Defend and serve and pay and explore the way according to the performance for being common

Defend and serve and pay and explore the way according to the performance for being common
The medical reform struggles The intersection of reporter and the intersection of strength and brave the intersection of Korea S. and Lu Yang, staff reporter of XiaoJun, Hu If the public health serves the funds and can be put in place, how should the funds use, how to examine to let the fund give play to benefit, and then realize the public health and take to serve equally? Henan Province the intersection of Jiaozhuo and the intersection of city and the intersection of Wuzhi and county grant the loan through World Bank / the intersection of British and grant defend 11 implementation of event, serve, bale 10 basic public health, pay tactics, carry on to basic the intersection of public health and funds bought to serve beneficial to explore. On May 23, China's rural hygiene development projects jointly supervise and guide the on-the-spot meeting for the third time and are held in Wuzhi county, the method of this county has caused the great interest of the representative participating in the conference. On the first day of each month, all the village of health station of strong points village of township of Ge shop of Wuzhi county of Henan Province cure the flat day to launch the teaching service of the health of state of Qin. May 1, he propagate single concentrating on waying that explaining and publicising, explain and publicise the intersection of brothers and the intersection of mouth and the intersection of disease and preventive treatment knowledge and notes to villager through take place. Propagate the behavior in spontaneous health that forms different from the past, since December of 2009, every gesture that state of Qin equals in the health teaching service should be placed on record - -Target how much people is target, propagate what form does it have and what kind of result,etc. does it reach. This is Wuzhi county in the basic demand to that medicine of village put forward of teaching service of the pilot health of 3 villages and towns. Work with teaching service of the health, from September of 2009, health control of hypertension, pregnant and parturient women's health control, children's health control, resident's health file administration, infectious disease report and dealing with, immunization campaign, old person's health control, 2 type diabetic health control, getting in weight spiritual disease are managed,etc. 10 items of basic public health serve and form and serve the bag in succession, from Wuzhi the counties defend 11 project it run it grant the loan World Bank /British grant China hygiene development projects (last 11 project)s rural Fund, buy to the health clinics in towns and townships in unison, and pay the performance according to the service result of the public health. How buys and " examining patients for the first time need to measure blood pressure over 35 the basic public health serve. " This is a warm suggestion to the patient of health station in the village of horse of township of Joe temple of Wuzhi county. Will it be September 2009, buy the intersection of hypertension and the intersection of health and the intersection of management service and the intersection of bag and pilot project start, two villages and towns in pilot project, this has already become the regular project that medicine of village has offered to patient. Wuzhi county defends 11 project office person in charge Mu GuoXing to tell reporters, according to the performance goal, the basic duke has defended and served and wrapped up and presumed the concrete index separately. For example hypertension the intersection of health and the intersection of management service and the intersection of bag and the intersection of requirement and health control rate can't lower than 80%, the qualification rate can't be lower than 90% to file, the rate of management standardized of hypertension patient can't be lower than 90%, it can't be lower than 60% to manage the controlling rate of crowd's blood pressure, it is not lower than 70% to manage crowd's satisfactory rate. In addition, the masses seek medical advice in the health station of the village, can also enjoy a addition policy of medicines. Bale and buy the basic public health service, the most basic work is to do the cost well to calculate. Mu GuoXing says, the main method that they take is that the project procedure examine algorithms, namely confirm the service procedure, calculate the actual cost of each link, accumulate the cost of service item. Mu GuoXing say, calculates through the cost, 10 pieces of basic public health of Wuzhi county serve the purchase cost (the cost of contract) of the bag ,Under the total responsibility system taking villages and towns as the centre, cover calculating according to population, per person is about 18 yuan, 10.9 yuan of per person for one grade of cost of township, 7.1 yuan of cost per person at village level among them. The cost of every service, the cost all according to raising funds, supervising cost, management cost calculating, and is distributed to two grades of townships, villages rationally. Reporter know while making and buying and serving the scheme, until " whether the intersection of contract and management + performance pay " As the core, the county defends 11 project offices and services to offer the organization (the health clinics in towns and townships, village health station) Sign, buy a certain execution agreement of service ' Contract) ,Define the rights of both sides ' Duty) With obligation, buying content, quality criteria, service price, performance appraisal content and standard, paying procedure and terms,etc.. County the intersection of project and office carry on performance appraisal regularly, according to appraise result and pay procedure to serve and offer organization to pay the fund. Mu GuoXing says: "Buy the public health, serve, should just solve the health organ at the basic level trend towards the profit obviously, service efficiency of low quality is low and lacks the problem of long-efficiency mechanism,etc.. " After the pilot work of the bag of serving the basic public health, the effect indicates the work is nearing to this goal. So far, the health control rate of two pilot hypertension patients of villages and towns of this county is up to 100%, the qualification rate is up to 95% to file, it is 62.5% to manage the controlling rate of crowd's blood pressure. 