Weiping Li: The Public Welfare in China Focuses on Building Disciplines and Improving Services

"The hospital's operating mechanism must achieve functional transformation, liberate itself from the self-investment construction model, shift its focus to adherence to the public welfare of public hospitals, strengthen the connotation of disciplines, talents, etc., optimize service processes, and improve modern and scientific management mechanisms. To improve the service capabilities of the society and the people.” On September 8, 2012, at the seminar on the reform of the public hospitals in Beijing and Shanghai, the theme of which was the “Separation of Medicines and Compensation Mechanism”, Li Weiping, Dean of Renji Hospital, Shanghai Jiao Tong University Hospital It is proposed that the compensation for discipline construction and personnel training be strengthened in particular.

According to Li Weiping, the current reform of the compensation system for public hospitals in Shanghai has the characteristics of large compensation, clear compensation items, widened compensation scope, and clear reimbursement criteria. The “5+3+1” project in Shanghai is the largest scale deployment of medical resources in Shanghai since the founding of New China. By optimizing the tertiary hospital settings, the feasibility of suburban residents enjoying quality medical services has been significantly improved. By 2012, each district and county in the suburbs will be equipped with a three-level public general hospital.

Li Weiping also introduced the compensation mechanism for Shanghai 5+3+1 hospitals. He said that in terms of financial compensation, the basic construction of the 9 hospitals involved in "5 + 3 + 1", large-scale equipment, start-up expenses, and compensation for future operating expenses are all guaranteed by the municipal and district levels of finance. For example, the total investment of the infrastructure project of the RenJin South Institute is 50.168 million yuan and the start-up fund is 150 million yuan, all of which are fully allocated by the second-tier government of Shanghai and Minhang District in proportion of 2:1.

He said that after the elimination of drug additions and the appropriate increase in fees for medical services, Shanghai's increased financial investment has a three-year transitional period, which is divided by the municipal and district finances by 1:2. At the same time, it will also rationalize the price structure of medical services, reasonably adjust service charge standards, and appropriately increase the price of medical services that embody the value of medical workers' technical services. The operating cost will increase by 15%.

In addition, Medicare payments will be combined with project-based payments and total prepayments. Continue to improve the total amount of medical insurance prepaid, combine outpatient consultation, explore payment by heads, combine the protection of hospital outpatients with serious illnesses, and explore the charge for diseases. During the three-year transition period, supportive budget management based on the actual amount of medical insurance services was implemented. Pay attention to the guidance of the basic mechanism, and retain the compound mechanism of incentive and restraint in the medical insurance budget management by referring to the same level of expense for similar hospitals at the same level.

In terms of operational mechanisms, the Bank implemented financial budget management, fully implemented the new hospital financial accounting system, rigorously managed public hospital budget management and income and expenditure management, strengthened cost accounting and control, implemented real-time settlement, internal and external auditing systems. Li Weiping said that this pressure on the financial management of the hospital is still quite large. In addition, the hospital will also set up the chief accountant and implement the system of appointment of the chief accountant to be sent to the hospital by Shanghai Shen Kang.

"All these mechanisms have brought about consideration to public hospitals," said Li Weiping. Under the current reform of public hospitals, it is obviously not feasible for hospitals to take the path of scale expansion. Therefore, we focus on academic and clinical services.

Li Weiping pointed out that the operating mechanism of the hospital needs to be transformed from the mode of self-investment construction to achieve functional transformation. The focus of work shifts to “keep the public good of public hospitals”, strengthen the connotation construction of disciplines, talents, optimize service processes, and improve modernization and science. The management mechanism has been improved to improve the service capabilities of the society and the people, as well as the specialized, scientific, and refined management of the hospital.

He believes that it is necessary to increase investment in disciplines and personnel construction. Subjects need to strengthen the construction of scientific research platforms, the matching of scientific research projects, and the rewards for scientific research achievements. In talent construction, we must increase the weight of performance.

Li Weiping emphasized the construction of the discipline's sub-professionals and improved the ability of the disease to be refined and specialized in diagnosis and treatment. He pointed out that it is necessary to establish a multidisciplinary diagnosis and treatment model based on disease, adhere to the "sub-professional" and systematically integrated medical methods, and improve the standardization, rationality, system, and individualized diagnosis and treatment ability of the disease.

The Shanghai Shenkang Hospital Development Center has proposed that the income level of medical personnel should be consistent with the economic development of Shanghai. In the past few years, the income level of medical personnel in Shanghai has increased at a rate of 20%. Shanghai's Ministry of Finance and the Ministry of Social Security also emphasize the importance of the distribution of scientific performance.

To achieve this, Li Weiping believes that it is necessary to achieve a transformation in the distribution of internal hospital performance. From focusing on balance of income and expenditure for performance distribution to establishing a scientific and rational performance distribution method, and focusing on patient satisfaction, job workload, workability, service quality, clinical research output and teaching quality, cost control and medical cost control And other core content, the establishment of the hospital internal performance evaluation index system. In addition, it is also necessary to no longer use income and expenditure balance as the basis for performance distribution, but to implement a hospital internal performance appraisal system based on job nature, job quality, and patient satisfaction, and a corresponding income distribution system.