After the publication of the Guidance Opinions for Deepening the Reform of the Medical and Health System (Draft for Soliciting Opinions), it has aroused great concern and hot discussion from all walks of life. It is not difficult to find through detailed reading of the part of the reform of medical institutions that many items are the deepening and improvement of the previous reform exploration. For example: the public hospital nature of public welfare and social responsibility positioning, adhere to the patient-centered optimization of service processes, establish and improve the hospital legal person management system, the implementation of separate management of medical income and expenditure and so on. It can be said that past reforms laid the foundation for the reforms to be carried out. What important reform practices have China's medical and health institutions ever since reform and opening up? Cao Ronggui, chairman of the Chinese Hospital Association, who was once the vice minister of the Ministry of Health, made the following review in an interview with reporters.
Looking back on 30 years
At the end of 1978, the Third Plenary Session of the Eleventh Party Congress made a great decision on reform and opening up. The Chinese hospital reform boat also set sail. Looking back at the 30-year process of Chinese hospital reform, it can be roughly divided into three phases:
In the first stage, set the chaos and improve service efficiency (1979-1996).
At this stage, the hospital carried out various reform attempts:
1979 to 1983
During the year, the first was the “exclusive office, big pot of rice, one size fits all, no accounting†at the time. The hospital became poorer and poorer. The hospital environment and order were dirty, chaotic and poor. The problems of difficulty in seeing a doctor, hospitalization, and difficulty in surgery began. Reorganizing and reforming focusing on economic management. Basically solved the chaotic phenomenon of drug management; rectified and improved the hospital charging system; set up a quota management system to improve work efficiency and equipment utilization.
From 1983 to 1987, the hospital reforms from point to face, from shallow to deep, from single to comprehensive, and implemented the contract responsibility system, the president responsibility system, the cadre staff appointment contract system, the talent flow system, the establishment of family beds, and the expert listing. Outpatient services, the establishment of a medical cooperation consortium, the socialization of hospital logistics services, and other reforms.
From 1989 to 1996, some hospitals tried out the "one hospital, two systems, or one hospital and multiple systems" business model and distribution methods; some hospitals conducted trials in the hospital, some used foreign capital, and introduced advanced technology; joint-stock hospitals Private hospitals began to appear, with the implementation of a pilot medical insurance model that combines social pooling and personal medical accounts, and a reform of "total control and structural adjustment" of medical expenses.
In the second stage, the innovation mechanism and the improvement of supporting measures (1996-2005).
The reform of the hospital is closely related to the goal of providing relatively high-quality medical services at a relatively low cost, striving to meet the basic medical service needs of the masses and promoting the healthy development of medical and health services, and adopting a series of measures to improve service quality and service attitude. Control medical expenses. The new cooperative medical system began to be established. Community health services started in reforms, developed during exploration, and improved in practice. Some large and medium-sized cities have begun to establish community health service networks. During this period of time, China has successively issued laws, regulations, and regulations such as the "Practicing Doctors Act," "Medical Accident Treatment Ordinance," "Interim Measures for the Administration of Sino-Foreign Joint Ventures, Cooperative Medical Institutions," and "Measures for the Management of Medical Cosmetology Services" to speed up medical treatment. Industry management legalization process.
The third stage clearly defined the direction and deepened institutional reforms (2006-2008).
In early 2006, the State Council promulgated the Guiding Opinions on the Development of Urban Community Health Services, and proposed to adhere to the public welfare nature of community health services, pay attention to the fairness, efficiency, and accessibility of health services, adhere to the government's lead, and encourage social participation. On October 11, 2006, the Sixth Plenary Session of the 16th CPC Central Committee made it clear that "we must adhere to the public welfare nature of public health care, build a basic health care system covering urban and rural residents, and provide the public with safe, effective, convenient, and inexpensive public services." Health and basic medical services: Establish a national basic medicine system, rectify the order of production and distribution of medicines, and ensure that people use basic medicines.†The new medical reform program began to gestate, and hospital reforms were integrated into the overall reform of the urban and rural medical and health systems.
Inventory five achievements
Prior to this hospital reform, various sectors of the community commented differently, even saying that "the reform is basically unsuccessful." Cao Ronggui believes that hospital reforms that lasted for 30 years cannot be simply evaluated as "successful" or "unsuccessful." It should be noted that the hospital reform has achieved many achievements in the past 30 years and laid the foundation for the next reform. These achievements are mainly:
