医改新政再申“强基” Health reform "New Deal""Strong base"

　　本轮医改在即将进入第四年之时重申“强基固本”，释放出利好基层的强烈信号，这有利于新医改既定目标的实现，因为新医改的关键就是“不能让基层弱”。

This round of reform reiterated when entering his fourth year"Strong base up",Release the good base of strong signal,This is conducive to the realization of the new medical reform goals,Because the new health reform is the key"Can't let weak at the grass-roots level".

　　2月20日，国务院办公厅发布《关于巩固完善基本药物制度和基层运行新机制的意见》(下称《意见》)。

February 20,,Issued by the general office of the state council[Consolidate the perfect system for basic drugs and grass-roots operation mechanism](Hereinafter referred to as[opinion]).

　　此后，这份6000余字的《意见》被冠以医改“新政”的名头，在社会广泛传播。

Since then,The more than 6000 words[opinion]As health care reform"The New Deal"The title of,Widely spread in society.

　　中国药学会医药政策研究中心执行主任宋瑞霖对《瞭望》新闻周刊评论说：“该《意见》与之前发布的医改文件一脉相承，并无质的变化，只是再次强调抓住基本药物、基层机构这个纲，纲举目张，最终实现医改设定的目标。”

Medicine, executive director of the centre for policy studies of China medicine institute Song Ruilin right[outlook]The weekly news magazine:"the[opinion]With previously published health file,There is no qualitative change,Just once again hold essential drugs/Grassroots organizations the outline,confusing,Ultimately achieve the goal of health care Settings."

　　宋瑞霖曾担任国务院法制办公室科教文卫法制司副司长，对中国的医药政策十分熟悉。

Song Ruilin served as the legal office of the state council science-education-culture-health, deputy director of the department of law,Very familiar with China's medical policy.

　　宋瑞霖分析说，本轮医改在即将进入第4年之时重申“强基固本”，释放出利好基层的强烈信号，这有利于新医改既定目标的实现，因为新医改的关键就是“不能让基层弱”。

Song Ruilin analysis said,The current health care when they are about to enter 4 years reaffirmed"Strong base up",Release the good base of strong signal,This is conducive to the realization of the new medical reform goals,Because the new health reform is the key"Can't let weak at the grass-roots level".

　　本刊记者从国务院医改办获悉，《意见》的总体考虑是，坚持“保基本、强基层、建机制”的既定方针，保持基层医改政策的连续性和稳定性，突出长效机制的建设，对地方上一些行之有效的创新做法给予充分吸纳，并对医改推进过程中出现的一些新情况、新问题提出相应政策措施。

This newspaper the reporter learns from the reform of the state council office,[opinion]Overall consideration is,Adhere to the"Cover the basic/Strong base/Build mechanism"Of the course,Maintain continuity and stability of the primary health care policy,Highlight the construction of long-term mechanism,Some effective innovation of local practices give full absorption,And in the process of reform to promote some new conditions/A new problem put forward the corresponding policies and measures.

　　

利好基层 Good at the grass-roots level

　　事实上，围绕“基层”这一工作重心，本轮医改已经付出了三年多的努力。

In fact,,Around the"At the grass-roots level"The job center of gravity,This round of reform has been more than three years of effort.

　　宋瑞霖说，三年多来，各级政府将财力重点投向基层，构建了崭新的基层医疗卫生服务平台，基层医疗环境出现翻天覆地的变化。然而由于历史欠账较多，基层仍然是卫生事业发展的薄弱环节，距离满足公众方便就医、经济就医等的需求仍有一定差距，所以卫生“十二五”规划依然将“强基层”作为重点，明确要继续从软件、硬件两个方面加强基层服务体系建设。

Song Ruilin said,For more than three years,Governments at all levels will focus on financial base,To build a new grassroots medical and health service platform,Grassroots medical environment appears earth-shaking changes.However due to historical debt,At the grass-roots level still is the weak link of health development,Convenient distance to satisfy the public/The economy still has certain gap between the demand for medical treatment, etc,So health"The 12th five-year"Planning will still have to get"Strong base"As a key,Clear to continue from the software/The hardware two aspects of strengthening the construction of service system.

