Notice of the General Office of the People’s Government of Yunnan Province on printing and distributing the overall plan for the comprehensive reform of Fuwai Cardiovascular Hospital in Yunnan Provinc
State and municipal people’s governments, provincial committees, offices, departments and bureaus:
"Yunnan Fuwai Cardiovascular Hospital Comprehensive Reform Pilot Overall Plan" has been approved by the provincial people’s government and is hereby issued to you, please implement it carefully.
General Office of Yunnan Provincial People’s Government
August 29, 2018
(This piece is publicly released)
Overall scheme of comprehensive reform pilot of Fuwai Cardiovascular Hospital in Yunnan Province
In order to promote the reform and development of Fuwai Cardiovascular Hospital in Yunnan Province (hereinafter referred to as Yunnan Fuwai Hospital), we strive to explore a new way of comprehensive reform of public hospitals that is in line with the actual situation in our province, build Yunnan Fuwai Hospital into a world-class high-end medical service center, and make every effort to help our province build a world-class "healthy living destination card".
I. Scope of reform
This reform pilot was implemented in Fuwai Hospital in Yunnan, which is managed as a public welfare second-class institution.
Second, the overall requirements
Guided by the Supreme Leader’s Socialism with Chinese characteristics Thought in the New Era, conscientiously implement the spirit of the 19th National Congress of the Communist Party of China, conscientiously deepen the reform and deployment of the medical and health system, follow the basic path of the "three-medical linkage" reform of medical care, medical insurance and medicine, earnestly implement the government’s responsibility for running medical services, give full play to the main role of Yunnan Fuwai Hospital, and try first in exploring and innovating the management system and operation mechanism of public hospitals. Efforts will be made to promote reforms focusing on medical consumables and drug procurement methods, total personnel management, medical insurance payment methods, personnel compensation systems, medical service prices, financial subsidies, etc., and strive to achieve the organic unity of social benefits and operational efficiency, forming a good situation in which the government is at ease, patients are satisfied, and hospitals are healthy and sustainable.
III. Objectives and tasks
By the end of 2020, we will explore the formation of a relatively perfect modern hospital management system and a new mechanism for maintaining public welfare, mobilizing enthusiasm and ensuring sustainable operation of public hospitals, so as to realize the homogenization of management between Yunnan Fuwai Hospital and China Academy of Medical Sciences, and significantly improve the medical level and service quality. Yunnan Fuwai Hospital has fully opened 12 clinical centers and 27 medical departments for coronary heart disease, hypertension, congenital heart disease and arrhythmia, with 10,000 cases of interventional surgery and 2,500 cases of heart, great vessels and peripheral vascular surgery each year, of which the proportion of third-and fourth-grade operations exceeds 50%, the total service volume and the number of difficult and severe cases in diagnosis and treatment have reached the leading position in China, and the number of new technologies and projects for diagnosis and treatment of cardiovascular diseases has been at the forefront in China, initially covering all. Yunnan Fuwai Hospital will be built into "Yunnan Congenital Heart Disease Screening Management Center" and "Yunnan Cardiovascular Disease Quality Control Center", and gradually become a national regional medical center and clinical medical research center based in Yunnan, facing southwest and radiating South Asia and Southeast Asia.
On the basis of accelerating the improvement of clinical discipline construction level and disease prevention ability of Fuwai Hospital in Yunnan, a high-quality cardiovascular disease specialist training base will be basically built, which will be used as a technical support platform to radiate the whole province and promote the continuous improvement of cardiovascular disease treatment ability of hospitals at all levels in the province. By 2020, more than 500 cardiovascular medical professionals will be trained in the province, and the cardiovascular department of 50 county-level hospitals in the province will meet the basic standards of medical service capacity of county hospitals required by the state, and 10 county-level hospitals will meet the recommended standards; Support five state-level hospitals to carry out more than 10 kinds of cardiovascular surgery, and provide technical support for the construction of the province’s cardiovascular chronic disease prevention and control system.
Fourth, reform measures
(a) to carry out the reform of modern hospital management system. Formulate the Articles of Association of Fuwai Cardiovascular Hospital in Yunnan Province. On the premise of strengthening government supervision and assessment, the relevant departments directly under the provincial government delegated the authority of internal personnel management, department setting, middle-level cadre appointment, internal performance assessment and salary distribution to Fuwai Hospital in Yunnan, giving the hospital full autonomy in operation and management. Strengthen the Party building in Fuwai Hospital of Yunnan in an all-round way, give full play to the leading role of the Party Committee of the hospital, and build the Party organization into a strong fighting fortress. Improve the internal management organization, management system, rules of procedure and procedures of Yunnan Fuwai Hospital, and standardize the internal governance structure and power operation rules.(Responsible unit: Provincial Health and Family Planning Commission, Editorial Office, Human Resources and Social Security Department, Finance Department, Yunnan Fuwai Hospital; The first one is the lead department, the same below)
(two) to carry out the reform of medical consumables and drug procurement methods. Yunnan Fuwai Hospital is allowed to be the main body of procurement, directly negotiate prices with high-value medical consumables manufacturers and purchase independently. Take the procurement with quantity and budget, explore the way of cross-regional and specialized hospital joint procurement, and reduce the inflated price of high-value medical consumables. High-value medical consumables are purchased in the high-value medical consumables procurement system of the provincial centralized drug procurement platform, and independent bargaining is carried out offline. The negotiated unit price and total amount are subject to the supervision of relevant departments. According to the reform requirements of Fuwai Hospital in Yunnan, the high-value medical consumables procurement system of the provincial centralized drug procurement platform was developed and reformed individually. In the medical insurance information system, the actual purchase price of Yunnan Fuwai Hospital is protected accordingly. Explore the implementation of the "one-vote system" for the procurement of high-value medical consumables, and Yunnan Fuwai Hospital will directly settle the payment with the production enterprises. According to the procurement method of high-value medical consumables, the procurement reform of suitable drugs and low-value medical consumables will be carried out. For the cases paid according to the project, Yunnan Fuwai Hospital reduces the burden of patients by reducing the high-value medical consumables and the inflated price of drugs.(Responsible units: Provincial Health and Family Planning Commission, Department of Finance, Department of Human Resources and Social Security, Public Resources Trading Administration, Yunnan Fuwai Hospital)