I. The principles, principles, goals, and guiding ideology of hospital-run colleges are increasingly clear.
In October 2007, General Secretary Hu Jintao made a clear statement on the road to socialist development with Chinese characteristics in the report of the 17th CPC National Congress. In a concluding speech at the 2008 Health Work Conference, Comrade Gao Qiang, Secretary of the Party Group and Deputy Minister of the Ministry of Health, gave a concrete explanation to the socialist development path of socialism with Chinese characteristics, namely, to adhere to the public health service for people's health and to serve people's all-round development. Services for economic and social development; Adherence to the public welfare nature of public health care; Adherence to the principle of prevention as the mainstay; Focusing on the countryside as the key; Equal emphasis on Chinese and Western medicine; separate administrative affairs, separation of management from administration, separation of medicines from profitability and non-profit separation; Responsibility and investment to improve the national health policy; establish a basic medical and health system, build a public health service system covering urban and rural residents, medical service system, medical security system, drug supply security system; provide safe, effective, convenient, and inexpensive Medical and health services enable everyone to enjoy basic medical and health services. This also points the way for the reform and development of the hospital.
Second, the understanding of the nature of public welfare in hospitals has become increasingly profound.
With the gradual deepening of reforms, especially in recent years, public hospitals have increasingly paid attention to the nature of public welfare. Hospitals have basically established business ideas that emphasize social benefits and focus on social responsibility while not ignoring economic benefits. After 30 years of reform, the perspective of hospital management is no longer confined to the medical institutions. It has changed from simply considering the development of the hospital itself to paying more attention to the overall interests of the people. In terms of hospital service functions, the medical treatment that focuses on prevention and health care has changed from a focus on prevention and health care to a focus on prevention and health care. It focuses on the management of hospital infections, attaches great importance to supporting rural and grassroots units, and pays attention to alleviating poverty, supporting agriculture, and providing disaster relief. Hospitals increasingly focus on fulfilling their social needs. responsibility.
Third, the overall quality and service level of the hospital have been significantly improved.
After 30 years of reform, the quality of hospital medical personnel, medical technology, hospital management, hardware facilities, and service capabilities have all significantly improved. The level of medical technology and facilities in large urban hospitals in economically developed regions have approached or reached the level of developed countries, and the medical conditions in the central and western regions and grass-roots hospitals have also significantly improved. After the hospital's classification management and hospital management activities, the quality of medical services in our hospitals has continued to improve, and patient safety has received the full attention of hospital managers and medical workers. The form of hospital services has evolved from a single medical service in the past to providing various forms of services such as medical services, rehabilitation services, family services, community services, social services, and psychological services. According to statistics, the per capita life expectancy in China has increased from 67.8 years in 1981 to 73.0 years in 2005; the infant mortality rate has dropped from 37.6‰ in 1981 to 15.3‰ in 2007; the maternal mortality rate was 80.0/10 million in 1991. It dropped to 36.6/10 million in 2007. The health of the Chinese people has reached a high level in developing countries. Of these, hospital reform has contributed.
Fourth, hospital management systems and incentive mechanisms have been increasingly perfected.
The hospital was transformed from an affiliate of the administrative department of health into an independent legal entity operating autonomously. The management system of the hospital leadership changed from the leadership system of the party and government regardless of the past to the system of the president’s responsibility. That is to say, the president is responsible for hospital administration as the hospital legal person. The organization and management system enables the dean to basically have the right and responsibility in the management and management, and some hospitals have begun to try standardized hospital corporate governance. At the same time, the hospital has expanded from a single universal or collective ownership system to a variety of ownership forms such as Sino-foreign joint ventures, joint-stock companies, joint-stock cooperatives, and individual private ownership. The operational efficiency of the hospital has been greatly improved, and it is more suitable for the actual national conditions of China's initial stage of socialism. The personnel system of the hospital has been transformed from "iron rice bowl" and "iron chair" to various forms of appointment system and employment system. Between hospitals and employees, a certain degree of two-way choice has been achieved. Most hospitals have implemented performance appraisal, implemented post management, introduced competition mechanisms, and the hospital’s distribution system has changed from being one of the most potent, imposing, and profitable equalitarian “big pots†to being implemented. With various forms of responsibility and incentive measures, the work enthusiasm and initiative of hospital staff have generally improved.
Fifth, the growing awareness of hospital management.
The operation and management of the hospital never considers the market, pays no attention to the operation, does not care about the cost, etc., relying on, and wants the planned economic management system model to become market-oriented, business-oriented, and cost-oriented market economy management system model. While paying attention to the hospital's services, technology and quality, we must pay full attention to the operation, accounting and benefits of the hospital, recognize that the hospital must follow the rules of market development and economic laws, and strengthen the importance of business management; attach importance to the investigation and development of the medical market and take Effective measures to adapt to market demand, improve the effectiveness of hospital services, make hospitals gradually adapt to the changes and development of the market economy, and lay a good foundation for the hospital's healthy development under the socialist market economic system.