　　在软件建设方面，针对基层医疗卫生机构人才不足的矛盾，《意见》提出加快推行全科医生制度，实施全科医生规范化培养和欠发达农村地区助理全科医生培训等措施予以缓解。

In the software construction,In view of the basic-level medical health agency talent shortage contradiction,[opinion]Gp system were presented,Implementation of the standardization training general practitioners and less-developed rural areas assistant general practitioner training and other measures to alleviate.

　　与此同时，为进一步调动基层医疗卫生机构医务人员的积极性，《意见》强调深化人事分配制度改革，从根本上巩固完善基层医改。

At the same time,In order to further arouse the enthusiasm of grassroots medical institutions of medical personnel,[opinion]Deepening the reform of personnel distribution system is emphasized,Fundamentally strengthen improve primary health care.

　　首先是深化编制和人事改革。一方面要明确基层医疗卫生机构法人主体地位，落实用人自主权；另一方面，则要全面推行聘用制度和岗位管理制度，实行定编定岗不固定人员，变固定用人为合同用人，变身份管理为岗位管理。

First of all is to deepen reform of preparation and personnel.On the one hand to clear grassroots health institutions legal person subject position,Implement the autonomy of choose and employ persons;On the other hand,Will be fully implementing employment system and job management system,Implement personnel allocation staff create positions,Fixed the employing of choose and employ persons to contract,Identity management to post management.

　　其次，加强对基层医疗卫生机构及负责人的考核。《意见》提出依托信息化手段，强化对基层机构的量化和效果考核，并将考核结果向社会公开。同时，主管部门要对基层机构的负责人进行考核，考核结果与其收入和任免挂钩，不允许将负责人的收入与基层机构的经济收入挂钩。

The second,Strengthen the basic-level medical health agency and the head of the assessment.[opinion]Relying on the information technology means is put forward,Strengthen the grassroots organization of quantitative and effect assessment,And the inspection results to the public.At the same time,Departments to the grass-roots institutions, head of the evaluation,The assessment results and income and to appoint or remove link,Head of income are not allowed to be pegged to the grass-roots institutions of economic income.

　　最后，提高基层医疗卫生机构人员待遇。《意见》明确，基层机构在核定的收支结余中可按照规定提取职工福利基金、奖励基金。允许各地从实际出发，在平稳实施绩效工资的基础上，结合医务人员工作特点，适当提高奖励性绩效工资比例，合理拉开收入差距，体现多劳多得、优绩优酬，但严禁将医务人员收入与药品和医学检查收入挂钩。

The last,Improve grassroots health institutions staff treatment.[opinion]clear,Grassroots organizations in the verification of the balance of payments balances can extract the worker welfare funds in accordance with the relevant provisions/Reward fund.Allow around from set out actually,Based on the smooth implementation of performance pay,Combining with the characteristics of medical staff work,Appropriately raise some bonus performance wage rate,Reasonable income gap,Is work more/Optimal blue-chip reward,But it is forbidden to the medical staff income linked to drugs and medical examination.

　　在硬件建设方面，《意见》瞄准稳定长效的多渠道补偿机制，计划从5个渠道对基层医疗卫生机构进行补偿：

In the aspect of hardware construction,[opinion]Aimed at long-term stable multi-channel compensation mechanism,Plan from five channels of grassroots medical institutions to compensate:

　　一是落实财政对基层医疗卫生机构的专项补助经费。政府举办的基层机构基本建设和设备购置等发展建设支出，由政府根据基层机构发展建设规划足额安排。对基层机构人员经费(包括离退休人员经费)、人员培训和人员招聘等所需支出，由财政部门根据国家规定合理安排补助。

One is to carry out the financial special subsidies for basic medical and health institutions.The government at the grassroots organization basic construction and equipment purchase, etc. Development and construction spending,According to the arrangement of infrastructure development and construction planning in full by the government.Funding to grassroots organization personnel(Including retirees)/The expenses necessary for the staff training and recruitment, etc,Reasonable arrangement of subsidies by the finance department according to state regulations.