(three) to carry out the total personnel management pilot. According to the type characteristics and related factors of Fuwai Hospital in Yunnan, the total number of personnel needed for Fuwai Hospital in Yunnan is determined scientifically and reasonably, and the dynamic adjustment is implemented. Strictly regulate the scope of the total number of personnel, and the personnel within the total number shall be managed according to the staffing of the institution and enjoy the treatment of the personnel of the institution. Simultaneously carry out the pilot reform of government procurement services.(Responsible unit: Provincial Organizing Office, Human Resources and Social Security Department, Finance Department, Health and Family Planning Commission, Yunnan Fuwai Hospital)
(four) to carry out the reform of medical insurance payment methods. The reform of medical insurance payment mode will be carried out mainly by grouping payment methods according to disease types and disease diagnosis. Medical insurance agencies at all levels in the province shall pay for the diseases with clear diagnosis and treatment plan and admission criteria and mature diagnosis and treatment technology in Fuwai Hospital, and reasonably determine the payment standard of diseases (disease groups), the proportion of medical insurance payment and the proportion of individual patients’ payment, and implement packaged payment, with the balance retained and the cost overruns not covered. Strive to make the proportion of cases paid by groups according to diseases and disease diagnosis in Yunnan Fuwai Hospital exceed 80% by 2020, and the medical insurance agency will adjust and maintain the settlement method and information system according to the reform needs of Yunnan Fuwai Hospital. The hospital information system of Yunnan Fuwai Hospital is open to medical insurance agencies and audit departments, and is subject to supervision and audit. According to the principle of "scientific, safe, standardized, effective, economical and ethical", the clinical pathway management and quality control work adapted to the functions and tasks of Yunnan Fuwai Hospital should be implemented, and the diagnosis and treatment behavior should be standardized in strict accordance with the diagnosis and treatment routine and technical regulations to ensure medical quality and safety.(Responsible unit: Provincial Department of Human Resources and Social Security, Department of Finance, Health and Family Planning Commission, Yunnan Fuwai Hospital)
(five) to carry out the reform of personnel compensation system. Establish a personnel management system that is compatible with the total personnel management. Implement the autonomy of employing people in Yunnan Fuwai Hospital, and allow Yunnan Fuwai Hospital to independently recruit and introduce personnel by means of examination or inspection under the premise of strictly implementing information disclosure, process disclosure and results disclosure. Encourage Fuwai Hospital in Yunnan to introduce outstanding professionals from abroad, and play a good role as a platform to cultivate and improve the level of relevant medical disciplines in the province. Talents who are urgently needed and in short supply from outside the province and have the qualifications of deputy senior and above professional and technical positions or have obtained doctoral degrees can re-establish personnel files after leaving their original units to work in Fuwai Hospital in Yunnan. Fuwai Hospital in Yunnan should change the fixed employees into contract employees, change the identity management into post management, and set up posts according to needs, compete for posts, hire by posts, and set salaries by posts. Formulate specific personnel management systems such as personnel entry and exit, assessment, rewards and punishments within the total amount, and establish an employment mechanism that can enter and exit, and can be promoted and demoted. Boldly innovate the talent incentive mechanism, and high-level talents introduced by Yunnan Fuwai Hospital can enjoy relevant subsidy policies and project support in accordance with regulations.(Responsible unit: Provincial Health and Family Planning Commission, Editorial Office, Human Resources and Social Security Department, Finance Department, Yunnan Fuwai Hospital)
In accordance with the requirements of "allowing hospitals to break through the current wage control level of public institutions, allowing medical service income to deduct costs and withdraw funds according to regulations to be mainly used for personnel rewards", we will actively explore the establishment of a salary system that conforms to the characteristics of the medical industry and fully mobilize the enthusiasm, initiative and creativity of medical personnel. Yunnan Fuwai Hospital will be included in the pilot unit of salary system reform of public hospitals in our province, and the corresponding policy inclination will be given when the total performance salary is approved. Support Yunnan Fuwai Hospital to actively explore various distribution methods such as target annual salary system, agreed salary system and project salary system. Explore the implementation of the target annual salary system management for the main person in charge of Yunnan Fuwai Hospital, and the required funds will be uniformly charged from the operating subsidy funds and service purchase funds arranged by the provincial finance, and will not be arranged separately. Encourage medical staff in Fuwai Hospital in Yunnan to strengthen scientific research innovation. If important scientific research achievements and achievements are transformed into clinical diagnosis and treatment standards and technical specifications, holders of scientific research achievements can enjoy 80% of the benefits from the transformation of achievements and promote the transformation of achievements. It is strictly forbidden to link the salary of medical staff with business income and income from medicines, consumables, inspections and tests.(Responsible units: Provincial Department of Human Resources and Social Security, Department of Finance, Health and Family Planning Commission, Science and Technology Department)
(six) to carry out the price reform of hospital medical services. Yunnan Fuwai Hospital is allowed to set its own price within the range of no more than 10% on the basis of the current first-class medical service price in our province. For the medical service items with no approved price in our province, if there are existing ones in Fuwai Hospital of China Academy of Medical Sciences, according to the principle of homogeneity and same price, Fuwai Hospital of Yunnan can refer to the medical service price of Fuwai Hospital of China Academy of Medical Sciences. Yunnan Fuwai Hospital’s new medical service project authorizes Yunnan Fuwai Hospital to independently check the trial price. On the basis of establishing and perfecting the clinical pathway management system, we will support Fuwai Hospital in Yunnan to carry out the reform of pricing mode of charging according to diseases and independently formulate charging standards. Yunnan Fuwai Hospital is allowed to carry out special outpatient service within the scope of not exceeding 10% of the total medical service, and the special outpatient service fee is subject to market adjustment. The actual implementation price of Yunnan Fuwai Hospital should be reported to the Provincial Price Bureau, the Health and Family Planning Commission and the Human Resources and Social Security Department for the record within 10 working days before implementation.(Responsible units: Provincial Price Bureau, Health and Family Planning Commission, Human Resources and Social Security Department)