It is undeniable that Chinese hospital reforms, like those in other fields, are still facing a series of problems and challenges while achieving achievements and accumulating experience. We have every reason to believe that under the guidance of the spirit of the party’s 17th National Congress, the majority of hospital administrators and medical personnel must be able to adhere to the scientific development concept, base on China’s national conditions, combine the actual conditions of the local and the hospital, and forge ahead with innovation and innovation. Continuously deepen the reform of hospitals, explore the path of hospital development that suits China's actual conditions, and make new contributions to the realization of the goal of universal access to basic medical and health services and the building of an overall well-to-do society.
Looking back on 30 years
At the end of 1978, the Third Plenary Session of the Eleventh Party Congress made a great decision on reform and opening up. The Chinese hospital reform boat also set sail. Looking back at the 30-year process of Chinese hospital reform, it can be roughly divided into three phases:
In the first stage, set the chaos and improve service efficiency (1979-1996).
At this stage, the hospital carried out various reform attempts:
1979 to 1983
During the year, the first was the “exclusive office, big pot of rice, one size fits all, no accounting†at the time. The hospital became poorer and poorer. The hospital environment and order were dirty, chaotic and poor. The problems of difficulty in seeing a doctor, hospitalization, and difficulty in surgery began. Reorganizing and reforming focusing on economic management. Basically solved the chaotic phenomenon of drug management; rectified and improved the hospital charging system; set up a quota management system to improve work efficiency and equipment utilization.
From 1983 to 1987, the hospital reforms from point to face, from shallow to deep, from single to comprehensive, and implemented the contract responsibility system, the president responsibility system, the cadre staff appointment contract system, the talent flow system, the establishment of family beds, and the expert listing. Outpatient services, the establishment of a medical cooperation consortium, the socialization of hospital logistics services, and other reforms.
From 1989 to 1996, some hospitals tried out the "one hospital, two systems, or one hospital and multiple systems" business model and distribution methods; some hospitals conducted trials in the hospital, some used foreign capital, and introduced advanced technology; joint-stock hospitals Private hospitals began to appear, with the implementation of a pilot medical insurance model that combines social pooling and personal medical accounts, and a reform of "total control and structural adjustment" of medical expenses.
In the second stage, the innovation mechanism and the improvement of supporting measures (1996-2005).
The reform of the hospital is closely related to the goal of providing relatively high-quality medical services at a relatively low cost, striving to meet the basic medical service needs of the masses and promoting the healthy development of medical and health services, and adopting a series of measures to improve service quality and service attitude. Control medical expenses. The new cooperative medical system began to be established. Community health services started in reforms, developed during exploration, and improved in practice. Some large and medium-sized cities have begun to establish community health service networks. During this period of time, China has successively issued laws, regulations, and regulations such as the "Practicing Doctors Act," "Medical Accident Treatment Ordinance," "Interim Measures for the Administration of Sino-Foreign Joint Ventures, Cooperative Medical Institutions," and "Measures for the Management of Medical Cosmetology Services" to speed up medical treatment. Industry management legalization process.
The third stage clearly defined the direction and deepened institutional reforms (2006-2008).
In early 2006, the State Council promulgated the Guiding Opinions on the Development of Urban Community Health Services, and proposed to adhere to the public welfare nature of community health services, pay attention to the fairness, efficiency, and accessibility of health services, adhere to the government's lead, and encourage social participation. On October 11, 2006, the Sixth Plenary Session of the 16th CPC Central Committee made it clear that "we must adhere to the public welfare nature of public health care, build a basic health care system covering urban and rural residents, and provide the public with safe, effective, convenient, and inexpensive public services." Health and basic medical services: Establish a national basic medicine system, rectify the order of production and distribution of medicines, and ensure that people use basic medicines.†The new medical reform program began to gestate, and hospital reforms were integrated into the overall reform of the urban and rural medical and health systems.
Inventory five achievements
Prior to this hospital reform, various sectors of the community commented differently, even saying that "the reform is basically unsuccessful." Cao Ronggui believes that hospital reforms that lasted for 30 years cannot be simply evaluated as "successful" or "unsuccessful." It should be noted that the hospital reform has achieved many achievements in the past 30 years and laid the foundation for the next reform. These achievements are mainly:
I. The principles, principles, goals, and guiding ideology of hospital-run colleges are increasingly clear.
In October 2007, General Secretary Hu Jintao made a clear statement on the road to socialist development with Chinese characteristics in the report of the 17th CPC National Congress. In a concluding speech at the 2008 Health Work Conference, Comrade Gao Qiang, Secretary of the Party Group and Deputy Minister of the Ministry of Health, gave a concrete explanation to the socialist development path of socialism with Chinese characteristics, namely, to adhere to the public health service for people's health and to serve people's all-round development. Services for economic and social development; Adherence to the public welfare nature of public health care; Adherence to the principle of prevention as the mainstay; Focusing on the countryside as the key; Equal emphasis on Chinese and Western medicine; separate administrative affairs, separation of management from administration, separation of medicines from profitability and non-profit separation; Responsibility and investment to improve the national health policy; establish a basic medical and health system, build a public health service system covering urban and rural residents, medical service system, medical security system, drug supply security system; provide safe, effective, convenient, and inexpensive Medical and health services enable everyone to enjoy basic medical and health services. This also points the way for the reform and development of the hospital.
