals of the Beijing Municipal Hospital Authority (Trial)” (Draft for Comment). Mao Yu, the deputy director of the Beijing Municipal Medical Management Bureau, said that in 2012, 22 Beijing-owned public hospitals under the management of the Beijing Municipal Hospital Authority will be evaluated in accordance with the above measures. This is the first time that the government has tried the government's mechanism for assessing hospital directors.

The assessment index system divides quantitative indicators and qualitative indicators into two categories, each with 100 points. The hospital's annual performance appraisal results are calculated by the percentage system, quantitative assessment accounts for 70%, and qualitative assessment accounts for 30%. Social satisfaction in the quantitative indicators accounted for 56 points, including specific items such as patient satisfaction, medical expenses control, and appointment consultation rates. Mao Yu said that this assessment system takes the satisfaction of the masses as the most important criterion in judging the performance of hospitals. There are seven indicators that reflect social satisfaction among the 10 core indicators, aiming to solve the problem of “difficulty in visiting the doctors” and expensive “unsafe for medical treatment”. And other issues.

Beijing Tongren Hospital and Jishuitan Hospital, on behalf of other public hospitals in Beijing, signed a “military order” with the Beijing Municipal Health Administrative Bureau—the responsibility for hospital performance evaluation. The reporter saw that the assessment method clearly stipulates that the hospital performance appraisal results serve as the basis for the payment of hospital performance salaries, and is an important basis for the selection and appointment of hospital directors and party committee secretaries and the training of education.

Wei Jiang, deputy secretary of the Beijing Municipal Medical Management Bureau, introduced that the performance pay of the president of the public hospital and the secretary of the party committee is based on the annual salary system, and the assessment results are linked to the performance annual salary. If the hospital fails to pass the annual performance appraisal, the Hospital Authority is responsible for conducting conversations with the hospital's dean and party secretary. If they fail for two consecutive years, they will be dismissed from the hospital president and the party committee secretary.

Wu Tongxiang, the new president of Beijing Tongren Hospital, said that after the establishment of the Beijing Municipal Hospital Authority, a large capital medical group was formed and 22 hospitals were members of the medical group. Performance assessment is the starting point for the Hospital Authority to manage the hospital. After the signing of the letter of responsibilities, the Dean’s pressure was very great. Each hospital originally had its own performance appraisal method, but it was not uniform. Now, each medical institution must quickly formulate its own performance appraisal system based on this unified performance appraisal index and formulate performance appraisal standards at different levels within the hospital.

In addition, public hospitals in Beijing are managed according to public institutions, and employees in public hospitals are equivalent to "iron rice bowls." According to the requirements of “division of government affairs” in Beijing's medical reform, the hospital will change its management model and establish a corporate governance structure similar to “corporate” in pilot hospitals. The hospital establishes a council to make decisions on matters such as hospital development and budgets. The dean, as the manager, is responsible for day-to-day operations and delicacy management. Ding Xiangyang, deputy mayor of Beijing, described the dean as the "CEO" of the hospital.

A few days ago, Beijing for the first time competitively selected the positions of the chiefs of six municipal public hospitals, which meant that Beijing would change the way in which former presidents of municipal public hospitals were simply appointed by the organization. Mao Yu said that at present, there is a phenomenon that the head of Beijing's top-three hospitals has reached age, overage age, and empty posts. The party committee of the Municipal Hospital Authority decided to implement step-by-step adjustments for leading cadres in the hospital and first proceed with the adjustment and deployment of hospital directors.

Improve the service model for all patient-centered

In order to make it more convenient for the people to seek medical treatment in Beijing municipal hospitals, improve medical experience, and make better use of high-quality medical resources, this year Beijing public hospitals will also be patient-centered and improve in the service sector.

The big hospitals in Beijing are generally known as "difficult people who are registered." Some of the top-three hospitals are on the verge of waiting for registration every day. Since the appointment and registration of a unified platform was opened in July last year, patients who came to Beijing for medical treatment can dial a unified phone number or log in to a unified booking registration site. Mao Yu said that the appointment registration made it unnecessary for some patients with chronic diseases to suffer from the hospital’s overnight queuing. This year, the Hospital Authority will further optimize the procedures for appointment and medical treatment for patients and shorten the waiting time for patients in the hospital.

In order to facilitate the patient's medical treatment and prevent patients from taking part in large hospitals, the Beijing Municipal Hospital Authority will gradually establish a hierarchical treatment model. From this year onwards, trials will be conducted at Beijing Friendship Hospital and Beijing Chaoyang Hospital to explore the establishment of stable consultation and referral mechanisms and models between tertiary hospitals and regional primary hospitals, and to attract more community residents to primary hospitals. Sub-acute convalescent patients in tertiary hospitals were referred to primary hospitals for continuation of treatment and rehabilitation, which improved the comprehensive utilization efficiency of medical resources in the region.

On the other hand, Beijing will select some of Beijing's tertiary hospitals, explore the construction of rehabilitation and nursing homes, and establish a comprehensive rehabilitation hospital and nursing home service system.

After the patient arrived at the hospital, he did not know the problem of finding a doctor in that department. Mao Yu said that public hospitals in Beijing will regulate outpatient services. Among them, all the outpatient service centers with unified identification will be set up in Beijing Royal Hospital. At present, all hospitals have similar medical guides, information desks, etc., but the service content is not comprehensive. In the future, major hospitals will establish outpatient service centers with unified labeling and uniform service content to provide patients with triage, guidance, consultation, education, and appointments. Self-help management and convenience services.

In the future, the patient's patient number service will no longer be a unified black and white article or blue-and-white article, but will have a more humanized design based on different styles such as age and gender. Mao Yu said: "The hospital should reflect the humane care and respect for patients, and improve the hospital treatment environment, we must start from the patient's most direct feelings. In addition to the number of patients, bed linen will be improved."

The bathroom of some large hospitals is unclean and smelly, which is a phenomenon that many patients report strongly. Mao Yu said that another important measure for improving the hospital environment is to make the bathroom smell-free this year. The Beijing Municipal Medical Management Bureau will formulate standards and cleanliness standards for sanitary evacuation of municipal hospitals, and focus on the development of hospital toilets to achieve no odor standards for bathrooms.