中新网太原8月27日电 题：基层医院独立法人资格制困扰山西县域医改

Taiyuan in Beijing on August 27 - problem：Basic-level hospitals with independent legal person qualification system reform, shanxi county

　　作者 李鹏飞

The author Allen

　　从考核零分到二级甲等，山西省朔州市平鲁区人民医院借助与山西省人民医院的深度合作，走了不到两年的时间，因此被选做山西省医改现场会的举办地，不过，这份殊荣正在承受着更大的挑战。

From zero to assessment of second class，Shanxi Province ShuoZhouShi flat lu district people's hospital with and Shanxi Province people's hospital of the depth of cooperation，Go less than two years，So was chosen to do the site of the medical reform in Shanxi Province will，but，This award is under greater challenges。

　　刚去职平鲁人民医院院长的山西省人民医院普外科主任张燕忠，虽然多次得到当地政府的嘉奖，但他为自己过去两年半在平鲁的表现仅给出了及格分，他更直言，县域医改要走得更远，“县级医院必须有独立的法人，享有独立的人事权和自主经营权。”

Just find flat lu people's hospital of Shanxi Province people's hospital ZhangYanZhong director general surgery，Although many times to get the local government's awards，But he is my past two and a half years in the flat lu performance is given only a passing grade，He was more the truth，County cure to go farther，“The hospital at or above the county level must have an independent legal person，Enjoy independent the power over personnel and independent management。”

　　

考核零分的平鲁医院 Assessment of zero flat lu hospital

　　2009年10月10日，对山西省人民医院普外科副主任张燕忠来说，是个特别的日子。这一天，是他到太原200公里之外的朔州市平鲁区人民医院履新院长的第一天。

On October 10, 2009，In Shanxi Province people's hospital, deputy director of general surgery for ZhangYanZhong，It is a special day。This day，Is he to taiyuan, 200 kilometers away ShuoZhouShi flat lu district people's hospital he came to the first day of the dean。

　　两个月前，山西省人民医院与朔州市平鲁区正式签订合作协议，平鲁区人民医院全权交由省人民医院管理，实现“管办分离”。彼时，这个概念在国家层面尚未提及。

Two months ago，Shanxi Province people's hospital and ShuoZhouShi flat lu area officially signed a cooperation agreement，Flat lu district people's hospital authorized by provincial people's hospital management，realize“Tube do separation”。At the，This concept at the national level did not mention。

　　“我来的时候这所医院几乎是最低谷的时候，几乎没什么病人，可以说，仅仅是在维持”，张燕忠说。

“I come this hospital is almost when its lowest ebb，Almost nothing patients，Can say，Is only in maintaining”，ZhangYanZhong said。

　　平鲁区发改委资料显示，过去的十多年来，医院没有人外出进修学习，没有学术氛围，技术水平停滞不前，200多人的医疗队伍，只有2名副高主任医师，连个主任医师都没有，临床科主任中竟然没有一个本科学历，且梯队断层严重。

Flat lu area development and reform commission data show，The past ten years，Hospital no one out for further study，No academic atmosphere，The technical level stagnation，More than 200 medical team，Only two subtropical high chief physician，Even a chief physician all have no，Clinical department director in unexpectedly has no a bachelor's degree，And echelon fault serious。

　　“医院没有高质量的手术，连24小时的值班制都没有，关于医院的制度没有任何的文字记录，10年没有发表任何学术文章，没有任何等级没有参加过任何评选”，张燕忠说，“我去之前平鲁医院是80%的差额事业单位，甚至有的医护人员一个月工资加奖金仅有个位数。”

“The hospital not high quality of surgery，Even the 24 hours of duty system all have no，About the hospital system without any written records，Ten years has not made any academic articles，No level did not attend any selection”，ZhangYanZhong said，“Before I go flat lu hospital is 80% of the difference between business units，Even some medical staff a monthly wages plus bonus only single-digit。”

　　在同年11月山西省卫生厅组织的“质量万里行”评比考核中，平鲁医院，零分。

In the same year November Shanxi Province health department of the organization“Quality tour”Comparison assessment of，Flat lu hospital，Zero points。

　　资金投入不足，设备更新缓慢、人员培训滞后，医疗水平落后，进而病人和人才流失，致使医院门庭冷落进入恶性循环。

Insufficient capital investment，Slow renewal of equipment、Personnel training lag，Medical level behind，Then the patient and loss of talented people，The hospital swing left out in a vicious circle。

　　“由于现今交通便利，市郊医院尤其难做”，平鲁区医院距离朔州市区仅17公里之遥，该院宣传部部长杜鹏说，“怀仁县医院效益也不好”，它离大同市只30公里。

“Due to the convenient traffic now，Suburban hospital especially hard to do”，Flat lu district hospital distance downtown it is mined here only 17 kilometers away，The hospital DuPengShui minister of the propaganda department，“HuaiRenXian hospital benefit is bad”，It is only 30 kilometers of datong。