Second, the understanding of the nature of public welfare in hospitals has become increasingly profound.
With the gradual deepening of reforms, especially in recent years, public hospitals have increasingly paid attention to the nature of public welfare. Hospitals have basically established business ideas that emphasize social benefits and focus on social responsibility while not ignoring economic benefits. After 30 years of reform, the perspective of hospital management is no longer confined to the medical institutions. It has changed from simply considering the development of the hospital itself to paying more attention to the overall interests of the people. In terms of hospital service functions, the medical treatment that focuses on prevention and health care has changed from a focus on prevention and health care to a focus on prevention and health care. It focuses on the management of hospital infections, attaches great importance to supporting rural and grassroots units, and pays attention to alleviating poverty, supporting agriculture, and providing disaster relief. Hospitals increasingly focus on fulfilling their social needs. responsibility.
Third, the overall quality and service level of the hospital have been significantly improved.
After 30 years of reform, the quality of hospital medical personnel, medical technology, hospital management, hardware facilities, and service capabilities have all significantly improved. The level of medical technology and facilities in large urban hospitals in economically developed regions have approached or reached the level of developed countries, and the medical conditions in the central and western regions and grass-roots hospitals have also significantly improved. After the hospital's classification management and hospital management activities, the quality of medical services in our hospitals has continued to improve, and patient safety has received the full attention of hospital managers and medical workers. The form of hospital services has evolved from a single medical service in the past to providing various forms of services such as medical services, rehabilitation services, family services, community services, social services, and psychological services. According to statistics, the per capita life expectancy in China has increased from 67.8 years in 1981 to 73.0 years in 2005; the infant mortality rate has dropped from 37.6‰ in 1981 to 15.3‰ in 2007; the maternal mortality rate was 80.0/10 million in 1991. It dropped to 36.6/10 million in 2007. The health of the Chinese people has reached a high level in developing countries. Of these, hospital reform has contributed.
Fourth, hospital management systems and incentive mechanisms have been increasingly perfected.
The hospital was transformed from an affiliate of the administrative department of health into an independent legal entity operating autonomously. The management system of the hospital leadership changed from the leadership system of the party and government regardless of the past to the system of the president’s responsibility. That is to say, the president is responsible for hospital administration as the hospital legal person. The organization and management system enables the dean to basically have the right and responsibility in the management and management, and some hospitals have begun to try standardized hospital corporate governance. At the same time, the hospital has expanded from a single universal or collective ownership system to a variety of ownership forms such as Sino-foreign joint ventures, joint-stock companies, joint-stock cooperatives, and individual private ownership. The operational efficiency of the hospital has been greatly improved, and it is more suitable for the actual national conditions of China's initial stage of socialism. The personnel system of the hospital has been transformed from "iron rice bowl" and "iron chair" to various forms of appointment system and employment system. Between hospitals and employees, a certain degree of two-way choice has been achieved. Most hospitals have implemented performance appraisal, implemented post management, introduced competition mechanisms, and the hospital’s distribution system has changed from being one of the most potent, imposing, and profitable equalitarian “big pots†to being implemented. With various forms of responsibility and incentive measures, the work enthusiasm and initiative of hospital staff have generally improved.
Fifth, the growing awareness of hospital management.
The operation and management of the hospital never considers the market, pays no attention to the operation, does not care about the cost, etc., relying on, and wants the planned economic management system model to become market-oriented, business-oriented, and cost-oriented market economy management system model. While paying attention to the hospital's services, technology and quality, we must pay full attention to the operation, accounting and benefits of the hospital, recognize that the hospital must follow the rules of market development and economic laws, and strengthen the importance of business management; attach importance to the investigation and development of the medical market and take Effective measures to adapt to market demand, improve the effectiveness of hospital services, make hospitals gradually adapt to the changes and development of the market economy, and lay a good foundation for the hospital's healthy development under the socialist market economic system.
It is undeniable that Chinese hospital reforms, like those in other fields, are still facing a series of problems and challenges while achieving achievements and accumulating experience. We have every reason to believe that under the guidance of the spirit of the party’s 17th National Congress, the majority of hospital administrators and medical personnel must be able to adhere to the scientific development concept, base on China’s national conditions, combine the actual conditions of the local and the hospital, and forge ahead with innovation and innovation. Continuously deepen the reform of hospitals, explore the path of hospital development that suits China's actual conditions, and make new contributions to the realization of the goal of universal access to basic medical and health services and the building of an overall well-to-do society.
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