　　二是完善财政对基层医疗卫生机构运行的补助政策。中央财政已建立基本药物制度实施后对地方的经常性补助机制并纳入财政预算，支持地方完善财政对基层机构运行的补助政策，中央对地方补助标准随着经济社会发展相应提高。

Second, we will improve fiscal subsidies for basic medical and health care institutions run policy.After the introduction of the central government has established the basic drug system to place the current subsidy mechanism is included in the budget,Support local improve fiscal subsidies for basic operation policies,The central government to the local subsidies standards increase along with economic and social development.

　　三是保障基本公共卫生服务经费。各级财政要及时足额下拨基本公共卫生经费，确保专款专用，不得截留、挪用、挤占。基本公共卫生服务经费要先预拨后考核结算，并随着经济社会发展相应提高保障标准。同时，基层机构承担的突发公共卫生事件处置任务由财政按照服务成本核定补助。

Three basic public health service is the guarantee funds.At all levels to basic public health provides timely financial funds,To ensure that the special fund is special,Shall intercept/Misappropriation of/Crowding out.Basic public health services provision to appropriations after settlement,And along with the economic and social development the corresponding improve security standards.At the same time,Grass-roots institutions, undertake the task of public health emergency disposal in accordance with the approved service cost subsidy from government finance.

　　四是全面实施一般诊疗费。《意见》要求各地结合实际合理确定一般诊疗费标准，原则上10元左右。要严格落实一般诊疗费医保支付政策，将其纳入基本医保门诊统筹支付范围。

Four is the comprehensive implementation of general fee.[opinion]To reasonable standards generally fee according to the reality,In principle, 10 yuan.We will strictly implement general fee payment policy,Be included in the basic medicare outpatient service as a whole to pay limits.

　　五是发挥医保支付的补偿作用。扩大门诊统筹范围，合理确定医保支付范围和标准。医保支付比例要向基层医疗卫生机构倾斜，鼓励使用中医药服务。要推进医保支付方式改革，逐步建立激励与约束并重的支付制度。采取购买服务方式对基层医疗卫生机构提供的基本医疗服务给予补偿。

Fifth, bring into play the function of health care to pay compensation.Expanding the scope of the outpatient service as a whole,Reasonable medical insurance to pay limits and standards.Health care payment proportional to leaning to grassroots health institutions,Encourage the use of traditional Chinese medicine services.To promote the reform of medical insurance payment,Gradually establish incentive and constraint and payment system.Purchasing service ways of grassroots medical institutions to provide basic health services offer compensation.

　　

巩固基药 Consolidate the base medicine

　　在宋瑞霖看来，《意见》的另一个亮点，是将基本药物制度作为抓手，统筹推进综合改革，建立基层医疗卫生机构运行新机制。

It seems to Song Ruilin,[opinion]Another bright spot,Is the system for basic drugs as a gripper,Push forward comprehensive reforms,Grassroots medical institutions operation mechanism is established.

　　基本药物制度是本轮医改的一项全新制度，涉及遴选、生产、定价、招标、配送、使用、报销等多个环节。一般认为，基本药物制度是对基层医疗卫生机构药品供应保障体系的根本性变革，并将对医疗机构和广大患者的用药行为产生深远影响。

The basic drug system is the reform of a new system,Involved in the selection/The production/pricing/The tender/distribution/use/Reimbursement and so on.It is generally believed,The basic drug system of grassroots medical institutions and drug supply security system of the fundamental change,And will be for medical institutions and the vast majority of patients with drug use behavior have a profound impact.

　　本刊记者获悉，已经实施基本药物制度并开展规范集中采购的省份，基本药物实际销售价比制度实施前平均下降30%左右，工信部纳入统计的规模以上工业企业生产的药品占中标品种的63%，有效遏制了过去基层药品采购渠道不正规，回收药、假劣药充斥市场等的情况。

This reporter learned that,Have implemented the basic drug system and to standardize the centralized purchasing provinces,Before the implementation of basic drugs than the actual sales price system fell around 30% on average,Ministry of industry and included in the statistics of industrial enterprises above designated size production accounted for 63% of the winning varieties of drugs,Effectively curb the grassroots drug purchase channels is not normal in the past,Recovery of medicine/JiaLie medicine flooding the market, etc.

