According to the news from the Chinese government's website, the General Office of the State Council issued a notice on the "Pilot Opinions on the Comprehensive Reform of County-level Public Hospitals" and the Opinions require strengthening the capacity building with talents, technology, and key specialties as the core to coordinate the county's medical and health system. Development, and strive to increase the rate of visits within the county to 90% or so, the basic realization of serious illness no county.

The following is the full text of the comments:

The opinions on the pilots for comprehensive reform of county-level public hospitals are based on the “Opinions of the CPC Central Committee and State Council on Deepening the Reform of the Medical and Health System” (No. 6 [2009] No. 2009) and the “Guiding Opinions of the CPC Central Committee and State Council on Classifying and Promoting the Reform of Institutions” (Chinese). Issue No. 5 (2011)), "Notice of the State Council on Printing and Distributing the Plan and Implementation Plan for Deepening the Reform of the Medical and Health System During the Twelfth Five-Year Plan Period" (Gongfa [2012] No. 11) and the General Office of the State Council on Issuing Public Hospitals in 2011 The “Circular on the Reform of the Pilot Work Arrangement” (Guobanfa [2011] No. 10) is to actively and steadily promote the pilot reform of county-level public hospitals (referring to county and county-level public hospitals, hereinafter referred to as county-level hospitals), and now puts forward the following opinions.

I. Overall requirements In accordance with the requirements of ensuring basic, strong grass-roots, and construction mechanisms, and following the principles of up and down linkage, internal vitality, and external thrust, the requirements for reforms surrounding separation of government affairs, separation of management from management, separation of medicines, profitability, and nonprofit separation are required. To break through the “drug-to-doctor” mechanism as the key link, reform the compensation mechanism and implement the hospital's self-management rights as the entry point, and coordinate the promotion of the management system, compensation mechanism, personnel distribution, price mechanism, medical insurance payment system, and procurement mechanism. Comprehensive reforms such as the supervision mechanism have established a mechanism to safeguard public welfare, mobilize enthusiasm, and ensure the sustainability of county-level hospital operation mechanisms. Adhere to the promotion of reform to promote development, strengthen the capacity building with talent, technology, and key specialties as the core, coordinate the development of the county's medical and health system, and strive to increase the rate of visits within the county to around 90%, and basically achieve serious illness without counties.

Second, a clear positioning of functional county-level hospitals is the county's medical and health center and the three-tier rural medical and health service network leader, and the division of labor with the city's major hospitals. Mainly provide basic medical services for county residents, including the use of appropriate medical technology and drugs, carry out common and frequently-occurring medical treatment, treatment of critically ill patients, referral for major and difficult diseases, and popularization and application of appropriate medical technology for rural primary health care institutions. Staff provide training and technical guidance; undertake some public health services, as well as medical treatment for natural disasters and public health emergencies.

Third, the reform of the reform mechanism to reform the "drugs make up for medicine" mechanism to encourage the exploration of various forms of medical separation. The drug addition policy was abolished, and the compensation for county-level hospitals for trials was changed from the three channels of service fees, drug additions, and government subsidies to service fees and government subsidies. The hospital's reduced reasonable income will be compensated by adjusting the prices of medical technology services and increasing government investment. Raise the fees for diagnosis and treatment, surgery and nursing fees to reflect the reasonable cost of medical technology services and the value of medical personnel's technical services. The charges for medical technology services are included in the scope of the medical insurance payment policy, and the reform of payment methods for medical insurance is also promoted. The increased government investment will be subsidized by the central government. The local government will adjust the expenditure structure according to the actual situation and increase the investment.

(1) Play the role of medical insurance compensation and control fees. County-level hospitals should provide suitable technical services that are compatible with the scope of basic medical insurance protection and control medical services outside the scope of basic medical insurance. The medical insurance fund compensates the basic medical services provided by the hospital in time by purchasing services. The gap between the proportion of reimbursement within the scope of the Medicare fund policy and the actual reimbursement ratio was narrowed. Reform the medical insurance payment system. Give full play to the role of reasonable control of medical insurance costs and quality of medical services. Implement budget management of medical insurance fund revenues and expenditures, establish a control mechanism for Medicare to coordinate the growth of medical expenses in the region, formulate overall control targets for expenditures of medical insurance funds and decompose them into fixed-point medical institutions, and control the growth of medical expenses per capita (disease) medical expenses and individuals The burden of quota control is included in the rating system. The total amount of advance payment, disease-by-disease, head-to-head, service-by-service payment, etc. shall be implemented to increase the total amount of control. Scientifically and rationally measure and determine payment standards, establish and improve the negotiations and consultation mechanisms and risk sharing mechanisms of medical insurance agencies and medical institutions, and gradually determine the scope of services, payment methods, payment standards, and service quality through negotiation between medical insurance agencies and public hospitals. Claim. The medical insurance payment policy is further tilted toward the grass-roots level, encourages the use of Chinese medicine services, guides the masses for reasonable medical treatment, and promotes the formation of a hierarchical diagnosis and treatment system.