(seven) to carry out the reform of financial subsidies. Reform and improve the financial guarantee mode for Fuwai Hospital in Yunnan, explore the establishment of financial support mode suitable for the reform of Fuwai Hospital in Yunnan, and gradually arrange hospital operation subsidy funds by purchasing services to realize the decoupling of financial subsidy funds from staffing. From 2018 to 2021, according to the principle of "full support, fixed subsidy, gradual adjustment and stimulating vitality", the operating subsidy funds of Yunnan Fuwai Hospital will be reasonably arranged; After 2022, according to the quantity and quality of services provided by Fuwai Hospital in Yunnan, the government will approve the funds for purchasing services. The financial subsidy funds are invested in the planned equipment purchase, key discipline development, personnel training, retirees’ expenses in line with national regulations, policy loss subsidies, and government-designated emergency treatment, disaster relief, foreign aid, agriculture support, border support and counterpart support for urban and rural hospitals.(Responsible units: Provincial Department of Finance, Development and Reform Commission, Human Resources and Social Security Department, Health and Family Planning Commission)
(eight) to carry out the reform of hospital service model. The Provincial Health and Family Planning Commission delegated the establishment of departments and the management authority of doctors’ practice in Fuwai Hospital of Yunnan. Yunnan Fuwai Hospital can set up its own departments according to the needs of reform and development, and report them to the Provincial Health and Family Planning Commission for the record; Doctors and nurses from Fuwai Hospital of China Academy of Medical Sciences are allowed to practice at Fuwai Hospital in Yunnan and report to the Provincial Health and Family Planning Commission for the record. Fuwai Hospital in Yunnan should strengthen the construction of hospital culture and build a harmonious doctor-patient relationship. Carry out appointment diagnosis and treatment, increase the proportion of appointment diagnosis and treatment services, and vigorously promote appointment diagnosis and treatment by time and centralized appointment inspection. Steadily carry out daytime surgery to shorten the time for patients to wait for hospitalization and surgery. Take patients as the center, promote multidisciplinary diagnosis and treatment mode, and provide "one-stop" diagnosis and treatment service for patients. Innovate emergency services to provide patients with a green channel for medical treatment and integrated comprehensive treatment services. Using Internet technology to continuously optimize the medical service process, and provide patients with convenient services such as appointment, mobile payment, inter-clinic settlement, bedside settlement, medical reminder, result inquiry and information push.(Responsible unit: Provincial Health and Family Planning Commission, Yunnan Fuwai Hospital)
V. Safeguards
(1) Strengthen organizational leadership. The leading group for the construction, reform and development of Fuwai Cardiovascular Hospital in Yunnan Province and Yunfu International Cardiovascular Hospital should strengthen the overall coordination of the pilot reform of Fuwai Hospital in Yunnan Province.
(2) create a good atmosphere. Relevant departments at the provincial level should strengthen the overall situation awareness and sense of responsibility, cooperate with each other and make concerted efforts to form a joint effort and a good atmosphere for fully caring for and supporting the reform and development of Yunnan Fuwai Hospital, and give active support to Yunnan Fuwai Hospital in participating in scientific research projects and achievements declaration in the province, employing graduate students with teachers’ qualifications, and evaluating the first and the best. Other medical and health institutions in the province should strengthen cooperation and exchanges with Fuwai Hospital in Yunnan with a more open and inclusive attitude, and jointly promote the continuous improvement of the diagnosis and treatment capacity of cardiovascular diseases in the province.
(3) Strengthen performance appraisal. The Provincial Health and Family Planning Commission should guide Yunnan Fuwai Hospital to formulate performance evaluation methods, establish a public welfare-oriented evaluation system, and effectively strengthen the internal management of the hospital. According to the specialty characteristics of Fuwai Hospital in Yunnan and the requirements of the reform pilot task, the assessment and evaluation indicators are determined scientifically and reasonably, with emphasis on indicators such as the degree of public welfare goal realization, medical quality, cost control, sustainable development, operational performance, social satisfaction and employee recognition. The performance appraisal of Yunnan Fuwai Hospital should be carried out simultaneously with the annual and term target responsibility appraisal of the dean, and the party building work should be carried out simultaneously with the professional work. The assessment results should be linked with financial subsidies, medical insurance payment, total performance salary, salary, appointment and dismissal, rewards and punishments of the dean (secretary), so as to promote the improvement of medical service quality in Yunnan Fuwai Hospital.
(4) Strengthen supervision and evaluation. Give full play to the role of monitoring, evaluation and special supervision, timely supervise the implementation of key tasks of Fuwai Hospital in Yunnan, establish and improve the supervision and inspection mechanism and evaluation accountability mechanism, increase supervision and guidance, and focus on matters that are ineffective or slow in progress. The Provincial Health and Family Planning Commission takes the lead in establishing a monitoring and evaluation system, formulating methods for evaluating the effect of hospital reform, regularly monitoring and evaluating the implementation of the pilot reform of Fuwai Hospital in Yunnan and the reform effect, analyzing and studying the difficulties and problems arising in the reform process in a timely manner, and monitoring the reform progress once every six months to form a monitoring report. By the end of 2020, the third party will be organized to evaluate and summarize the reform effect of Fuwai Hospital in Yunnan, and mature and effective experiences will be promoted in due course. Relevant provincial departments should sum up and improve relevant reform policies in time to ensure the continuity of policies and the stable and sustainable development of Fuwai Hospital in Yunnan.
Attachment: 1. Pilot Program for the Reform of Medical Consumables and Drug Purchase Mode in Fuwai Cardiovascular Hospital of Yunnan Province
2. Yunnan Fuwai Cardiovascular Hospital Staff Total Management Pilot Program
3. Yunnan Fuwai Cardiovascular Hospital Medical Insurance Payment Mode and Personnel Compensation System Reform Pilot Program
4. Yunnan Fuwai Cardiovascular Hospital Medical Service Price Reform Pilot Program
5. Yunnan Fuwai Cardiovascular Hospital Financial Subsidy Reform Pilot Program
6. Implementation plan for improving the diagnosis and treatment capacity of Fuwai Cardiovascular Hospital in Yunnan Province
Annex 1
Pilot program for the reform of medical consumables and drug procurement mode in Fuwai Cardiovascular Hospital of Yunnan Province
In order to promote Yunnan Fuwai Cardiovascular Hospital (hereinafter referred to as Yunnan Fuwai Hospital) to carry out the pilot reform of medical consumables and drug procurement methods, this plan is formulated according to the Overall Plan for Comprehensive Reform Pilot of Yunnan Fuwai Cardiovascular Hospital.
