Medical and nursing income may be greatly adjusted! Salary, establishment and distribution, and assessment results are linked to public health subsidies...

Medical and nursing income may be greatly adjusted! Salary, establishment and distribution, and assessment results are linked to public health subsidies... 18 important measures were introduced

Guide:

The results of the performance appraisal are linked to the subsidy of public health services, the payment of the medical insurance fund, the approval of the total amount of performance salary, and the salary, appointment and dismissal, rewards and punishments of the responsible personnel.

According to the Hebei Provincial Health Commission, 10 departments, including the Provincial Health Commission, the Provincial Party Committee, and the Provincial Development and Reform Commission, jointly issued the "Implementation Opinions on Comprehensively Promoting the Construction of a Close-knit County Medical and Health Community" (hereinafter referred to as the "Implementation Opinions"). The "Implementation Opinions" include 18 specific tasks in 4 aspects. The document puts forward task requirements for optimizing the internal operation mechanism of the county-level medical community from four aspects, and at the same time, improves the external governance mechanism and guarantee support policies from the aspects of investment security, medical insurance policy, personnel establishment, and salary system.

Image source: Hebei Provincial Health Commission

The "Implementation Opinions" make it clear that by the end of 2024, the policies supporting the construction of county-level medical communities such as organization and management, investment guarantee, personnel establishment, remuneration and medical insurance payment, etc., will be further improved, and all counties (county-level cities, municipal districts with conditions can refer to) will basically build a county-level medical community with reasonable layout, unified management of personnel, property and property, clear rights and responsibilities, efficient operation, division of labor and cooperation, continuous service, and information sharing.

Improve the leadership and management system and organizational management system

The "Implementation Opinions" emphasize the improvement of the management system. The construction of county-level medical community should be regarded as an important part of the comprehensive deepening of reform and the performance evaluation of government target management. At the same time, optimize and integrate county-level medical and health resources. The leading hospital of the county-level medical community shall generally be a non-profit general hospital or traditional Chinese medicine hospital of the second level or above. Encourage qualified county-level traditional Chinese medicine hospitals to take the lead in establishing county-level medical communities. In accordance with the principle of voluntariness, with the focus on homogeneous management of business and strengthening rural services, encourage and guide social forces to run medical institutions to join the county-level medical community. Promote the integration of counties and townships and villages. Second- and third-level hospitals should improve the service capacity and management level of the county-level medical community through the dispatch of experts, joint construction of specialties, clinical teaching, remote collaboration, scientific research and project collaboration. The document makes it clear that by the end of 2025, 200 township health centers in the province will meet the construction standards of community hospitals. Qualified public village clinics will be gradually converted into village-level medical service points extended by township health centers, and unified management of personnel, wages, finance, medicine and equipment, business, access and exit, training and education, performance appraisal, rewards and punishments, etc. will be implemented.

Strengthen internal operation management,

Improve the performance appraisal system

Adhere to the positioning of the county-level medical community as the main body of service, and promote the realization of unified management of administration, personnel, finance, business, medication, information, logistics, etc. Implement the establishment of posts according to needs, competitive recruitment, and salary based on posts, promote the rational flow of personnel, and give priority to ensuring the employment needs of primary medical and health institutions.

Improve the performance appraisal system

The Hospital Management Committee clarifies the annual task objectives and performance evaluation indicators of the county-level medical community, highlighting the content of resource sinking, health promotion, and cost control. The county-level health administrative department, in conjunction with relevant departments, regularly carries out county-level medical community assessments, and the performance evaluation results are linked to public health service subsidies, medical insurance fund payments, the total amount of performance wages, and the salary, appointment and dismissal, rewards and punishments of responsible personnel. The county-level medical community has established and improved the internal assessment mechanism, and the assessment indicators are inclined to the sinking of resources, patrol stationing, family doctor contracting, cost control, etc., and reasonably determine the distribution of the remaining income of the medical insurance fund and performance wages in member units, pay attention to the grassroots level, and establish a long-term incentive mechanism. By the end of 2024, all counties that carry out the construction of medical communities will establish a performance appraisal system that is in line with reality.

Promote the interconnection and sharing of resources and services,

Implement the contracted service of family doctors

Encourage the construction of county-level central pharmacies relying on county-level medical communities, establish a system for drug shortage registration, distribution and shortage of drug reserves, and solve the problem of drug use by rural residents. Give full play to the role of the county's medical laboratory, medical imaging, electrocardiogram diagnosis, pathological diagnosis, disinfection supply and other resource sharing centers, and by the end of 2025, the sharing center services will cover all member units.

Implement the contracted service of family doctors

County-level general hospitals should set up general medicine departments, organize physicians to rely on basic medical and health institutions to carry out contracted services for family doctors, and ensure contracted services for the general population and key populations, and increase the coverage rate of contracted services for the entire population and key populations by 1-3 percentage points every year. Establish and improve the system of family doctors' first diagnosis of residents, track the treatment process of referred patients, and do a good job of continuing services. In the county-level medical community, the higher-level hospitals reserve more than 20% of the resources in terms of expert number sources, inpatient beds, and appointment examinations to give priority to patients referred by family doctors.

Optimize personnel establishment management,

Deepen the reform of the salary system

In terms of investment guarantees, it is emphasized that all levels will coordinate funds such as basic public health services and subsidies for basic drug systems to support rural medical and health institutions. The new fiscal health expenditure of local governments should be appropriately tilted towards the primary medical and health institutions within the county-level medical community.

Promote the reform of medical insurance payment methods

The county-level medical community is paid according to the diagnosis related group (DRG) or according to the disease score (DIP) under the total budget management. Strengthen the assessment of the growth rate of medical expenses, the proportion of medical insurance reimbursement, the rate of primary medical treatment, the proportion of fund expenditure in the county, and the proportion of medical insurance funds in primary medical and health institutions in the county, and link the assessment results with the retention of medical insurance fund balances and overexpenditure sharing. Improve the surplus retention mechanism, and the surplus funds will be used as the business income of the county-level medical community, of which 60%-70% can be used for the salary payment of medical staff, and 30%-40% can be used for the development of medical institutions. Improve the mechanism for sharing reasonable overspending of the medical insurance fund in the overall planning area.

Optimize personnel establishment management

The county-level medical community is given more autonomy in terms of establishment and use, personnel recruitment, personnel arrangement, performance appraisal, and professional title evaluation. The establishment of public medical and health institutions within the county-level medical community is approved separately, and more attention is paid to the overall use of personnel, and the county management and township use and township employment are implemented according to the needs of the post. Strengthen the training and recruitment of grassroots general practitioners, traditional Chinese medicine physicians, public health physicians, pharmacists, pediatricians, etc. With the county-level medical community as a unit, make full use of the number of professional and technical posts, and appropriately increase the proportion of intermediate and senior professional and technical posts in primary medical and health institutions. For master's students, urgently needed, scarce and high-level talents with intermediate titles and above, support the introduction of county-level medical communities through selection and recruitment, and the human resources and social security departments will unblock the "green channel" and implement on-the-go processing.

Deepen the reform of the salary system

Implement the requirements of the "two permits", coordinate and balance the level of performance-based wages at the county and township levels, and reasonably regulate and control the income gap between all levels and types of medical and health institutions. Encourage the implementation of an annual salary system for the heads of medical and health institutions within the county-level medical community. On the premise of ensuring the normal operation and sustainable development of the business, the county-level medical community can independently declare the total amount of performance work, and can independently adjust the proportion of basic performance and incentive performance salary within the approved total amount.

Source: Hebei Provincial Health Commission