(B) adjust the price of medical services. In accordance with the principles of total volume control and structural adjustment, the prices of medicines and high-value medical consumables are reduced, and the prices for inspection and treatment of large-scale medical equipment are reduced. Large-scale medical equipment purchased by the government is formulated at a reasonable cost without equipment depreciation, and inspection and treatment prices are established. Large-scale equipment purchased or fundraising is, in principle, bought back by the government, and buyback has difficulty in reducing the price within the time limit. It is strictly forbidden for hospital loans or fundraising to purchase large medical equipment. Reasonably increase the prices of medical treatment and medical treatment, medical care, surgery and other items that embody the value of medical workers' medical services so that medical institutions can obtain reasonable compensation through the provision of quality services. The price adjustment must be linked to the health insurance payment policy. We will reform medical service-based pricing methods and actively implement trials for disease-based fees, with no fewer than 50 disease types.

(C) regulate the procurement of drugs. Adhere to the principle of giving priority to quality and reasonable prices, and establish a centralized tender procurement mechanism that combines the quantity and price of medicines (including high-value medical consumables) and the combination of recruiting and mining. We will mobilize the enthusiasm of enterprises for the production and supply of pharmaceuticals, vigorously develop modern pharmaceutical logistics, reduce and standardize circulation links, and reduce distribution costs. All localities can actively explore the procurement and supply methods that can effectively ensure the timely supply of drugs and consumables, reliable quality, and reasonable prices on the basis of exploring provincial-level centralized procurement. Resolutely manage commercial bribery in terms of drugs and consumables. To improve the policies and measures that encourage the use of essential drugs, county-level hospitals should give priority to the use and use of essential drugs and increase the proportion of essential drugs.

(d) Implement and improve government investment policies. Full implementation of the government's basic construction of public hospitals and purchase of large-scale equipment, development of key disciplines, personnel training, retired personnel costs in line with state regulations, subsidies for policy-based losses, public health tasks and emergency services, support for borders, support for public services, and other public services Investment policy. The county-level government fulfilled its responsibility for capital contribution to the hospitals it administers, and prohibited county-level hospitals from building debt.

For the county-level hospitals located in the sparsely populated and remote areas, it is possible to explore the implementation of two lines of revenue and expenditure. The government will provide necessary guarantees. The average wage level of the hospital will be linked to the average wage level of the local institutions.

Fourth, the reform of the personnel distribution system (a) innovative establishment and post management. According to factors such as county-level hospital functions, workload, and existing establishment usage, the staffing establishment should be determined scientifically and reasonably. Encourage the places with conditions to explore and implement county-level hospital compilation and preparation systems and establish dynamic adjustment mechanisms on the basis of formulating and perfecting the standards.

County-level hospitals shall autonomously determine their positions according to the relevant regulations in the preparation of the scale or the record preparation according to the proportion of general jobs, grades, and structures determined by the state. Gradually changing identity management to job management, the hospital implements a unified management system for all personnel.

(b) Deepening the reform of the employment mechanism. Implement the autonomy of the county-level hospitals for employing people, implement the employment system in an all-round way, insist on competing for posts, employ by posts, and contract management, and establish a flexible employment mechanism that enables energy input, energy efficiency, and energy efficiency; and new recruits implement open recruitment and merit-based recruitment. Combined with the actual placement of unskilled personnel. Promote the socialization of social security services such as the retirement of medical staff in county hospitals. We will improve the standards for assessing the titles of health professionals in county hospitals and highlight clinical skills assessment.

(3) Improve the internal income distribution incentive mechanism in hospitals. Increase the proportion of hospital personnel expenditures in business expenditures, and gradually increase the treatment of medical personnel. Strengthen personnel performance appraisal, and improve the internal distribution mechanism centered on service quality, quantity, and patient satisfaction, so as to achieve more work, more rewards for superior performance, equal pay for equal work, and embody the value of medical personnel's technical services. The income distribution should be tilted toward the front line, key positions, business backbones, and outstanding contributions, and the gap should be opened appropriately. It is forbidden to link the personal income of medical staff with the hospital's medicines and inspection income.

