General practitioner Fu Delin's 29-year medical practice trajectory is like a "triple jump", with every step "jumping" to the place where the masses need it most. He worked in Qingxi Health Center in Taixi Township, Youxi County, Sanming City for 18 years and Xibin Central Health Center for 6 years, and then seconded to the Emergency Department of the County General Hospital. To this day, many villagers in Qingxi and Xibin still remember this Dr. Fu.
After returning from Xinjiang in 2023, he was officially transferred to the Chengdong Community Health Service Center due to the work needs of the Chengdong Community Health Service Center. In addition to being "incorporated" to the center, he brought the technology of county-level hospitals and the grassroots work experience accumulated over the years and the ability of basic public health services to the community, standardizing the business process of the center and helping the center improve its service capacity.
Fu Delin's "change in preparation" is based on a "sharp sword" of "Youxi", a star county of Sanming's medical reform. Since 2023, under the premise that the total number of medical communities remains unchanged, Youxi County General Hospital has adjusted the staffing number of member units in combination with the existing township service population and business development priorities, flexibly employed personnel, and solved the "last mile" problem of the construction of a compact medical community.
Open up the establishment of the medical community
As early as 2017, Youxi County took the lead in integrating county-level medical resources in the province. The county and rural areas implement the "seven unified" management of personnel, finance, medicine and equipment, business, performance, information and traditional Chinese medicine, and create a "four-in-one" health management group of management, responsibility, interests and service.
Youxi County General Hospital, as the "patriarch" of the county-level close-knit medical community, implements the "only" legal person system of the medical community, the president of the general hospital concurrently serves as the president of all member units, and all the member units of the medical community are responsible for the personnel, finance, materials, affairs, performance and management of the county general hospital, and the government gives the general hospital full autonomy in personnel management, internal distribution, operation management and financial management, so as to realize the "family" management of county and rural public medical institutions.
In order to truly realize the "family" of the general hospital (medical community), it is necessary to give more autonomy to the medical community in terms of establishment and use, personnel recruitment, personnel arrangement, etc., so as to strengthen the personnel management of the close-knit county-level medical community and further promote the integration of medical resources.
In September 2023, the Health Commission of Sanming City, Fujian Province and other four departments jointly issued the "Opinions on Deepening the Management of Personnel of Close-knit County-level Medical Communities", which clearly opened up the boundaries between the establishment of general hospitals and primary medical institutions. In December, ten national departments jointly issued the "Guiding Opinions on Comprehensively Promoting the Construction of a Close-knit County Medical and Health Community".
By March 2024, Youxi County General Hospital has passed two rounds of adjustment of the staffing of 12 member units under the premise that the total number of medical community establishments remains unchanged.
It is understood that it is not the first attempt to break the barriers to the internal flow of personnel in the General Hospital (Medical Community) and transfer internal personnel. Since 2017, in order to meet the needs of integrated management and actual business development, 14 business personnel of primary medical institutions (financial appropriation) have been transferred to county-level hospitals (financial subsidy), and 45 personnel from the same funding channels within the medical community have been transferred.
What is the point of breaking the boundaries of staffing?
Youxi County General Hospital through practice
The "three good" answers were obtained:
Good work, good management, good development
"Good things to do"
Among the 12 establishments in the two rounds of adjustments, 11 new ones have been added to the Chengdong Community Health Service Center. Among them is Dr. Fu Delin.
The center is the only community health service center in Youxi County, which provides basic public health services and diagnosis and treatment of common and frequent diseases for more than 100,000 residents in the urban area. With the advancement of urbanization, the amount of community services in the east of the city has increased year by year in recent years. However, the original staff of the center was only 23, and in order to meet the needs of medical and basic public health work, the staff gap could only be filled through recruitment and other means.
"The original 18 non-staff personnel, accounting for a high proportion, not only the personnel ratio is unreasonable, but also increases the cost of personnel, which is actually not conducive to the long-term development of the center. The person in charge of the Chengdong Community Health Service Center said frankly.
Since 2023, Youxi County General Hospital (Medical Community) has adjusted the number of staff members according to the service personnel, workload and business development priorities of the Chengdong Community Health Service Center.
"For example, reducing the number of township health centers with small resident populations, such as Taixi and Youxikou, this round of adjustment has increased the number of establishments to the Chengdong Community Health Service Center by 4, and it will be easier for someone to do things. According to the data, in 2023, the total income of the center's medical business will be 25.3935 million yuan, and the basic public health income will be 3.2 million yuan, an increase of 2.46 million yuan and 400,000 yuan respectively compared with 2022. The person in charge of the personnel department of Youxi County General Hospital sighed sincerely, "This is difficult to achieve in other systems, but why can we do it? It is based on the 'family' management model of the medical community." ”
"Good management"
Breaking down the barriers to personnel flow also plays an important role in helping the financial integration management of the medical community.
Sanming City implements a double package system of medical insurance funds, financial subsidies and special funds of all general hospitals (medical communities). The medical insurance fund will be contracted to the general hospital on an annual, county-by-county, and capitation basis, and the incentive and restraint mechanism of "total lump sum, overspending will not be supplemented, and the surplus will be retained", and the surplus fund will be allocated by the general hospital independently, so as to promote the members of the medical community to adhere to the equal emphasis on medical treatment and prevention. All personnel funds, national basic public health service funds and other funds will be allocated to the general hospital, which will make overall planning and distribution, and all employees of the medical community will be calculated and distributed by the general hospital, so as to promote the "risk sharing and benefit sharing" of the member units of the medical community.
The person in charge of the personnel department of Youxi County General Hospital said: "Originally, the health centers made their own accounts, and the financial management of each health center was not uniform and standardized. In 2017, the county general hospital transferred 6 financial personnel from township health centers (including community health service centers) to form a grassroots financial department, and the financial management and accounting of all health centers were uniformly managed, and the salaries of employees were assessed and distributed in a unified manner, so as to better promote the management of 'one account' within the medical community. In 2023, we will transfer all the financial personnel of each township health center and Chengdong Community Health Service Center to the county general hospital, and the personnel management will be more standardized. ”
"Good development"
Xiao Fangjun, a public health physician, is a first-hand witness of medical reform and an "insider" of Youxi County's "establishment reform" in recent years.
He was originally a public health physician at Meixian Health Center in Youxi County, and has been engaged in basic public health work for more than 20 years. In 2017, after the General Hospital entrusted the basic public health at the grassroots level, it was urgent to set up a public health professional team to be responsible for the management of basic public health at the grassroots level. As a senior public health professional, he was transferred to the National Health Management Department of the County General Hospital in the form of a loan, and will be officially transferred to the General Hospital in 2023.
"Originally, in the township, I only had to be responsible for the specific business of a branch hospital, and after being seconded to the general hospital, I had to be in charge of the county's basic public health and national health management, which was more stressful, but my ability was indeed well trained. After the establishment is officially transferred to the General Hospital in 2023, I have a stronger sense of belonging, I can work more freely, and I have a stronger ability to manage and execute the management of various health centers and villages. Xiao Fangjun spoke about the changes in his mind in recent years.
Innovate the personnel management of the medical community, break the boundaries of staffing, and provide better development opportunities for medical workers like Xiao Fangjun one after another. As a member of the construction of a close medical community, their development can undoubtedly further promote the development of the county-level close medical community, promote the integration of county-level medical resources, promote homogeneous management, improve primary medical services, and promote the general hospital (medical community) to truly realize "one family", "one heart" and "one account", and provide high-quality basic medical and public health services for the people.
(Deng Jianyun, Chen Weiqiong)
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