I. General requirements
In accordance with the general direction and requirements of the reform of public hospitals, adhere to the principles of openness, fairness and justice, strengthen the "three-medicine linkage" of medical care, medical insurance and medicine, encourage Fuwai Hospital in Yunnan to try first, and further reduce the inflated prices of medical consumables and medicines through various procurement methods such as independent procurement, quantity procurement and joint procurement.
Yunnan Fuwai Hospital uses business income and its own funds to carry out medical consumables and drugs procurement projects, allowing hospitals to purchase independently, openly selecting distribution enterprises to be responsible for distribution, and linking with medical insurance payment and disease charging policies. Encourage Yunnan Fuwai Hospital to jointly purchase with relevant specialized hospitals across regions, and further improve the participation of hospitals in centralized drug procurement. The procurement projects of medical consumables and drugs carried out by Yunnan Fuwai Hospital with special financial funds are carried out in strict accordance with the provisions and procedures of People’s Republic of China (PRC) Government Procurement Law, People’s Republic of China (PRC) Bidding Law and other laws and regulations.
Second, the reform measures
(A) the scientific preparation of procurement plans
According to the catalogue of medical consumables and drugs used in Fuwai Hospital of China Academy of Medical Sciences, the procurement plan and budget are put forward with reference to not less than 80% of the medical consumables and drugs used in the previous year.
(B) to carry out high-value medical consumables procurement reform.
1. Purchasing method. On the premise of carrying out the compound payment mode of grouping payment according to disease type and disease diagnosis, and combining various payment methods, Yunnan Fuwai Hospital is allowed to be the main purchasing body, adopt online procurement and offline negotiation on the provincial centralized drug procurement platform, and directly negotiate the purchase price of high-value medical consumables with high-value medical consumables manufacturers, and the negotiated unit price and purchase amount are subject to the supervision of relevant departments. According to the reform requirements of Fuwai Hospital in Yunnan, the high-value medical consumables procurement system of the provincial centralized drug procurement platform was developed and reformed individually. In the medical insurance information system, the actual purchase price of Yunnan Fuwai Hospital is protected accordingly. Yunnan Fuwai Hospital is allowed to explore cross-regional joint procurement with relevant domestic specialized hospitals to ensure that the procurement price is lower than the reference price of the provincial centralized drug procurement platform.
2. Distribution management. Yunnan Fuwai Hospital openly selects high-value medical consumables comprehensive service enterprises according to relevant laws and regulations. Comprehensive service enterprises can set up a first-class management warehouse of high-value medical consumables in Fuwai Hospital of Yunnan, and implement zero inventory management to ensure the timely supply and quality safety of high-value medical consumables.
(three) to carry out the reform of purchasing methods of drugs and low-value medical consumables.
1. Purchasing method. In accordance with the principle of "platform procurement, bargaining with quantity, two-vote system and centralized distribution" and the relevant provisions of the provincial health and family planning commission on classified procurement, Yunnan Fuwai Hospital is allowed to carry out bargaining procurement of drugs and low-value medical consumables with quantity through the provincial centralized drug procurement platform, which will be distributed centrally by distribution enterprises. Belonging to the pricing procurement, the winning bid price announced by the provincial centralized drug procurement platform is the highest price limit, and the method of exchanging price for quantity is adopted, and the quantity procurement is linked with the quantity price; Belonging to bargaining procurement, independent bargaining procurement on the provincial centralized drug procurement platform; For special drugs, such as poisonous drugs, blood products and some new drugs, which are not hung on the procurement platform, they are indeed purchased for the record according to the relevant requirements because of clinical needs.
2. Distribution management. According to relevant laws and regulations, Fuwai Hospital of Yunnan Province selected distribution enterprises for drugs and low-value medical consumables to ensure the supply, quality and safety of drugs and low-value medical consumables.
(4) Charge management
1. Charge for high-value medical consumables. For cases paid by the project, the high-value medical consumables used are charged according to the actual purchase price and the markup rate stipulated in the Interim Measures for the Price Management of Non-profit Medical Services in Yunnan Province. According to the disease, according to the disease diagnosis related group payment cases, the balance retained, cost overruns do not make up.
2. Fees for drugs and low-value medical consumables. Drugs are charged according to the winning bid price announced by the provincial centralized drug procurement platform, and the bonus is cancelled. Low-value medical consumables shall be implemented in accordance with the relevant provisions of the price management of medical services in our province. With the further improvement of the national drug price negotiation mechanism, the scope of negotiation varieties is gradually expanded, and the policy convergence with medical insurance management and handling departments is well done.
3. Price protection. The list of expenses issued by Yunnan Fuwai Hospital to patients can only list the quantity of drugs and medical consumables used, subtotal and total expenses, and protect the prices of individual categories.
(5) Contract management
Yunnan Fuwai Hospital signed a distribution service contract with the distribution enterprise. The procurement of high-value medical consumables is subject to the "one-vote system".
Third, the job requirements
(1) Strengthen supervision. Provincial Health and Family Planning Commission, Public Resources Trading Administration, Food and Drug Administration, Finance Department, Audit Office and other departments should strengthen the supervision and inspection of the procurement, distribution and use of medical consumables and drugs in Yunnan Fuwai Hospital. Information on the purchase and use of medical consumables and drugs in Fuwai Hospital of Yunnan Province should be disclosed to the public in a timely manner and consciously accept social supervision; It is necessary to establish a publicity and interview system, implement prescription comments, give full play to the role of pharmacists in rational drug use, and improve the level of rational use of medical consumables and drugs; It is necessary to strengthen prescription management and ensure that doctors prescribe drugs according to their generic names. Outpatients can choose to buy drugs at Fuwai Hospital or retail pharmacies in Yunnan by prescription. Strictly control the unreasonable increase of medical expenses.
(2) Strengthen the prevention and control of integrity risks. Fuwai Hospital in Yunnan should make collective decisions by including medical consumables and drug procurement in the "three majors and one big project"; It is necessary to focus on strengthening the system construction, with the support of modern information technology, to build a clean and honest risk prevention and control system with clear powers and responsibilities, standardized processes, clear risks, effective measures, timely early warning and in line with the characteristics of the health industry, and to establish a long-term working mechanism to control commercial bribery in the field of medical purchase and sale.
