By the end of 2019, there were 1.227 million rural doctors in the country, of which 435,000 were qualified to practice (assistant) physicians.
Recommendation No. 4433, Recommendation No. 4562 and Recommendation No. 7750 of the Third Session of the Thirteenth National People's Congress all pay attention to the training, income, and pension of rural doctors.
Recently, in response to the above suggestions, the relevant departments of the National Health Commission have replied one by one.
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On speeding up the training of reserve village doctors -
The reply mentioned that in 2010, China officially launched the training of free medical students for rural orders, and proposed the policy of "two exemptions and one supplement" (free tuition, free accommodation, and subsidized living expenses), focusing on cultivating general medical and health talents in clinical medicine and traditional Chinese medicine for township health centers and medical and health institutions below.
In the past ten years, 30 provinces across the country have carried out free training of rural order-oriented medical students, the central government has invested a total of 1.6 billion yuan, and more than 20,000 graduates have been employed, effectively alleviating the shortage of grass-roots health talents.
In order to expand the talent team, optimize the educational structure, and improve the level of medical services in rural areas, in 2020, the National Health Commission issued the "Opinions on Allowing Graduates of Medical Colleges and Universities to Apply for Rural Doctor Practice Registration Without Examination", allowing fresh graduates of clinical medicine, traditional Chinese medicine, integrated traditional Chinese and Western medicine and other related majors who are willing to engage in rural doctors and have full-time college degree or above (including graduates who have not implemented work units during the career selection period) to apply for rural doctor practice registration without examination.
After graduates of medical colleges and universities engaged in rural doctors participate in the open recruitment of township health centers and are hired, the township health centers sign employment contracts or labor contracts with them in accordance with law to ensure their relevant treatment.
Regarding the proper settlement of the income of rural doctors -
The answer is clear that after the implementation of the basic drug system, the income of rural doctors is mainly composed of three parts: basic public health service subsidies, basic drug subsidies, and general diagnosis and treatment fees.
First, the per capita subsidy for basic public health services has increased year by year. The subsidy increased from 15 yuan in 2009 to 74 yuan in 2020, in principle, about 40% of the work tasks will be undertaken by the village clinic, and the subsidy funds will be allocated according to the assessment of the work tasks, and the basic public health service funds obtained by rural doctors will also increase.
In 2020, the central government will issue a total of 60.3 billion yuan of subsidies for basic public health services, requiring that all 5 yuan of new funds be implemented in rural and urban communities, which can be used for regular expenditures such as personnel funds and public funds of grass-roots medical and health institutions such as community health service centers (stations), township health centers and village clinics in accordance with relevant regulations.
The second is to support the implementation of the essential drug system. In village clinics where the basic medicine system is implemented, village doctors can receive subsidies for basic drugs. Since 2011, the central government has allocated basic drug subsidies to various localities according to the standard of 5 yuan per person for the rural population. In 2020, the central government will arrange subsidies of 9.1 billion yuan (including 2.69 billion yuan of subsidies for village clinics).
The third is the subsidy for general medical treatment fees. Basic medical services provided by rural doctors are compensated through general medical fees. Most of the general diagnosis and treatment fees in village clinics in various places are 5 yuan, and Hebei, Tianjin and other places have raised the standard to 10 yuan to increase the income of rural doctors.
In addition, areas with better conditions give certain subsidies to rural doctors and village clinics for the operation of funds.
Hebei Chengde gives a fixed subsidy of 5,000-15,000 yuan per year to the village clinics serving a population of less than 1,000 people, and at the same time, gives the village clinics an annual operating subsidy of 3,000-5,000 yuan.
Shanxi Taiyuan arranges subsidies of not less than 1,000 yuan per village every year for the operation of the water, electricity, heating and information network of the village clinic.
Hainan Qionghai clarified the standard of rural doctors' work funds, and included the network tariffs of village clinics and medical waste disposal fees into the municipal financial budget, with network tariffs of 600 yuan per year and medical waste disposal fees of 900 yuan per year, reducing the operation costs of village clinics and ensuring normal operation.
On strengthening the basic medical care and old-age security of rural doctors——
The reply mentioned that the participation of rural doctors on the job in endowment insurance can be divided into three situations, one is that personnel who have a formal business establishment of township health centers participate in the endowment insurance of organs and institutions according to relevant regulations.
Second, the non-staff medical personnel employed by the township health center shall participate in the basic old-age insurance for the employees of urban enterprises in accordance with the law, and the township health center and the hired personnel shall pay the basic old-age insurance premium in full and on time.
Third, medical personnel who have not signed an employment contract or labor contract or established a labor relationship may voluntarily participate in the basic old-age insurance for enterprise employees as flexible employment personnel in accordance with local regulations, and may also choose to participate in the old-age insurance for urban and rural residents.
By raising the income level of rural doctors when they are employed, helping them to pay long contributions, and raising the basic pension level after retirement.
For rural doctors who have left their posts at least 60 years old, in 2015, the General Office of the State Council issued the "Implementation Opinions on Further Strengthening the Construction of the Rural Doctor Team", which proposed that various forms such as subsidies can be taken to further improve the pension treatment of rural doctors in combination with actual conditions.
For rural doctors who leave their posts for the elderly, most places use fixed subsidies or seniority subsidies based on years of service to improve pension benefits.
Guangxi, Hainan, Ningxia and other provinces and regions are given annual subsidies according to the standard of 15-20 yuan per month per year of work, and the longer the working time in the village clinic, the higher the pension treatment; Guangdong gives a fixed subsidy according to the standard of 700-900 yuan per person per month.
In addition, Anhui, Jiangxi, Henan, Qinghai and other provinces also give no less than 300 yuan per month to rural doctors who have worked continuously in village clinics for more than 10 years, and improve the pension treatment of rural doctors who leave their posts.
In view of the next step of the work goals and planning, the National Health Commission has made it clear -
Continuously improve the income level of rural doctors. Guide all localities to actively coordinate with relevant departments to strictly implement rural doctors' basic public health service subsidies, basic drug subsidies, and general diagnosis and treatment fees, standardize the assessment of basic public health services and the allocation of funds, and ensure that subsidy funds are allocated in full and in a timely manner in accordance with regulations. At the same time, we will implement the contract service fees for family doctors, promote the settlement of medical insurance in village clinics, effectively include eligible village clinics in the scope of overall payment of basic medical insurance outpatient clinics, and improve the income treatment of rural doctors through multiple channels.
Continue to promote the solution of the problem of rural doctors' retirement from the elderly. Encourage local governments to take measures to improve the pension treatment of rural doctors, and support and guide qualified rural doctors to participate in the basic old-age insurance for employees in accordance with regulations.
Accelerate the construction of a close-knit county medical community and the integrated management of rural areas, promote the reform experience of "township employment and village use" in Guangdong, Gansu and other places, and solve the problems of income treatment and old-age security for rural doctors from a deep level.
At the same time, we will guide rural doctors to participate in insurance early, pay more fees, and accumulate more, improve the level of their personal account pensions, and continuously improve the level of old-age security for urban and rural residents, including rural doctors.
Continue to strengthen the access management of rural doctors. Encourage rural doctors on the job to participate in the rural general practice assistant physician qualification examination, take the initiative to improve their academic level and practice qualifications, gradually improve the policy support system for the development of the rural doctor team, and classify and implement policies according to the level of economic and social development in different regions in the eastern, central and western regions, and steadily promote the transformation of rural doctors into practicing (assistant) physicians.
■ Liu Jie