　　本轮医改在基层实施基本药物制度的同时，启动了与之配套的综合改革，在管理、人事、分配、补偿等方面初步建立了基层医疗卫生机构运行新机制。而在新机制的运转过程中，稍有松懈即可能出现摇摆和反复，因此基本药物制度还需巩固完善。

This round of reform implementation at the grassroots level system for basic drugs at the same time,Launched the comprehensive reform to go with them,In the management/The personnel/distribution/Compensation, etc of grassroots medical institutions have been established operation mechanism.And in the process of the new mechanism operation,Frailty is possible swing and repetitive,So the basic drug system still need to consolidate the perfect.

　　针对基本药物制度实施以来出现的新情况新问题，如一些生产企业恶性竞争，有的药品配送不及时等，《意见》提出以下改进措施：

According to the basic drug system since the implementation of new problems appeared in the new situation,As some vicious competition,Some drug delivery not in time, etc,[opinion]The following improvement measures are put forward:

　　在集中采购方面，要求各地在全面贯彻落实国务院办公厅关于《建立和规范政府办基层医疗卫生机构基本药物采购机制的指导意见》的基础上，对经多次采购价格基本稳定的基本药物试行国家统一定价；对独家品种实行国家统一定价，也可探索以省(区、市)为单位，直接与生产企业议定采购数量和采购价格；对少数基层必需但用量小、市场供应短缺的基本药物，采取招标定点生产等方式确保供应。

In terms of centralized purchasing,Requirements across the full implementation of the general office of the state council[Establish and standardize the government grass-roots medical institutions essential medicines procurement guidance mechanism]On the basis of,By repeated purchasing prices basically stable, the basic drugs for pricing for national unity;The exclusive varieties price of national unity,Also can explore to province(area/The city)For the unit,Directly with the manufacturers agreed purchase quantity and purchase price;For a few basic essential but the amount is small/Market supply of basic drugs,Take the bidding fixed-point production, ensure supply.

　　在完善“双信封”制方面，要求在经济技术标准评审中，对药品质量、生产企业的服务和信誉等进行全面审查，将企业通过《药品生产质量管理规范(2010年版)》(GMP)认证作为质量评价的重要指标；在商务标评审中，对竞标价格明显偏低的药品进行综合评估，避免恶性竞争。优先采购达到国际水平的仿制药，激励企业提高基本药物质量。

In the perfect"Double envelope"System in terms of,Demand in the economic and technical standard of review,The drug quality/Production enterprise to conduct a comprehensive review of service and credibility,The enterprise through the[Drug production quality management norms(The 2010 version)](GMP)Certification as an important index of quality evaluation;In the business in the review,Comprehensive evaluation of bid prices significantly lower drug,Avoid vicious competition.Prior purchasing reached the international level of generic drugs,Motivate enterprises to improve the quality of essential drugs.

　　在供应配送方面，基本药物配送原则上由中标生产企业自行委托药品批发企业进行配送或直接配送，并强调做好偏远、交通不便地区的药品配送服务。

In the aspect of supply and distribution,Basic drug distribution in principle by the production enterprise commissioned by pharmaceutical wholesale enterprises in distribution or distribution directly,And stressed that remote/Inaccessible areas of drug delivery.

　　在资金支付方面，要求基本药物采购机构对基层医疗卫生机构基本药物货款统一支付，鼓励通过设立省级基本药物采购周转资金等方式优化付款流程，确保货款及时足额支付。

In terms of money payment,Demand basic drugs procurement agencies to grassroots health institutions basic payment unified payment,Encouraging the establishment of essential medicines at the provincial level through the purchasing process optimization of working capital and other payment,Ensure the timely and full specified amount pay payment for goods.

　　在国家基本药物目录调整方面，提出遴选基本药物要坚持防治必需、安全有效、价格合理、使用方便、中西药并重的原则。对国家基本药物目录规定原则上每三年调整一次。由省级人民政府统一增补本省(区、市)目录外药品品种，要求从严控制增补数量，并禁止将权限下放到市(地)、县(市、区)或基层医疗卫生机构。在增补品种时，要充分考虑基层常见病、慢性病用药与当地公立医院用药的衔接问题。

In the national list of essential medicines adjustment,Put forward the selection of essential medicines to control required/Safe and effective/The price is reasonable/Easy to use/The principle of paying equal attention to Chinese and western medicine.On the national list of essential medicines prescribed in principle once every three years to adjust.By the unified supplemented the province people's government at the provincial level(area/The city)Catalogue varieties of drugs,Requirements strictly control supplemented quantity,And it is forbidden to access down on the city(to)/county(The city/area)Or grassroots medical and health institutions.When supplementary varieties,Common diseases at the grass-roots level should be fully considered/Chronic drug use with local public hospital drug use problem.