　　杜鹏介绍说，之前财政拨款只能支付60%，后来又减少到60%的60%，这种情况一直持续了10多年之久。人员培训不能说没有，但很少，设备更新也很少。

DuPeng said，Financial allocation can only pay 60% before，Later reduced to 60% of 60%，This kind of situation has been lasted for 10 years。Personnel training can't say no，But few，Renewal of equipment rarely。

　　平鲁区医院是差额事业单位，一直“欠着药厂的、医药公司的钱”。这并不奇怪，中国医院协会会长曹荣桂曾说，全国90%的县级医院都在负债经营。

Flat lu area hospital is difference institution，Has been“Owing the pharmaceutical factory、Pharmaceutical company's money”。This is not strange，China hospital association CaoRongGui said，The national 90% at or above the county level of the hospital are in debt management。

　　此外，由于该院以单纯业务量计算工资，医务人员只想着如何开单挣药品提成，职称也不在分配中体现，除去跳槽的医护人员，留下来的人也难以承担起医治“看病难、看病贵”的顽疾的重任。

In addition，Due to its simple volume calculation wage，Medical staff just want to how to make sheet of drug commission，The title is not reflected in distribution，Remove job-hopping of health care workers，Stay also difficult to assume heal“See a doctor difficult、The doctor your”The burden of the ill。

　

　院长的60分答卷 Results of 60 points

　　从零分到二级甲等，平鲁医院用了不足两年的时间。

From zero assigned to the second class，Flat lu hospital in less than two years of time。

　　在山西省人民医院和平鲁医院签订的协议中，双方明确议定了管办分离“五不变”，即所有权不变、公益性质不变、职责职能不变、行政隶属不变、区政府扶持不变；“五享有”——省人民医院享有行政管理权、人事支配权、经营自主权、资产使用权和收益分配权。

In Shanxi Province people's hospital peace lu hospital in the agreement，It is expressly agreed the tube do separation“Five constant”，Ownership is the same、Public properties unchanged、Duties function the same、Administrative belonging to the same、The district government support unchanged；“Five enjoy”- province people's hospital enjoy executive、Personnel eminent domain、Autonomy in management、The right to use assets and income distribution。

　　此外，该区政府加大财政投入，将平鲁医院由差额事业单位变成全额，并投资1.5亿元建成了一座高标准的新医院，投资近1亿购置了先进的医用设备，在全省的县级医院都少有。

In addition，The government increase financial investment，Will ping lu hospital by balance institutions become full，And investment of 150 million yuan RMB built a high standard of the new hospital，Investment nearly 100 million acquisition of advanced medical equipment，In the province at or above the county level of the hospital are rare。

　　然而张燕忠要做的，首先就是建纲立制，完善医疗核心制度。按照二甲医院标准，新增了相应科室，规划并运行了各临床科室的重点专业，建立了院领导晨会制、围手术期医疗安全制度、首诊负责制、会诊制、交接班制度等，同时建立院领导查房制，每月末组织全院行政查房，明确科主任负责制，恢复三级医师查房制度，对急危重病人较多的科室重点监控，并制定临床护理相关制度。

However ZhangYanZhong to do，The first is to build steel made system，Perfect medical core system。According to dimethyl hospital standard，Add the relevant departments，Planning and operating various clinical departments focus on professional，Establish a hospital leadership an assembly system、Perioperative medical security system、First diagnosis responsibility system、Consultation system、Handing-over system, etc，At the same time establish school leadership ward inspection system，The end of every month partial organization administrative ward inspection，Clear of director of division of responsibility system，Recovery level 3 doctors ward inspection system，For acute critically ill patients more department key monitoring，Clinical nursing and make relevant system。

　　这些看似稀松平常的规章制度，此前却一直是空白。

These seemingly quite common rules and regulations，Previously have been is blank。

　　此外，张燕忠主导的薪资调整也向一线医务人员倾斜，希望通过奖金分配改革调动人员积极性，年底便产生了效果。

In addition，ZhangYanZhong leading salary adjustment to a line medical staff tilt，Hope that through bonus distribution reform to mobilize staff enthusiasm，The end of the year he has had an effect。

　　2009年12月，平鲁医院已经完成手术90台，突破了建院以来的历史最高水平。

In December of 2009，Flat lu has been completed surgery hospital 90 sets，Broke through the hospital building since the historical highest level。

　　张燕忠并不满足，1952年建院的平鲁医院不仅历史悠久，而且曾经吸引了60年代的大学生在此就业，“山西省人民医院有些老专家就是从这所医院出来的。”