Annex 2
Pilot Program of Total Staff Management in Fuwai Cardiovascular Hospital of Yunnan Province
In order to promote Yunnan Fuwai Cardiovascular Hospital (hereinafter referred to as Yunnan Fuwai Hospital) to carry out the pilot project of total personnel management, this plan is formulated according to the Overall Plan of Comprehensive Reform Pilot of Yunnan Fuwai Cardiovascular Hospital.
I. General requirements
In accordance with the relevant requirements of deepening the classification reform of public institutions, deepening the reform of "streamline administration, delegate power, strengthen regulation and improve services" and deepening the reform of medical and health system, we should persist in the innovation of system and mechanism, innovate the staffing management of Fuwai Hospital in Yunnan, implement the management of total personnel, and establish an employment mechanism that can enter and exit, and can be promoted and demoted. Adhere to decentralization, fully give Yunnan Fuwai Hospital the autonomy of employing people, and stimulate the endogenous motivation of hospital reform and development. Adhere to the principle of "active, cautious and controllable", steadily push forward the reform pilot work, study and solve the difficulties and problems in the pilot work in time, and accumulate experience and practices.
Second, the reform task
(1) Scientifically and reasonably verify the total number of personnel. The provincial editorial office, together with the Provincial Health and Family Planning Commission, the Department of Finance and the Department of Human Resources and Social Security, comprehensively considers the characteristics of Yunnan Fuwai Hospital, the actual number of open beds, the service population, the service volume, the personnel structure and the development trend, and scientifically and reasonably determines the total number of personnel needed for Yunnan Fuwai Hospital. The total number of staff in Yunnan Fuwai Hospital is 550 for the first time. The total number of personnel shall be dynamically managed, and in principle, it shall be dynamically adjusted once every two years.
(two) the scope and proportion of total personnel management. The personnel included in the total personnel management include: members of the hospital leadership, administrative personnel, professional and technical personnel (doctors, pharmacy, medical technology, nursing and other professional and technical personnel) and the backbone of the workers. Within the approved total number of personnel, the proportion of professional and technical personnel is not less than 90%, and the administrative personnel and workers are not higher than 10%.
(3) Establish a personnel management system that is compatible with the total personnel management. In accordance with the relevant requirements of the "streamline administration, delegate power, strengthen regulation and improve services" reform, simplify administration and decentralize power, and fully give Yunnan Fuwai Hospital the autonomy of employing people. According to the staffing management of public institutions, the personnel within the total amount enjoy the corresponding treatment of the staff of public institutions in terms of post employment, professional title evaluation, assessment, rewards and punishments, social insurance, personnel flow, income distribution and retirement benefits. The recruitment staff of Fuwai Hospital in Yunnan should make the recruitment plan and scheme according to the requirements of information disclosure, process disclosure and results disclosure, and after being approved by the Provincial Health and Family Planning Commission and the Provincial Department of Human Resources and Social Security, take the form of examination or investigation to recruit independently; After joining the company, it is qualified by the evaluation of Fuwai Hospital in Yunnan and approved by the Provincial Health and Family Planning Commission and the Provincial Department of Human Resources and Social Security, and can be included in the total personnel management.
Fuwai Hospital in Yunnan should establish and improve the employment mechanism of being able to enter and exit, be able to go up and down, formulate the evaluation method, index system and specific personnel management system for the entry and exit of personnel within the total number of personnel, and organize the implementation after being reported to the provincial office, the Department of Finance, the Department of Human Resources and Social Security and the Health and Family Planning Commission for the record.
Third, the job requirements
(1) Strengthen organizational leadership. The provincial editorial office is responsible for verifying the total number of staff in Yunnan Fuwai Hospital and taking the lead in coordinating and promoting the pilot work; The Provincial Health and Family Planning Commission is responsible for the guidance and supervision of Fuwai Hospital in Yunnan; The Provincial Department of Finance and the Department of Human Resources and Social Security cooperate to do the relevant work. Fuwai Hospital in Yunnan is the main body responsible for the pilot work, so we should earnestly organize and implement it.
(2) Steady and orderly progress. Fuwai Hospital in Yunnan should formulate a specific implementation plan and refine the work tasks item by item; It is necessary to strictly implement various policies and regulations, strictly perform work procedures, establish a correct orientation for employing people, and fully mobilize and stimulate the enthusiasm of cadres and workers.
(3) Strengthen supervision and guidance. The provincial editorial office shall, jointly with the Provincial Health and Family Planning Commission, the Department of Finance and the Department of Human Resources and Social Security, strengthen supervision and guidance on the pilot work, closely follow the progress of the pilot work, study and solve problems in the work in a timely manner, and sum up experiences and practices.
Annex 3
Pilot scheme of medical insurance payment method and personnel salary system reform in Fuwai Cardiovascular Hospital of Yunnan Province
In order to promote Fuwai Cardiovascular Hospital of Yunnan Province (hereinafter referred to as Yunnan Fuwai Hospital) to carry out the pilot reform of medical insurance payment method and personnel compensation system, this scheme is formulated according to the Overall Plan for Comprehensive Reform Pilot of Fuwai Cardiovascular Hospital of Yunnan Province.
I. General requirements
Focusing on the goal of deepening the reform of medical and health system, we will explore the establishment of medical insurance payment methods that conform to the actual situation and medical service characteristics of Fuwai Hospital in Yunnan, and stimulate the endogenous motivation of hospitals to standardize diagnosis and treatment behavior, control costs, and reasonably treat and refer patients; Explore the establishment of a flexible and efficient personnel management system that is compatible with the total personnel management; According to the requirements of "allowing hospitals to break through the current wage control level of public institutions, allowing medical service income to deduct costs, and then withdrawing various funds according to regulations, we will explore the establishment of a salary distribution system that conforms to the actual situation of Fuwai Hospital in Yunnan, and strive to reflect the value of medical staff’s knowledge, technology and labor, mobilize the enthusiasm of medical staff, enhance the public welfare of the hospital, and promote the healthy development of Fuwai Hospital in Yunnan.
Second, the reform task
(A) to carry out medical insurance payment reform pilot.
