上周，东莞相继出台《东莞市公立医院改革试点实施意见》和《东莞市市属公立医院管理中心组建方案》两个指导性文件，延续3年的“医改”向深水区迈出实质性步伐。这其中，关于建立公立医院管理中心、推行三个层次公立医院格局、成立药品采供监督委员会等，都是在探索政事分开、管办分开、医药分开等“分权”尝试下，努力回归“公益性”的制度创新。改革“攻坚战”自此拉开帷幕。

Last week,The dongguan have issued[Trial reform of public hospitals following enterprise implementation opinion]and[Dongguan city public hospital management center construction scheme]Two guidance documents,Continue 3 years"medical"To deep water area substantial step.the,On the establishment of a public hospital management center/Implementation of the three levels of public hospital pattern/Establish a drug purchase supervision committee, etc,Are all exploring separate politics/Pipe run separate/Medicine such as separate"decentralized"try,Efforts to return"Public welfare"System innovation.reform"Tough sell"Since then the curtain.

　　按照文件，东莞将组建公立医院管理中心作为政府办医机构，实行集团式管理、规模化运作的改革路径。而最新的解读是，该医管中心将暂时委托市卫生局管理，并在试点阶段由市卫生局局长兼任主任。

According to the file,The dongguan will set up public hospital management center as a government-run medical institutions,The chief management/Large-scale operation of the reform path.And the latest reading is,The medical tube center will temporarily entrusted the municipal bureau of health management,And in the pilot stage by the municipal public health bureau director concurrently.

　　这一做法从现实层面看，似乎依然不能从先天的体制设置上，完全摆脱行政部门的管理。按照如此操作，医管中心将成为卫生局下的二级单位，其发言权、决策权相对有限，能否保持相对独立性令人生疑。当然，东莞的目的是想采用中性的做法，更加稳妥地推进改革。而回首过往历史，改革的重点即在于理顺管理体制，如今的制度安排意味着未来改革的空间仍然很大。

This practice from the reality of perspectives,Seems to still can't from innate system setting,Completely get rid of administrative department management.According to such operation,Medical tube center will be the health bureau of the secondary unit,The voice/Relatively limited decision-making power,Can keep the relative independence suspect.Of course,The dongguan purpose is to want to use neutral practice,More and steadily push forward the reform.And looking back the history,A key to the reform of the management system that is to straighten out,Today's system arrangement means that future reform of space is very big still.

　　事实上，东莞公立医院改革方案酝酿已久。早在去年3月，东莞市政府就曾宣称，要在去年6月前出台公立医院改革方案。此后这一说法又变更为“最快于去年年底出台”。直到如今浮现“庐山真面目”，改革方案的“难产”已是不争事实。对此，东莞市副市长吴道闻曾解释，公立医院改革推迟主要与“简镇强政”政策有关。

In fact,The dongguan public hospital reform scheme simmering.As early as in March last year,Dongguan city government has claimed,In June last year to come before the public hospital reform scheme.Since then this view and change for"The fastest in the end of last year issued".Until now to emerge"Looks like",Reform plan"dystocia"Already there is a fact.this,Dongguan city vice mayor WuDaoWen was explained,Reform of public hospitals was delayed primarily and"Jane town strong political"policies.

　　吴道闻说，目前部分镇街医院的人、财、物管理已经从市卫生局下放到部分中心镇。在新行政框架下，如何统筹市级医院和镇街医院的发展，是个新课题。其言下之意，市级统筹与基层医改，已经成了东莞公立医院改革亟须“分类对待”的管理命题。

WuDaoWen said,Currently, some ZhenJie hospital/wealth/Content management has from the municipal bureau of health, to the part of the central town.In the new administrative framework,How to plan as a whole the municipal hospital and ZhenJie hospital development,Is a new topic.Its implication,City as a whole and grassroots medical reform,Dongguan has become a public hospital reform is"Classification treatment"Management proposition.

　　而从此次文件公布的名单来看，选取的莞城、石碣、道滘等3个镇街公立医院，就将结合“简政强镇”进行基层公立医院改革试点；而此前“医改方案”提到过的市新涌医院、石龙人民医院等，则将作为市级医院纳入到市属公立医院管理中心进行管理。各自身份的不同归属，透射着改革背后复杂的管理关系。

And from the file list posted to see,Selected Guan city/shijie/Tao kau, three ZhenJie public hospital,Will be combined with"Simplify strong town"Base on trial reform of public hospitals;And after"Reform scheme"Mentioned city new chung hospital/Shilong people's hospital, etc,Will as municipal hospital into municipal public hospital management center management.Their identity of different ownership,Transmission with reform the management of the complex relationship between behind.

　　这从财政投入上也能“管中窥豹”。目前规定，市级财政负责举办市属公立医院，市镇两级财政按比例共同举办区域中心公立医院，镇街财政负责举办镇街公立医院。市及区域中心公立医院实行市属集约化管理，镇街公立医院实行属地化管理。财政补贴的投入多少，将决定着公立医院在实行“医药分开”、破解“以药补医”的这条道路上能够走多远。因此不同的管理方，显然在改革的程度和力度上也会有所区别。

This from a financial commitment can also"Ab uno disce omnes".The current regulations,The municipal finance is responsible for conducting a municipal public hospital,Town two levels of financial scale jointly sponsored by regional center public hospital,ZhenJie finance is responsible for conducting a ZhenJie public hospital.City and regional center public hospital practice under the intensive management,ZhenJie public hospital implement local administrator.The investment of financial subsidies how much,Will decide the public hospital in practice"Medicine separate"/crack"In medicine for medical"This road to walk far.Therefore different management,Obviously in the extent of the reform and strength also makes a difference.

　　早前就有人提出，东莞公立医院管理的“婆家”太多，比如人事任命、经费来源、医疗保险、药品质量与价格等方面，都出现了“多头管理”的复杂局面，甚至工商、公安等部门也有相应的管辖权。在公立医院“去行政化”的过程中，如何彻底向市场主体进行转变，亟须政府部门转变职能，在明确管理主体的前提下，整合现有的管理资源，这样才能达到“管办分离”的真实目的。

Earlier he was put forward,The dongguan public hospital management"Husband's family"Too much,Such as personnel appointed/Funding sources/Medical insurance/The drug quality and price, etc,has"Bull management"Complex situation,Commerce even/The public security departments also have corresponding jurisdiction.In the public hospital"To the administrative"process,How to thoroughly to the market main body to change,It is urgent to change the function of government departments,On the premise of clear management main body,Integration of the existing management resources,In order to achieve"Tube do separation"Real purpose.

　　当然，“医改”之路任重而道远。正是要在不断的改革探索中，形成主体明确、路径一致的管理局面，公立医院改革才能成为“社会、医生和政府都满意的医院”。必须牢记的是，改革不是管理方“从左手到右手”的简单转换，而是要在坚持公立医院的公益性质和主导地位的基础上，实现多层协同治理。(记者 朱晋)

Of course,"medical"Road heavy responsibities.It is in constant reform exploration,Formation subject clear/Path consistent management situation,Public hospital reform can be"social/The doctor and the government are satisfied hospital".Must keep in mind is that,Reform is not management"From hand to hand"Simple conversion,But to insist on public hospital public welfare nature and the leading position of the basis,To realize multiple cooperative governance.(Reporter ZhuJin)