建设并完善有中国特色的公立医院制度 Construction and perfect has the Chinese characteristic of public hospital system

——访卫生部副部长马晓伟 Vice minister of health - visit MaXiaoWei

　　伴随着新中国的成长，我国公立医院体系走过了60余年的发展历程。事实证明：历史和人民选择了社会主义制度，社会主义中国的政治制度和经济制度选择了以公立医院制度为重要组成部分的中国特色基本医疗卫生制度。

With the growth of the new China,Public hospital system in our country through the 60 years of development history.Facts have proved:The history and the people's choice the socialist system,Socialist China's political system and economic system in the choice of public hospital system is an important part of the basic medical and health system with Chinese characteristics.

　　“中国共产党本着来自人民、植根人民、服务人民的质朴情怀，不回避矛盾，不畏惧困难，遇到问题解决问题，推动我国公立医院制度逐步建立健全，在保障人民身体健康、培养医学合格人才、引领医学科学发展方面发挥了主体作用。”近日，卫生部副部长马晓伟接受本报记者专访，详尽阐释了具有中国特色的公立医院制度的内涵、意义、目标和规划。

"The communist party of China in line with from the people/Based on people's/Service people's plain feelings,Don't avoid contradictions,Not afraid of difficulties,Encounter problems to solve the problem,To promote the country's public hospital system gradually establish and perfect,In protecting the health of the people/Medical training qualified personnel/Lead the development of medical science has played a main role."recently,Vice minister of health MaXiaoWei accepting our newspaper reporter to interview,The detailed interpretation with Chinese characteristics the connotation of public hospital system/significance/Goals and planning.

　　公立医院改革要把握住什么 Reform of public hospitals to seize??????

　　记者：公立医院制度在我国医疗服务体系中占有着怎样的位置？

reporter:Public hospital system in our country medical service system of how the position?

　　马晓伟：我国医疗服务体系采取坚持非营利性医疗机构为主体、营利性医疗机构为补充，公立医疗机构为主导、非公立医疗机构共同发展的办医原则，这是由我国国情所决定的。

MaXiaoWei:Chinese medical service system to adhere to the non-profit medical institutions as the main body/For-profit medical institutions for the supplement,The public medical institutions as the leading factor/The public medical institutions for medical common development principles,This is determined by China's national conditions of.

　　第一，公立医院制度体现了党和政府对人民的责任。党和政府始终把保障人民健康权利作为社会公平正义的重要方面，公立医院是政府建立的保障群众基本医疗服务需求的机构，是党和政府保护人民健康权益的直接体现。

The first,Public hospital system embodies the party and the government responsibility to the people.The party and the government always take safeguard people's health rights as an important aspect of social fairness and justice,Public hospital is established by the government guarantee the basic medical service needs of the institution,Is the party and the government to protect the rights of the people's health directly reflect.

　　第二，公立医院制度符合我国国情和医疗卫生事业发展规律。我国社会主义初级阶段的基本国情是人多，病多，经济社会发展不平衡，人民生活水平还不高，这就要求中国特色的医疗卫生制度要以社会可接受的成本解决群众看病就医问题。卫生事业的发展历史和国际经验都充分证明，公立医院制度通过建立覆盖城乡的医疗服务网络，将不同层级、不同专业特长的医院统一管理，保证了机构间的协作和医疗服务的连续性，有利于医疗服务体系整体绩效的提高。

The second,Public hospital system conforms to China's situation and the law of development of medical and public health services.Our country socialism initial stage basic national conditions are many,Disease more,Economic and social development is not balanced,The people's living level is not high,This requires that the Chinese characteristic medical and health system to social acceptable cost solve the problem hospital.The development of the cause of health history and international experience are proved,Public hospital system through the establishment of medical service network covering both urban and rural areas,Different levels/Different specialty hospital unified management,Ensure the cooperation between institutions and medical service continuity,Medical service system is beneficial to the improvement of the overall performance.

　　第三，公立医院在医学人才培养和各类突发公共卫生事件紧急救治中承担着重要作用。我国公立医院承担着为13亿人民培养医生的重任。

The third,Public hospitals in medical personnel training and all kinds of public health emergencies in the emergency treatment assume an important role.Our country public hospital bear the for 1.3 billion people's culture the doctor's responsibility.

　　记者：为什么说公立医院改革处于“机遇大于挑战”的关键时期？在这个关键时期，要重点把握住什么？

reporter:Why to say public hospital reform in"Opportunities outnumber challenges"The key period of?In this critical period,To focus on hold???????

　　马晓伟：深化医药卫生体制改革启动3年多来，基本医疗保障制度逐步健全。我们依靠政府的力量，建立起了世界上最大的基本医疗保障制度，公立医院改革发展面临战略机遇期。

MaXiaoWei:Deepen the medical and health system reform start for more than 3 years,The basic medical security system gradually perfect.We rely on the power of the government,Set up the world's largest basic medical security system,Public hospital reform development face period of strategic opportunities.