1. The implementation of multiple compound medical insurance payment methods based on disease types and disease diagnosis related groups. According to the characteristics of medical services in Fuwai Hospital in Yunnan, for diseases with clear diagnosis, clear diagnosis and treatment path and mature diagnosis and treatment technology, payment is implemented according to the disease type and related groups of disease diagnosis. For complex cases that cannot be settled by disease type and disease diagnosis, they shall be paid according to the project. All kinds of payment methods implemented by Fuwai Hospital of China Academy of Medical Sciences and outside the province can be supported in time in combination with the actual situation in our province. By 2020, Yunnan Fuwai Hospital will make the proportion of cases that are paid according to diseases and diseases diagnosis more than 80%, and medical insurance agencies will adjust and maintain the settlement methods and information systems according to the needs of hospital reform. Establish and improve the equal consultation mechanism between medical insurance agencies and Yunnan Fuwai Hospital, and the incentive and risk sharing mechanism of "balance retention and reasonable cost overruns sharing".
2. Support Yunnan Fuwai Hospital to develop new technologies and projects. The provincial human resources and social security department timely studied and formulated the medical insurance payment policy to support the new technologies and new projects carried out by Fuwai Hospital in Yunnan.
(B) to carry out the personnel management system reform pilot.
1. Decentralize the right to evaluate professional titles. The right to evaluate the deputy senior title of health technology was delegated to Yunnan Fuwai Hospital, which independently evaluated the qualification of the deputy senior title of health technicians in our hospital in accordance with the national and provincial professional and technical title evaluation procedures and relevant management regulations.
2. For foreign high-level experts and young doctors under 40 years old who are mainly introduced from Fuwai Hospital in Yunnan Province, if they are selected as "high-end foreign experts" and "special young talents" in Yunnan Province’s Thousand Talents Program after evaluation, they will be given a one-time working and living allowance of 500,000 yuan and a maximum project funding of 1 million yuan.
3. The high-level talents introduced by Fuwai Hospital in Yunnan Province are in urgent need of shortage in our province. Upon the assessment of the Provincial Department of Human Resources and Social Security, they are given 500,000 yuan, 300,000 yuan and 200,000 yuan housing subsidies and 100,000 yuan, 70,000 yuan and 50,000 yuan working funds respectively, and actively do a good job in introducing talents.
4. Timely apply for the "Green Channel Service Certificate for Introducing High-level Talents in Yunnan Province" for talents who meet the prescribed conditions introduced by Yunnan Fuwai Hospital, and enjoy corresponding services in accordance with the regulations.
(C) to carry out the pilot reform of the salary system
1. Yunnan Fuwai Hospital will be included in the pilot reform of salary system of public hospitals in our province. Yunnan Fuwai Hospital is allowed to break through the current wage control level of public institutions, allowing medical service income to deduct costs and withdraw various funds according to regulations, which are mainly used for personnel rewards.
2. Tilt the relevant salary policy. Yunnan Fuwai Hospital is allowed to establish a salary system that adapts to the characteristics of the hospital in accordance with the Implementation Opinions of the Provincial Department of Human Resources and Social Security, the Department of Finance, and the Health and Family Planning Commission (Yun Ren She Fa [2017] No.96). The Provincial Department of Human Resources and Social Security gives corresponding policy inclination when approving the total amount of performance pay.
3. Give internal distribution autonomy. Give Yunnan Fuwai Hospital autonomy in performance appraisal and internal distribution, focusing on key positions and high-level talents, focusing on reflecting the value of medical staff’s technical services and mobilizing the enthusiasm of medical staff.
Third, the job requirements
(1) Strengthen organizational leadership. Relevant departments directly under the provincial government should closely cooperate and coordinate to promote reform, properly link up policies and give full play to policy synergy; It is necessary to carry out the evaluation of the reform effect in time to provide support for the reform and improvement of the province’s medical insurance payment method and personnel compensation system.
(2) Strengthen internal management. Fuwai Hospital in Yunnan should establish and improve the internal management system matching with the reform pilot, make full use of the role of medical insurance in regulating, guiding, supervising and restricting medical service behavior and expenses, strengthen the management of medical personnel, actively control costs and expenses, and improve the efficiency of the use of medical insurance funds. On the basis of the approved total number of personnel, exercise the autonomy of hospital personnel management and salary distribution according to the law and regulations.
(3) Strengthen supervision and management. Provincial departments should strengthen the supervision and management of medical service behavior, personnel management and salary distribution of Fuwai Hospital in Yunnan. The medical insurance management department should strengthen the management of medical insurance service agreement, improve the medical insurance information system, improve the scientific and reasonable assessment system, strengthen the dual control of medical expenses and medical quality, and link the assessment results with the medical insurance fund payment.
Annex 4
Pilot scheme of medical service price reform in Fuwai Cardiovascular Hospital of Yunnan Province
In order to promote Fuwai Cardiovascular Hospital of Yunnan Province (hereinafter referred to as Yunnan Fuwai Hospital) to carry out the pilot reform of medical service price, this scheme is formulated according to the Overall Plan for Comprehensive Reform Pilot of Fuwai Cardiovascular Hospital of Yunnan Province.
I. General requirements
Actively and steadily push forward the reform of the pricing mode of medical services in Fuwai Hospital in Yunnan, do a good job in linking the price of medical services with policies such as medical care, medical insurance and medicine, and gradually establish a scientific, reasonable, dynamic adjustment and multi-participation medical service price formation mechanism to ensure the sustainable operation of Fuwai Hospital in Yunnan, the affordability of medical insurance funds and the overall burden of the masses.
Second, the reform task
(1) Yunnan Fuwai Hospital is allowed to set its own price within the range of no more than 10% on the basis of the current price of first-class medical services in our province.
(II) For the medical service items with no approved price in our province, if the Fuwai Hospital of China Academy of Medical Sciences already exists, according to the principle of homogeneity and the same price, Fuwai Hospital of Yunnan can refer to the medical service price of Fuwai Hospital of China Academy of Medical Sciences.
(three) the new medical service projects carried out by Fuwai Hospital in Yunnan Province shall be independently approved by the hospital for trial price.
(4) For the diseases that have not been charged by diseases in our province at present, on the basis of establishing and perfecting the clinical pathway management system, support Yunnan Fuwai Hospital to carry out the reform of charging by diseases and independently formulate charging standards.
(5) In order to meet patients’ medical service needs at different levels, Yunnan Fuwai Hospital is allowed to carry out special outpatient service within the scope of not exceeding 10% of the total medical service, and the special outpatient service fee is subject to market adjustment.
