With the establishment of national health commission and national health insurance bureau, China's hospitals are undergoing or have undergone profound changes under the general situation of comprehensively deepening reform. Hospital leaders, hospital staff at all levels, must recognize, face and adapt to this change.
I. the leadership system of China's public hospitals, which has been in operation for 33 years, has undergone profound changes.
In June 2018, the cac issued the opinions on strengthening party building in public hospitals. Clearly put forward, public hospitals under the leadership of the party committee of the President responsibility system. The collective decision-making mechanism of the party committee of the hospital was further clarified and strengthened, and the responsibilities and rights of the party secretary of the hospital were clearly strengthened. The general office of the hubei provincial party committee has issued the implementation opinions on strengthening the party construction of public hospitals in the whole province, which makes it clear that the party secretary is generally responsible for the hospital work, performs the responsibilities of the first person responsible for the hospital work, and supports the President to independently and responsibly exercise his duties according to the law and regulations. The opinions specify that the collective decision-making system of the hospital party committee should be strengthened, and the party secretary should be given the right to lead, supervise and support the administrative work of the hospital President. The rights and responsibilities of the secretary should be clearly strengthened, and the administrative power of the President should be checked and balanced. The reform of the leadership system of public hospitals undoubtedly adjusts the power distribution of the main leaders in public hospitals. Hospital secretaries and directors should adapt to the new role, and members of the hospital team, cadres and staff at all levels should also adapt to the change of the leadership system. Cadres and staff at all levels in public hospitals must carefully study, study and understand the opinions of the CPC central committee and the opinions of party committees of provinces and cities, so that the new leading bodies can carry out their work in accordance with the requirements of the opinions as soon as possible. Hospital cadres and staff at all levels should also fully understand and adapt to the new leadership system, and actively support the new system team work, so that the new system team work in the hospital smoothly launched and implemented.
Second, the adjustment of the price of hospital charges will bring changes to the hospital, and the imbalance of hospital income and expenditure will be more prominent.
National medical reform imposes zero price difference on drugs in public hospitals, which has a huge impact on hospital revenue. The policy has only been in place for a year, and many hospitals are suffering severe losses. State financial subsidies cannot be fully implemented, and the balance of payments is in negative balance.
The price of medical examination items will be lowered, and some doctors' technical expenses and labor costs will be appropriately raised. At present, the increase in doctors' technical expenses and labor costs is far from enough to make up for the zero price difference of drugs, and the reduction in the price of inspection items has reduced the total revenue of the hospital. The income and expenditure of public hospital appears deficit commonly, how to do? Some hospitals have been in arrears with the payment of drugmakers' consumables. If we just wait for the government subsidy, I'm afraid it is unrealistic. We should strengthen internal management, reduce costs, and increase revenue and reduce expenditure. In addition, the secretaries and directors of public hospitals still need to actively report to the decision-making departments of medical reform that the technical expenses of doctors are still seriously low and the prices of labor cost charging items are low. To this medical reform decision-making department must boldly change, changes in place.
Third, the regulation of medical insurance expenses is becoming stricter and stricter, and the practice of medicine in accordance with laws and regulations is becoming more and more standardized.
After the CCTV exposed the insurance fraud of two private hospitals in shenyang, medical insurance departments at all levels across the country are conducting a large-scale inspection on the compliance of medical insurance charges for hospitals at all levels. Although the phenomenon of fraudulent insurance and hedging mostly occurs in a few private hospitals, there are also some non-compliance problems in some public hospitals.
In January 2018, the media exposed the insurance fraud case of the third affiliated hospital of anhui university of traditional Chinese medicine. Some public hospitals with poor management and poor efficiency will also more or less have some marginal medical insurance violations, and some large hospitals will have the problem of high single-disease cost, which is also the focus of the newly established medical insurance bureau. In 2019, the secretaries and directors of public hospitals must strictly implement the medical insurance policy, not cross the red line and make mistakes in this aspect.
Fourthly, the national health insurance bureau will purchase in quantity, the price of drugs will drop sharply, the phenomenon of supporting doctors with medicine will gradually disappear, and the real income of doctors will decline.
On December 7, 2018, the state administration of health insurance organized and adopted the organizational form and idea of "national organization, alliance procurement, platform operation" to promote the development of Beijing, Shanghai, tianjin... Public medical institutions in 11 provinces and cities, etc. are the main body of centralized procurement. Procurement alliances are organized to gather demand and strength and improve bargaining power. The average price of the selected drug decreased by 52% and the highest by 96%. The cost of drug production is constant, and the price reduction is squeezed by the cost of drug sales, so the phenomenon of drug rebates will be greatly suppressed or even disappear.
This time the national health insurance bureau has just started to purchase medicines in bulk. In the future, large quantities of medicines will be purchased in an all-round way, and the price of medicines consumed by patients will be greatly reduced. In the past 20 years, the phenomenon of "medicine for medicine" in China has become so serious that it has to be cured. Drug rebate is a very abnormal social phenomenon. If we do not remove this phenomenon, it will not be successful in medical reform. After the elimination of drug rebates, doctors' income will drop, and their work enthusiasm will be affected? It's also something hospital leaders and health care departments should consider. I'm afraid it is necessary to return to the value of doctors' technical labor, improve doctors' technical labor costs, and restore the essence of medical costs.
Five, the problem of doctors' multi-point practice, the impact on public hospitals.
The state encourages and supports multi-site doctor practice. Although the policy has been relaxed, the phenomenon of large-scale multi-site doctor practice has not appeared yet. Some hospitals have ordered doctors not to be allowed out of multi-site practice. On the other hand, most directors and experts in public hospitals are busy and laborious, and do not have time and energy to practice more.
Multi-point practice of doctors is the general trend and cannot be stopped. In some public hospitals, some experts have started small-scale multi-site practice, going to third-party hospitals for surgery, consultation, ward rounds and clinic visits. For example, dentists use their spare time to practice medicine outside the home to increase their income. Public hospital leaders, how to deal with this new situation, how to change ideas from the ideological to adapt to face, how to formulate the corresponding rules and regulations to regulate, is the right choice.
Six, other factors affecting hospital reform.
The reform of military hospitals has entered the final stage. Centering on medical service and combat readiness, the military hospitals have significantly reduced the number of local patient beds and the number of patients admitted to them. Public hospitals should pay attention to the outflow of patients from military hospitals, and should take the initiative to seize this part of the medical market.
A Ⅰ medical and Internet + although just beginning, but rapid development momentum. A Ⅰ health in some disciplines, such as image diagnosis, pathological diagnosis have been part of the hospital began to application, and use well and greatly improve efficiency and reduce cost. Online medical services have also been liberalized in some areas. Ma claimed that in the future, online diagnosis of patients and express delivery of medicine will become an important part of medical treatment. The secretaries and directors of our hospital must closely track this new type of business form and timely apply it in their own hospitals to meet this future medical treatment.
The rise of medical city also brings huge influence to medical industry. More than 30 medical enterprises have settled in hainan boao international medical pilot zone, and boao super hospital and boao Evergrande international hospital have started operation. Under the strong support of national policies and the support of large capital, this emerging form of medical industry is emerging in an unprecedented way. It has tax-free privileges. The application of some new drugs and technologies is in sync with advanced medical countries such as Europe, America and Japan.
In 2019, the year of health reform, the new health commission and the newly established health insurance bureau are bound to push forward the existing major health care reform measures, or will introduce some major health care reform measures. 2019 is destined to be an extraordinary year in the medical field. Let's embrace it with full confidence.