ZhangYanZhong not satisfied，In 1952 constructed the flat lu hospital not only has a long history，And once attracted 60 s of college students in the employment，“Shanxi Province people's hospital is some old experts from the hospital out。”

　　他希望重现平鲁医院上世纪60年代的辉煌。于是开设眼科、影像、腔镜、内科等重点科室，成为全省第一家实施白内障手术的县级医院；选拔培养医生护士各一个进修内镜专业，引进两个超声、放射线对口专业的本科生。

He hopes to recreate flat lu hospital 1960 s brilliant。So open an eye、image、Cavity mirror、Such key internal medicine department，Become the province's first implementation of cataract surgery at or above the county level of the hospital；Selection of cultivation doctors and nurses each a study endoscopic professional，Introduce two ultrasonic、Radiation of undergraduate professional。

　　2011年，山西省医改现场会在平鲁召开，作为对其县域医改成果的肯定。但张燕忠认为，

In 2011,，Shanxi Province will cure in a flat lu，As the reform, the affirmation of the achievements of county。But ZhangYanZhong think，

　　无论是培养人才还是形成一个优势专业都需要很长时间，“两年半的时间太短了”。

Whether it is training talents or form a advantage majors takes a long time，“Two and a half years of time is too short”。

　　

吁促独立法人制突破县域医改 Promote independent of dunhuang county resettlement medical breakthroughs

　　山西省人民医院心内科副主任张林虎，今年4月接替张燕忠成为平鲁医院的第二任院长，除了在管理方面继续加强外，他主导的心内科病房和冠心病加护病房正在筹建中，“大同朔州这边的人都是大块吃肉大碗喝酒，而且油盐很重，心血管疾病发病率高。”

Shanxi Province people's hospital, deputy director of the heart ZhangLinHu，In April this year to replace ZhangYanZhong become flat lu hospital's second President，In addition to management continue to strengthen external，He leading heart ward and coronary heart disease in intensive care unit is under，“It is mined here datong people here are large meat large bowl of wine，And necessities are very heavy，High incidence of cardiovascular disease。”

　　如今平鲁医院连心梗这样的病人都敢收治了，而且连朔州市里的人都跑到平鲁医院来看病，之前是不能想象的。

Now flat lu hospital even myocardial infarction of these patients were all dare the，It is mined here and even the city people ran to the flat lu hospital to see a doctor，Before is unthinkable。

　　张林虎认为，这是消弭城乡医疗水平差距，均衡城乡医疗资源的一次有益地努力。

ZhangLinHu think，This is the level gap between urban and rural medical level，Balance urban and rural medical resources a good hard。

　　随着忻州、吕梁等市的15所非试点县医院的主动加入，省内三甲医院包干帮扶的综合改革试点医院今年总计已达到49所。

Along with the XinZhou、Luliang city, such as the 15 non ShiDianXian hospital voluntarily join，Province 3 armour hospital supporting local comprehensive reform pilot hospitals in this year has reached the 49。

　　山西省卫生厅希望通过综合改革对口包干制度，在县级医院重点推进现代医院管理制度，促进基层医院管理创新。该厅厅长高国顺说，通过探索和实践，试点县医院的门诊人次、出院人次、群众满意度明显上升，门诊患者次均费用、出院病人次均费用、(新农合)县外转诊率有所下降。

Shanxi Province health department hope through the comprehensive reform of responsibility system，At or above the county level in the hospital focus in the development of modern hospital management system，Promote the basic-level hospital management innovation。GaiTing director GaoGuoShun said，Through the exploration and practice，ShiDianXian hospital outpatient service people、discharges、The masses satisfaction increased obviously，Clinic patients second all expenses、Discharged patients second all expenses、(New farmers joint)Outside the county referral rate declined。

　　对口包干成效明显，体制瓶颈也同样明显。

Contra-aperture responsibility made obvious progress，System bottlenecks are also obvious。

　　虽然协议中明确山西省人民医院拥有独立的经营权和人事支配权，但只是停留在纸上。

Although the agreement expressly Shanxi Province people's hospital have independent management and personnel eminent domain，But just stay on the paper。

　　“即使稍微做些利益机制的调整，都会有人冲进你的办公室搅闹，如果要开掉一个人，更要经过区政府的批准”，张燕忠认为，“如果率先赋予县级医院独立的法人资格，让其享有充分的人事权和经营权，那将是对全国县级医院模式的颠覆。”(完)

“Even if a little do some benefit mechanism adjustment，Will someone rushed into your office a stir，If you want to drive away one，More should pass the district government approval”，ZhangYanZhong think，“If the hospital at or above the county level shall give independent legal person qualification，Let its enjoy fully the power over personnel and management，That will be at or above the county level to the national hospital model of subversion。”(finish)