Third, the job requirements
(1) Strengthen guidance and supervision. The Provincial Price Bureau, the Health and Family Planning Commission, and the Human Resources and Social Security Department should closely cooperate and cooperate with each other, strengthen the guidance and supervision of the reform of medical service price in Fuwai Hospital in Yunnan, make overall consideration of the interests of all parties, and do a good job in the convergence of policies such as medical service price, medical insurance and fee control; It is necessary to guide Yunnan Fuwai Hospital to establish and improve the internal price management system, implement the system of clearly marked price and detailed list of medical expenses, and create an honest medical unit.
(2) Do a good job in monitoring and evaluation. The Provincial Price Bureau, the Health and Family Planning Commission, and the Human Resources and Social Security Department should pay close attention to the situation after the reform of medical service prices to prevent the relevant supporting policies from being in place, resulting in an increase in the burden on hospitals or patients; It is necessary to strengthen the evaluation of the reform situation and effect, and timely adjust and improve the reform policy.
(3) Strengthen support for reform. Fuwai Hospital in Yunnan should scientifically calculate the cost of medical services and diseases, and provide scientific data support and reference for setting prices; It is necessary to bring cost accounting, price management and patient burden into the hospital performance appraisal system, and mobilize the enthusiasm of medical staff and management personnel to control fees; It is necessary to publicize the service items, prices and charging basis, supervision and reporting telephone numbers and other contents to the society in a prominent position.
(4) Standardize the price adjustment behavior. For medical services that are subject to market adjustment and independently set prices, Yunnan Fuwai Hospital reasonably sets prices according to service costs and market conditions and keeps them relatively stable, and the price adjustment period shall not be less than one year. The actual implementation price of Yunnan Fuwai Hospital should be reported to the Provincial Price Bureau, the Health and Family Planning Commission and the Human Resources and Social Security Department for the record within 10 working days before implementation.
Annex 5
Pilot program of financial subsidy reform in Fuwai Cardiovascular Hospital of Yunnan Province
In order to promote Fuwai Cardiovascular Hospital of Yunnan Province (hereinafter referred to as Fuwai Hospital of Yunnan Province) to carry out the pilot reform of financial subsidies, this plan is formulated according to the Overall Plan for Comprehensive Reform of Fuwai Cardiovascular Hospital of Yunnan Province.
I. General requirements
Adhere to the public welfare nature of public hospitals, reform and improve the way public finance supports public hospitals, establish a scientific and reasonable financial guarantee and compensation mechanism, and promote the formation of a new mechanism for hospital operation that is conducive to maintaining public welfare, mobilizing enthusiasm and ensuring sustainability.
Second, the reform task
(1) Arrangement of subsidy funds
From 2018 to 2021, Yunnan Fuwai Hospital will be subsidized by means of fixed subsidy and gradual adjustment. Among them, 70 million yuan will be allocated for operation subsidy in 2018, 70 million yuan in 2019, 60 million yuan in 2020 and 50 million yuan in 2021.
After 2021, in accordance with the requirements of government procurement service reform of public institutions and referring to the security policies of other provincial public hospitals, Yunnan Fuwai Hospital will be subsidized.
(2) Ways of financial subsidies
In 2018, the transitional financial subsidy policy was implemented, and the financial funds were directly allocated to Yunnan Fuwai Hospital. Starting from 2019, we will implement the reform of financial support mode based on government purchasing services, and arrange the financial subsidy funds of Yunnan Fuwai Hospital to be included in the departmental budget of the Provincial Health and Family Planning Commission for protection. As the main body of government purchasing services, the Provincial Health and Family Planning Commission will include the subsidy funds in the departmental budget of the Provincial Health and Family Planning Commission in the form of government purchasing services, and report them to the Provincial Department of Finance for review, and sign a government purchasing service contract with Yunnan Fuwai Hospital in accordance with the relevant provisions on government purchasing services, and pay them according to the contract.
Third, the job requirements
(1) Strengthen policy implementation. The Provincial Department of Finance earnestly implemented the financial subsidy policy for Fuwai Hospital in Yunnan. The Provincial Health and Family Planning Commission studied and formulated a specific implementation plan for the reform of government procurement services in Fuwai Hospital in Yunnan.
(2) Improve financial management. All revenues and expenditures of Yunnan Fuwai Hospital are included in the budget management, and the relevant provisions of the financial system and accounting system are strictly implemented. The Provincial Department of Finance strengthens the overall budget and financial management of Fuwai Hospital in Yunnan, and organizes the annual financial report audit of the hospital in conjunction with the Provincial Health and Family Planning Commission to promote the steady and healthy development of the hospital.
(3) Strengthen performance appraisal. The Provincial Department of Finance, together with the Provincial Health and Family Planning Commission and other departments, explored the third-party performance evaluation of government-purchased services in Fuwai Hospital of Yunnan Province, and established an incentive and restraint mechanism linking the assessment results with the subsidy funds. The evaluation results served as an important reference for the payment of service purchase funds and the selection of service purchase projects, and effectively improved the efficiency in the use of financial funds.
Annex 6
Implementation plan of improving diagnosis and treatment ability of Fuwai Cardiovascular Hospital in Yunnan Province
In order to further improve the diagnosis and treatment ability and level of Fuwai Cardiovascular Hospital in Yunnan Province (hereinafter referred to as Yunnan Fuwai Hospital), this plan is formulated according to the Overall Plan for Comprehensive Reform of Fuwai Cardiovascular Hospital in Yunnan Province.
I. General requirements
Relying on the support of the medical management level and technical force of Fuwai Hospital of China Academy of Medical Sciences (hereinafter referred to as Fuwai Hospital of the Academy of Medical Sciences), we will gradually improve the diagnosis and treatment ability and level of Fuwai Hospital. Yunnan Fuwai Hospital has fully opened its clinical center and medical technology department, and its discipline construction has reached the requirements of the national evaluation standard for key clinical specialties. It has basically built a high-quality cardiovascular disease specialist training system, which is used as a technical support platform to radiate the whole province, promote the continuous improvement of cardiovascular disease treatment ability of hospitals at all levels in the province, provide technical support for the construction of the prevention and control system for cardiovascular chronic diseases in the province, and realize the objectives and tasks set in the Overall Plan for Comprehensive Reform of Cardiovascular Hospital in Fuwai, Yunnan Province.