Sixth, improve basic medical service capabilities (a) rational allocation of medical resources. In accordance with the main health problems of the county population, according to the population and distribution, geographical transportation and other factors, formulate county health planning and medical institution setting plan, reasonably determine the number, layout, function, scale and standard of hospitals in the county. The government focuses on 1-2 county-level hospitals (including Chinese medicine hospitals) in each county (city). In accordance with the principle of “filling in and filling up”, the standardization of county-level hospitals has been completed. At least one county (city) with a population of 300,000 or more has at least one hospital that has attained Grade A. The county-level hospitals will be perfected to perfect the county-level emergency service system, and county-level pre-hospital emergency care systems will be established. Strictly control the construction scale and large-scale equipment configuration of county-level hospitals. Encourage the intensive use of resources, explore the establishment of inspection and inspection centers, implement inspection and inspection results, mutual recognition of medical institutions, and logistic service outsourcing. Encourage qualified regions to explore the integration, restructuring and restructuring of medical resources and optimize resource allocation. Implement policies to support and guide social capital and medical treatment.

(B) improve the level of technical services. Prepare county-level hospitals' key specialist development plans and support the construction of county-level hospitals as planned. The recent emphasis has been placed on the development of clinical specialty departments for intensive care, hemodialysis, neonatal, pathology, infection, first aid, occupational disease prevention and mental health, and for the top 4 disease referral rates in the past three years. Carry out good treatment for major diseases such as cervical cancer, breast cancer, end-stage renal disease and hemodialysis, and screening and referral for complex and difficult diseases such as childhood leukemia and congenital heart disease. Promote the application of appropriate medical technology and appropriately relax the institutional access conditions for the second and third categories of relatively mature technologies. All local health and medical insurance management departments shall organize county-level hospitals to formulate and implement clinical pathways that meet the basic medical needs, meet the actual conditions of county-level hospitals, and adopt appropriate technologies according to the actual local conditions and pay according to the type of disease, and the number of diseases is not less than 50. One, standardize medical behavior.

(3) Strengthen the information construction. In accordance with the unified standards, the county-level hospital information system with the focus on electronic medical records and hospital management will be established. Its functions include electronic medical records, clinical pathways, diagnosis and treatment norms, performance assessment, and comprehensive business management, and will be linked to medical insurance and information systems of primary health care institutions. Gradually realize interconnection and interoperability. The development of remote diagnosis and treatment systems for rural grassroots and remote areas will gradually realize remote consultation, remote (pathological) diagnosis and distance education. Build medical health information network.

(D) Improve county medical service capabilities. Focusing on local major diseases, we actively use local Chinese medicine resources, give full play to the characteristics and advantages of simple and inexpensive Chinese medicine inspection, improve the level of dialectical treatment, strengthen support and guidance for primary health care institutions, promote Chinese medicine into the grassroots, enter rural areas, and provide Prevent disease. Strengthen the capacity building of traditional Chinese medicine services in county-level hospitals and implement a policy of tilting investment in Chinese medicine hospitals.

(e) Strengthen the building of a talent team. Guide doctors who have undergone standardized training for residents to work in county-level hospitals and create conditions for their long-term work in county-level hospitals. The gradual realization of new medical personnel entering county-level hospitals must have corresponding qualifications for practice. Clinicians should conduct standardized training for residents. Establish a sound continuing education system. Actively train or introduce county leaders. Strengthen the strength of nursing staff, and the ratio of medical care is not less than 1:2. The establishment of a tertiary-level hospital in the city to rotate to the county-level hospitals to station doctors and management personnel systems, and strengthen the evaluation of the status of the three-tier hospitals stationed. From the tertiary hospitals in the city, a group of professional leaders with management experience can be selected to serve as the dean, deputy director or section chief at the county-level hospitals that support him/her. Encourage and guide key physicians employed or retired in major urban hospitals to practice at county-level hospitals. Through the government’s policy support, promotion of titles, and honor awards, it attracts and encourages talents to practice at county hospitals for a long period of time. Approved to set up special positions in county hospitals to introduce high-level personnel in urgent need, reasonably determine the financial subsidy standards, financial support from the central and provincial levels, and recruit outstanding medical and technical personnel to work in county-level hospitals.

(6) To carry out services to facilitate the people and benefit the people. Establish a patient-centered service model, implement appointment registration, optimize service procedures, improve service attitude and quality, promote quality nursing services, and implement basic medical insurance payment settlement. Improve patient complaint mechanisms and strengthen communication between doctors and patients.