　　在这一关键时期推动改革，要特别注重医疗服务体系与医疗保障体系的有效衔接和协同发展。医疗保障对医疗服务的支付，是两大体系的衔接点；改革医保支付方式，是促进两大体系协同发展的关键。改革医保支付方式可以转变医疗行为的激励导向，变药品、耗材、检查等收入为医疗服务提供成本，促进医院和医生自觉调整结构，科学诊治，控制费用。与此同时，支付方式改革还对公立医院改革产生三方面影响，即推动分级诊疗格局的形成；提高医院内部管理水平；完善激励机制，调动医务人员积极性。

In the key period to promote reform,Must pay special attention to medical service system and the medical security system effective cohesion and collaborative development.Medical security on medical service payment,Is two big system's connection point;Reform of the medical insurance payment,Is to promote the coordinated development of the two big system of the key.Reform of the medical insurance payment can be changed medical behavior incentive guide,Variable drugs/consumables/Inspection income for medical service cost,To promote the hospital and doctor consciously adjust structure,Scientific diagnosis and treatment,Control cost.meanwhile,Payment reform of public hospital reform produce three aspects of influence,That is to promote the formation of the pattern classification diagnosis and treatment;Improve the hospital internal management level;Perfect incentive mechanism,Mobilize medical staff enthusiasm.

　　我们希望以支付方式改革为引领，促进公立医院实现“三个转变”，即转变发展方式，从规模扩张型转向质量效益型；转变管理模式，从粗放的行政化管理转向精细的信息化管理；转变投资方向，公立医院支出从投资医院发展建设转向扩大分配、提高医务人员收入水平。在“三个转变”的基础上，再实现“三个提高”，即提高效率，通过资源纵向流动提升服务体系整体绩效；提高质量，以临床路径管理为抓手加强医疗质量管理；提高待遇，通过改善医务人员生活待遇切实调动医务人员积极性。

We hope to payment reform for lead,To promote public hospitals to realize"Three transformation",Namely transformation development mode,From scale expanding to quality-benefit;Change management mode,The security administration from extensive management to fine the information management;Transformation investment direction,Public hospital expenditure from investment hospital development construction to expand distribution/To improve medical personnel income level.in"Three transformation"Based on,To realize"Three improve",Namely, increasing the efficiency,Through the resources longitudinal flow improve service system overall performance;Improve quality,With clinical pathway management as the gripper strengthening medical quality management;Improve treatment,Through the improvement of medical personnel life treatment to mobilize medical staff enthusiasm.

　　三级医疗服务体系如何架构 Level 3 medical service system how to structure

　　记者：要想做好公立医院改革的制度设计，就需要完善覆盖城乡的三级医疗服务体系。对此，卫生部门有何设想？

reporter:If you want to make public hospital reform system design,Will need to improve covering both urban and rural areas of the three levels of medical service system.this,The health department has any ideas?

　　马晓伟：下一步完善三级医疗服务体系的重点是提升能力、提高效率、鼓励发展，以实现居民半小时之内到达一所基层医疗卫生机构、24小时之内转诊到一所二级以上医院的目标，使群众能够公平可及地享受基本医疗服务。

MaXiaoWei:The next step perfect level 3 medical service system is the focus of the hoisting capacity/Improve efficiency/To encourage the development,In order to realize people arrive within half an hour a basic medical and health institutions/Within 24 hours referral to a second class above hospital goal,To be fair to the masses can enjoy and basic medical service.

　　一是要建立健全三级医疗服务体系的基本构架。在国家层面，综合考虑地理因素和经济社会发展水平，划分6—7个大区，在每个大区设立一定数量国家医疗中心，代表国家医学前沿水平，并承担人才培养和科学研究职责；在各省设立省级医疗中心，代表区域医学先进水平，基本解决省内疑难重症患者的诊疗，并承担一定的人才培养、科学研究和省内医务人员在职教育工作；各地级市设立若干公立医院；县(市)公立医院除承担县域居民常见病、多发病诊疗的医疗职责外，还对县域医务人员进行培训和指导，并承担部分公共卫生职责，达到县域内就诊率超过90%，实现“大病不出县”。最终在全国范围内，政府重点办好100所左右的医疗中心、1000所左右省、地市级医院和2000所左右县(市)级医院，使之成为医疗体系的骨干。

One is to establish and perfect the tertiary medical service system of the basic frame.At the national level,Comprehensive consideration of the geographical factors and the development level of economy and society,Divided 6-7 region,In each region set up a certain amount of national medical center,On behalf of the state medical frontier level,And bear the responsibility of cultivating talents and scientific research;In the provinces set provincial medical center,On behalf of the regional medical advanced level,Basic solve difficult critically ill patients in the diagnosis and treatment,And assume a certain talent cultivation/Scientific research and province medical staff on-the-job education work;Each locally administratered level's set up a number of public hospital;county(city)Public hospital in addition to county residents for common diseases/Frequently occurring disease diagnosis and treatment of medical duty outside,The county medical personnel training and guidance,And bear part of the responsibility of public health,To JiuZhenLv county in more than 90%,realize"Serious illness a county".Finally, in a nationwide,The government key done 100 or so medical center/About 1000 provinces/Prefecture-level hospitals and 2000 or so county(city)Level hospital,Make it become the backbone of the medical system.