　　重视村医

Attaches great importance to the village doctor

　　《意见》的第三个亮点，是格外关注乡村医生队伍建设，着力夯实农村三级医疗卫生服务网网底。

[opinion]The third point,Is particularly interested in team building of rural doctors,Strive to strengthen the rural three-level health service network of the population.

　　宋瑞霖认为，在广大农村地区，农民有了头疼脑热，习惯上会去找村医治疗，这意味着实现“小病不出村”靠的是乡村医生。那么，如何让村医靠本事吃得上饭就是稳定村医队伍的关键。

Song Ruilin think,In the vast rural areas,Farmers had headaches brain fever,Habit would be to find the village doctor treatment,This means that to achieve"Ailment is not out of the village"By rural doctors.then,How to make the village doctor depend on the ability to eat a meal is key to stabilizing village doctor team?.

　　《意见》提出全面落实乡村医生补偿政策。明确村卫生室和乡镇卫生院的基本公共卫生服务任务分工和资金分配比例，原则上将40%左右的基本公共卫生服务任务交由村卫生室承担，考核后拨付相应的服务经费，不得挤占、截留和挪用。各地要将符合条件的村卫生室纳入新农合定点，合理制定村卫生室一般诊疗费标准，并确定新农合支付标准和办法。村卫生室实施基本药物制度，中央财政已建立补助机制，地方各级财政要采取定额补助的方式给予专项补助，财政补助总体水平与当地村干部的补助标准相衔接。鼓励地方进一步提高对在偏远、艰苦地区执业的乡村医生的补助水平。

[opinion]Implement the compensation policy of rural doctors is put forward.Clear village clinics and township health hospital of basic public health services in the task division of labor and capital allocation proportion,Principle, around 40% of the basic public health services to village clinic,After assessment of funds allocated to the corresponding service,May occupy/Intercept and appropriate.Will conform to the conditions around the village clinics in new farming in fixed point,Establishing reasonable village clinics general fee standards,And determine the new farming and payment standards and methods.Village clinic implementation of essential medicine system,The central government has set up a subsidy mechanism,Local governments at various levels must take the way of fixed subsidies give special assistance,Overall level of financial aid with the local cadres, subsidies standards.Encouraging local further improve on the remote/Hard practice of rural doctors in subsidy levels.

　　此外，《意见》特别强调合理解决乡村医生的养老问题。支持乡村医生参加城乡居民社会养老保险，按规定领取养老金。鼓励有条件的地方采取多种方式适当提高村医的养老待遇。地方政府可以采取补助等多种形式，妥善解决好老年乡村医生的保障和生活困难问题。

In addition,[opinion]Special emphasis on reasonable rural doctors endowment problem.Support rural doctors attend social endowment insurance urban and rural residents,According to the provisions of pension.Encourage conditional place to take a variety of ways appropriate to improve the village doctor pay of provide for the aged.A variety of forms such as local government subsidies can be taken,Properly handle the guarantee of good old country doctor and difficult problems of life.

　　针对乡村医生反映突出的执业风险问题，《意见》鼓励各地积极探索降低乡村医生执业风险、调解医患纠纷的有效措施。

In view of the village doctor reflects outstanding practice risk problem,[opinion]Encourage active exploration, reduce the risk of rural doctors practising/Effective measures to mediate doctor-patient dispute.

　　这样一份意图改善乡村医生待遇和执业条件、完善基层机构服务能力的《意见》，会对中国的新医改作出何种贡献，还有待实践的检验。(《瞭望》新闻周刊记者 张冉燃)

Such an intention to improve the treatment of rural doctors and practice conditions/Perfect the grass-roots institutions service ability[opinion],What kind of contribution to China's new health care reform,Remains to be tested in practice.([outlook]Newsweek reporter zhang ran)