Seventh, strengthen the linkage between the upper and lower sides and actively explore the establishment of a long-term and stable division of labor and cooperation mechanism for county-level hospitals, primary-level medical and health institutions, and tertiary hospitals in cities in a variety of ways. County-level hospitals should play a leading role in county-level medical centers and rural three-tiered medical and health service networks, strengthen technical assistance guidance and personnel training for primary-level medical and health institutions, and explore the establishment of rotation of county-level hospitals to township and township hospitals to send directors and key physicians. The system, through the development of vertical technical cooperation, talent flow, management support and other forms, improves the overall efficiency of the rural medical and health service system, forms a long-term mechanism for the flow of high-quality medical resources, and allows common common diseases, chronic diseases, rehabilitation and other patients to sink to Grass-roots medical and health institutions have gradually established the first-level primary care, graded medical care, and two-way referral medical service model. Support county hospitals to carry out special training and periodic training for medical staff in township health centers and village clinics. The county-level hospitals must carry out remote consultations for critical cases and referrals for major cases of intractable diseases with urban tertiary hospitals.

VIII. Improve regulatory mechanisms Strengthen the supervision of health administrative departments on medical quality, safety, and behavior, and monitor and manage the growth of medical expenses at county hospitals. Timely investigate and punish irrational use of drugs, materials, and inspections in pursuit of economic interests. Establish a professional hospital accreditation system centered on safety quality; rely on provincial or prefecture (city) level medical quality control evaluation center, establish and improve the county hospital quality control system.

Establish a restraint mechanism that emphasizes the incentive and punishment of medical institutions for medical institutions. Give full play to the regulation, guidance and supervision of medical insurance institutions on the behavior and costs of medical services, and gradually extend the supervision of medical services on medical institutions to the supervision on the medical services of medical personnel. The use of basic medical insurance drug catalog drug use rate and self-charged drug control rate, drug share, the average cost, hospitalization rate, average length of stay and other indicators assessment, strengthen real-time monitoring, the results linked with the fund payments. We will improve the management methods for designated medical institutions, implement hierarchical management, and promote honest services. Strengthen the supervision of county-level hospitals in fulfilling functional orientation, development and construction, investment and financing, and strengthen the supervision of financial management such as budgets, income and expenditure, assets, and costs. Strengthen medical service charges and drug price supervision and inspection. All relevant departments should strengthen cooperation and cooperation and increase the investigation and punishment of violations of laws and regulations. Strengthen self-discipline and supervision in the industry, establish credit system and medical personnel assessment files. We will implement fair and transparent methods for assessing public satisfaction and strengthen social supervision. Promote county-level hospital information disclosure and promptly disclose to the public annual county hospital financial reports and information on quality, safety, cost, and efficiency.

IX. Actively and steadily push forward the pilot reforms (1) Strengthen pilot organization and leadership. About 300 counties (cities) were selected throughout the country as pilots for reform. The provincial government has overall responsibility and the county government has implemented it. The pilot provinces (autonomous regions and municipalities) must formulate opinions on the implementation of reform pilots, refine division of labor, and implement responsibilities. The pilot counties (cities) shall formulate implementation plans in light of local conditions, encourage specific measures for exploration and innovation according to local conditions, be meticulously organized, carefully planned, and promoted in a solid manner. Health, establishment, development and reform (price), finance, human resources and social security, and Chinese medicine and other related departments should closely cooperate with each other in accordance with the division of responsibilities, and strengthen supervision of local work. It is necessary to strengthen the monitoring, evaluation, and assessment of the progress and effectiveness of the reform pilots and coordinate the timely resolution of problems encountered in the pilots. We will strive to sum up the assessment in the first half of 2013 to form a basic approach and lay a foundation for the implementation of the staged reform goals for county hospitals in 2015.

(b) increase support for protection. According to the needs of the work, the pilot areas must give certain autonomy in the implementation of reform policies and measures. The county government must implement input policies, actively adjust the structure of fiscal expenditures, and support the comprehensive reform of county-level hospitals. Put the required government input into the budget and allocate it in time. Provincial governments must take effective responsibility to ensure that the required government investment is put in place. The central and provincial, prefecture-level and municipal governments should increase investment in pilot counties (cities) and give corresponding subsidies.

(c) do a good job in propaganda and guidance. In-depth and meticulous efforts to publicize and mobilize medical personnel, so that the majority of medical personnel become the main force of reform. Publicize and interpret the policy measures and objectives of the reform, strive for social understanding, cooperation and support, and create a good environment.