　　二是要建立医疗服务体系内部的分工协作机制。以公立医院的技术力量带动基层医疗卫生机构能力提升和共同发展，推动分级诊疗格局的形成。建立城市三级医院与县级医院长期稳定的分工协作机制，对城乡对口支援作制度性安排。在城市和农村分别以大型三级医院和县级医院为龙头，通过建立资源纵向整合的医疗联合体、医疗集团，实行县乡一体化管理等，提升医疗服务体系的整体效率和服务水平。

The second is to establish the medical service system internal division of labor cooperation mechanism.To public hospital technical force driving basic medical and health institutions to enhance the ability and common development,To promote the formation of the pattern classification diagnosis and treatment.Establishing the city tertiary hospital and hospital long-term stability at or above the county level of the division of Labour cooperation mechanism,To urban and rural contra-aperture support for institutional arrangement.In urban and rural respectively by large tertiary hospital and the hospital at or above the county level for leading,Through the establishment of resources longitudinal integration medical association/Medical group,Implement of county and township government integration management, etc,Improve medical service system of the whole efficiency and service level.

　　未来的公立医院什么样 The future of public hospital what kind of

　　记者：您一直认为，缓解群众“看病难”、推动公立医院机制创新，关键还是一个“人”的问题。如何调动医务人员的参与积极性？

reporter:You always think,Alleviate the masses"See a doctor difficult"/To promote public hospital mechanism innovation,The key is still a"people"problems.How to mobilize the enthusiasm of the medical staff to participate in?

　　马晓伟：改革开放以来，我们在公立医院改革方面所作出的最重要的一项工作就是激活医院微观运行机制，实行多劳多得、优绩优酬的内部分配制度，极大地调动了医务人员的积极性。

MaXiaoWei:Since the reform and opening up,We in the public hospital reform made one of the most important job is to activate the hospital micro operation mechanism,Implement more pay for more work/Optimal performance for optimal internal distribution system,Greatly mobilized the enthusiasm of the medical staff.

　　在医院内部完善分配机制的同时，作为政府，也要推动公立医院机制创新，做好外部政策的支持，包括要完善公立医院补偿机制，使医院调动积极性具备经济基础；通过外部政策调整，保证积极性的调动以公益性为导向。

In the hospital internal perfect distribution mechanism at the same time,As the government,Also want to promote public hospital mechanism innovation,Do external policy support,Including to perfect the compensation mechanism of public hospital,Make the hospital arouse the enthusiasm of have the economic base;Through the external policy adjustment,Ensure that the enthusiasm of the transfer to public welfare as the guidance.

　　记者：展望未来，在您心目中，我国未来的公立医院制度具备哪些特点？

reporter:Looking to the future,In your mind,China's future public hospital system have what characteristics?

　　马晓伟：随着经济社会发展水平的提高、老龄化社会的到来、疾病谱的变化等，也带来了医疗服务需求的变化；医疗服务领域生产力的变化，催生着生产关系和上层建筑的改变。从群众医疗服务需求出发，医疗服务体系建设应当做到“四个结合”，即城乡结合，城市医院持续帮扶县级医院；上下结合，大医院与基层医疗卫生机构、县级医院与乡村医疗卫生机构协作联动；急慢结合，大型公立医院在康复、慢病管理等方面让出市场空间，发展延伸服务机构；防治结合，以医院为平台发展公共卫生服务体系。

MaXiaoWei:With the improvement of the development level of economy and society/The coming of aging society/Such as the change of the disease,Also brought the change of medical service needs;Medical service field productivity change,Has the relations of production and superstructure change.From the masses medical service requirement,Medical service system construction should do"Four combinations",Namely of rural and urban combination,City hospital continued to assist the hospital at or above the county level;Fluctuation combined with,Big hospitals and basic medical and health institutions/The hospital at or above the county level and rural medical and health institutions collaborative linkage;Steep slow combined with,Large public hospital in rehabilitation/Slow disease management make market space,Development extension service agencies;Control combined with,To the hospital as a platform development of public health service system.

　　在“四个结合”的基础上，我想我国公立医院改革发展应当实现“四化”，即服务整体化，形成上下联动、急慢分治的服务格局；水平现代化，占据我国医学科学发展的制高点；管理企业化，充分学习和借鉴先进社会组织的管理经验；模式集团化，实现体制创新和机制转换，使医疗资源最大限度地发挥作用。(记者 张 蕾)

in"Four combinations"Based on,I think our country public hospital reform development should be realized"Four modernizations",Namely service integration,Formation and linkage/Steep slow partition service pattern;Modernization level,China occupied the commanding heights of the medical science development;Enterprise management,Fully studying and drawing lessons from the advanced management experience of social organization;Mode collectivization,To realize the innovation of system and mechanism transformation,The medical resources maximize function.(Reporter zhang budding)