Enlargement of ＂medical reform＂： patients’ ＂bad reviews＂ can affect doctors’ income.

　　A few days ago, the State Council issued the Guiding Opinions on Establishing a Modern Hospital Management System, which will basically form a modern hospital management system by 2020. The "Opinions" put forward three aspects: perfecting the hospital management system, establishing and perfecting the hospital governance system, and strengthening the party building in hospitals, with a total of 20 reform tasks: gradually canceling the administrative level of public hospitals; The heads of health departments at all levels shall not concurrently serve as leaders of public hospitals; Establish a salary system that adapts to the characteristics of the medical industry; It is forbidden to set income-generating indicators for medical staff … …

　　What will happen in the future? What reform dividends will medical staff reap? What will the hospital look like in 2020?

　　What’s the change in seeing a doctor?

　　Increase the service of benefiting the people and you can see a doctor at your doorstep.

　　City doctors have served at the grassroots or counterpart medical institutions for not less than 1 year before being promoted to the title of attending physician or deputy chief physician. Third-level public hospitals should all participate in the construction of medical complexes and play a leading role, further improve medical services, optimize medical procedures, rationally arrange facilities in consultation areas, scientifically implement appointment diagnosis and treatment, and implement daytime surgery, telemedicine and multidisciplinary joint diagnosis and treatment models. Strengthen the emergency rescue force and smooth the green passage in front of the hospital. Carry out information-based convenience services such as medical guidance, settlement between clinics, push of inspection results, and settlement of medical treatment in different places. At the same time, carry out quality nursing services and strengthen the services of social workers and volunteers.

　　Clear the first responsible person, and find the dean when there is a medical accident.

　　Establish a medical quality management and control system that covers the whole process of clinical diagnosis and treatment services, and strictly implement the core systems of medical quality and safety, such as first consultation, three-level rounds, graded nursing, surgical grading management, antibiotic grading management, and clinical blood safety.

　　It is clear that the dean is the first responsible person for the hospital’s legal practice and medical quality and safety, and the responsibility system for medical quality and safety is implemented at the hospital and department levels. Properly resolve medical disputes, promote the construction of "three mediations and one insurance" mechanism that organically combines hospital mediation, people’s mediation, judicial mediation and medical risk sharing mechanism, and build a harmonious doctor-patient relationship.

　　What changes have been made in the treatment of doctors?

　　Pay more for more work, and the salary shall not be linked to business income.

　　The Opinions require that the human resource management system be improved. Establish and improve the management of personnel employment, post management, professional title management, medical practitioners management, nursing staff management, income distribution management and other systems. In terms of post setting, income distribution, professional title evaluation, management and use, the internal and external personnel of the establishment should be considered as a whole. Public hospitals make independent distribution within the approved total salary, reflecting the post differences, taking into account the balance of disciplines, and achieving more work and more rewards. According to the relevant regulations, hospitals can explore the implementation of target annual salary system and agreed salary. The salary of medical personnel shall not be linked to the business income of drugs, sanitary materials, inspection and testing.

　　It is forbidden to set income-generating targets, and patient satisfaction will affect income.

　　The "Opinions" clarify that it is necessary to improve the performance appraisal system. The performance appraisal of hospitals by the government and the organizers will be implemented in departments and medical staff, and medical staff in different positions and ranks will be classified. Establish and improve the performance appraisal index system, focusing on the direction of running the hospital, social benefits, medical services, economic management, personnel training, sustainable development, etc., highlighting the performance of post responsibilities, workload, service quality, behavioral norms, medical quality and safety, medical cost control, medical ethics and patient satisfaction. It is strictly forbidden to set income-generating targets for medical staff. The assessment results are linked to the post employment, professional title promotion and personal salary of medical staff.

　　What are the new highlights of the reform?

　　Cancel the administrative level of public hospitals, and the person in charge of the health planning department is prohibited from concurrently leading.

　　Establish and improve the hospital governance system, actively explore various effective forms of separation of management and operation in public hospitals, and coordinate the implementation of government medical duties. The government exercises the right to hold public hospitals, the right to develop, the right to make decisions on major issues, the right to return on assets, etc., and deliberates the articles of association, development planning, implementation of major projects, revenue and expenditure budgets of public hospitals, etc.

　　Determine the total establishment of public hospitals within the existing local establishment, and gradually implement the filing system. In accordance with the relevant provisions of the Central Organization Department on the management of public hospital leaders, the selection and appointment of public hospital leaders. Gradually cancel the administrative level of public hospitals, and the heads of health and family planning administrative departments at all levels (including Chinese medicine management departments) are not allowed to concurrently hold leadership positions in public hospitals.

　　Luxury decoration is strictly prohibited in hospitals, and the proportion of special services does not exceed 10%.

　　Deepen the reform of medical insurance payment methods, give full play to the role of medical insurance in regulating, guiding, supervising and restricting medical service behavior and expenses, and gradually extend the supervision of medical insurance on medical institutions to the supervision of medical service behavior of medical personnel. Strictly control the bed size, construction standards and large-scale medical equipment in public hospitals, strictly prohibit debt construction and luxury decoration, and gradually compress beds beyond the scale standards. Control the scale of special services in public hospitals, and the proportion of special services provided shall not exceed 10%.

　　Clarify the government’s supervision function and establish a "blacklist" and accountability mechanism.

　　The "Opinions" require that the government’s supervision function on hospitals be clarified. Establish a comprehensive supervision system, focusing on strengthening the supervision of medical quality and safety, medical expenses, large prescriptions, fraudulent insurance fraud, drug rebates and other behaviors in hospitals at all levels, establishing a "blacklist" system, and forming a long-term and diversified supervision mechanism for the whole industry. An accountability mechanism should be established for acts such as arbitrary charges and bad practice that have a significant social impact, acts that cause major medical accidents and major safety accidents, serious cases of violation of law and discipline, and acts that seriously violate the construction of morals. Strengthen the medical service supervision function of the health and family planning administrative department, and improve the access and exit mechanism of institutions, personnel, technology and equipment.