Second, the main measures
(1) Homogenized introduction of advanced medical technology from Fuwai Hospital of Chinese Academy of Medical Sciences
1. Homogenization and introduction of hospital information system. Fuwai Hospital of Yunnan adopts the core information system independently developed by Fuwai Hospital of Chinese Academy of Medical Sciences to ensure the seamless connection of information between Fuwai Hospital of Yunnan and Fuwai Hospital of Chinese Academy of Medical Sciences, and the core information system is homologous and homogeneous. Establish a closed-loop information solution with hospital information system and electronic medical record system as the core, highly integrated image archiving and transmission system, laboratory information system and other whole processes, covering different fields such as medical treatment, teaching, scientific research and disease prevention and control.
2. Give full play to the leading role of experts stationed in Fuwai Hospital of Chinese Academy of Medical Sciences. Relying on the long-term team of doctors, technicians, nursing and management experts stationed in Fuwai Hospital of the Academy of Medical Sciences, we will accelerate the formation of an expert group integrating medical treatment, teaching, scientific research, personnel training and international cooperation, and lead the development of cardiovascular disease diagnosis and treatment in the province.
3. Actively carry out academic exchange activities at home and abroad. Fuwai Hospital of Chinese Academy of Medical Sciences sent first-class experts to Yunnan to carry out academic exchange activities. Fuwai Hospital of Yunnan actively undertakes academic exchange activities at home and abroad, such as the International Complex Congenital Heart Disease Summit Forum, Kunming International Cardiovascular Disease Forum, Fuwai Aortic Disease Treatment Seminar, the latest progress seminar of interventional therapy for cardiovascular diseases, and the "Heart Pacing in 100 Counties", so as to enhance the diagnosis and treatment ability of cardiovascular diseases in Yunnan and effectively play the role of radiation to drive and lead the demonstration.
(B) to strengthen the construction of talent team
Arrange all young and middle-aged doctors, technicians and nursing staff in Fuwai Hospital of Yunnan to go to Fuwai Hospital of Chinese Academy of Medical Sciences for standardized training in cardiovascular diseases. Fuwai Hospital in Yunnan adopts various forms, such as young doctors’ growth tutorial system, applying for a master’s degree with the same academic level, and circulating training for further professional study, to give full play to the role of experts in the hospital, to improve the overall quality of medical staff, to build a team of professional and technical personnel with both morality and skills, and to gradually make the academic qualifications, professional titles and age structure of the professional personnel more reasonable and perfect. Relying on the brand advantage of Fuwai Hospital of Chinese Academy of Medical Sciences, talents with associate senior and above professional and technical post qualifications or doctor’s degrees that are urgently needed in hospitals are introduced from outside the province, and personnel files can be re-established after leaving their original units to work in Fuwai Hospital of Yunnan. Fuwai Hospital of Yunnan creates favorable conditions for introducing talents.
(C) to strengthen medical quality control
Fuwai Hospital in Yunnan should standardize the diagnosis and treatment process according to the requirements of the national cardiovascular disease quality control index system, ensure that the diagnosis and treatment process meets the quality control requirements, effectively reduce the surgical mortality and infection rate, and ensure the homogeneity of hospital medical quality with Fuwai Hospital of Chinese Academy of Medical Sciences. Yunnan Fuwai Hospital should take the lead in establishing quality control indicators of cardiovascular diseases in Yunnan Province in accordance with the requirements of the Provincial Health and Family Planning Commission, and guide relevant medical institutions in the province to standardize the diagnosis and treatment of cardiovascular diseases.
(D) to strengthen the guidance and assistance to the grassroots.
1. Regularly send experts to primary hospitals to guide the work. Establish a cardiovascular disease specialist alliance with the participation of provincial, prefecture and county hospitals. Through the establishment of "Yunfu Clinic", ward rounds, surgical teaching, etc., directly participate in the clinical work of primary hospitals, and rapidly improve the diagnosis and treatment ability of cardiovascular diseases in primary hospitals. Fuwai Hospital in Yunnan should regularly organize experts to help primary hospitals, and send at least 5 experts with deputy senior titles or above to guide medical activities in cities, counties and hospitals every month for no less than 2 days.
2. Regular teaching and on-site training for primary hospitals. Set up a "Yunfu Lecture Hall", formulate personalized training programs according to the needs of primary hospitals and doctors, and strive to improve the standardization of diagnosis and treatment in primary hospitals. Establish a long-term cooperation mechanism with grassroots hospitals to open a "green channel" for people in remote areas to see a doctor. Give priority to the procedures of hospitalization, discharge, and application for special hardship fund for referral patients in primary hospitals, and apply for charitable fund for poor children with congenital heart disease.
3. Implement the "Yunyan Plan". Support cardiovascular internal medicine and surgeons from hospitals at or above the county level to go to Fuwai Hospital in Yunnan for standardized training in cardiovascular diseases. According to the needs of the grassroots, short-term (1-3 months), medium-term (3-6 months) and long-term (12 months) training programs are offered for key physicians of different levels, different seniority and different sub-professional directions.
4. Improve the scientific research level of primary hospitals. Relying on the scientific research platform of Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Hospital of Yunnan Province, we will set up horizontal scientific research projects, absorb the staff of grass-roots hospitals to participate in the research of scientific research projects, and improve the scientific research ability.
5. Establish a telemedicine service network. Relying on Fuwai Hospital of Chinese Academy of Medical Sciences and Yunnan Fuwai Hospital as the fulcrum, we will integrate the telemedicine network resources of tertiary hospitals, county hospitals and township hospitals in the province, and further develop the information platform and remote grading diagnosis and treatment network of Yunnan Cardiovascular Disease Diagnosis and Treatment Center. Establish a large database of cardiovascular disease prevention and control in Yunnan Province to improve the ability of cardiovascular disease prevention and control at the grassroots level.
Third, the job requirements
(1) Strengthen organization and implementation. Fuwai Hospital in Yunnan should refine the work tasks item by item, define the time schedule, and earnestly organize the implementation.
(2) Strengthen supervision and inspection. The Provincial Health and Family Planning Commission should strengthen the guidance, inspection and supervision of Fuwai Hospital in Yunnan, and regularly carry out monitoring and evaluation to ensure the effectiveness of the work.