4 pregnant and parturient women of pilot villages and towns have been pregnant for a long time to reach 100% building card rate, the antenatal health control rate reaches 83%, pregnant and parturient women are systematic ' Norm) Management rate reaches 75.6%, the rate of giving birth in hospital reaches 100%. 3 pilot neonates of villages and towns and a health care cards of children build card rate and reach 97.5%, health care of children under the age of 3 reaches 77% managing the coverage rate, the rate of management standardized of systems of children reaches 80%. (leave and rotate the 3rd) (have and connect the 1st) The match of president of commune hospital of township of Joe temple holds prosperously to tell reporters, after signing hypertension and serving the bag, until crowd go on, sift, check, sift consulting rate up to 88.6% over the the whole 15197 and a half person of township they, find 3529 patients of hypertension. President of township of Ge shop commune hospital Ma XueE says while giving an interview: "10 pieces of basic public health serve the implementation of the bag to make us realize, it can obtain rational compensation too to offer the basic public health service; While serving and wrapping up and launching, our clinic amount and the number of people obviously increase in hospital, have improved our enthusiasm and initiative of doing a good job of public health service. " Pay: The cost is calculated and served and made taking place with the performance rewards and punishments, how should the service quality of public health be assessed? The method of Wuzhi is, according to serving the difference of contents of bag, run by the county project and trusted county disease to accuse of professional public health organs or public and clinical hygiene professional and technical personnels such as the centre, healthcare hospital for women children,etc., carry on performance appraisal to the performance which serves the bag. The commune hospital carries on performance appraisal to the health station every quarter, confirm that pays proportion and amount; Run and carry on performance appraisal and combine announcement to the villages and towns again in project. County the intersection of event and office still engage the deputy to the National People's Congress, member of the CPPCC National Committee,etc. to make up the third party and supervise and appraise the group, and then carry on supervision to offering in terms of demanding party every half a year. Wrapping up for the example by the health management service of hypertension, Mu GuoXing has introduced the detail of performance appraisal to the reporter: In the course index, health control rate (filing rate) Up to 80% person get 6 scores,increase 5% plus one, it is if you can't sift, check whether because there aren't scheme and report form, examine blood pressure measurement last 0.5 fens piece commune hospital and village clinic not to have; It is qualified to file The person who up toes 90% of rate gets 8 scores, drop by 5% and deduct 1 fen each time; Touring to check, instruct, file quality control, follow up a case by regular visits to, supervise and guide and use medicine, supervise and guide content, lack, spike 2 by one rationally in year, there is not original record that does not score, the original record has no medicine of village to sign and deduct 2 fen, record and does not improve and deduct 1 fen; The rate of utilization of basic medicine is up to the getting 8 scores of 90%, lower 10% and deduct 1 fen each time It was result index that was examined and paid close attention to, the hypertension patient standardizes the qualification rate of management and gets 15 scores in 90%, drop by 5% and deduct 1 fen each time; Manage the person who reaches 60% of controlling rate of crowd's blood pressure and get 11 scores, 5% for every increase plus one, drop by 5% and deduct 1 fen each time; Manage crowd's satisfactory rate and reach the getting 10 scores of 70%, 5% for every increase plus one; The knowing rate of preventive treatment knowledge of community's hypertension reaches the getting 8 scores of 60%, 10% for every increase plus one. It is paid in advance that agree on according to the contract, buy the expenses which serve the bag and pay and adopt ", according to paying fixedly continuously according to the performance appraisal result " Way go on. Except prepay 30% according to regulation, county the intersection of project and office divide into, pay for continuously twice according to the intersection of performance appraisal and result, pay when finish with one year while running for half a year in project separately. It is carried on once that the county project is run and examined to the performances of the pilot villages and towns every quarter, among them pay continuously for the first time and pay according to the performance appraisal results of the first time and the second time, pay to pay according to the performance appraisal results of the third time and the fourth time continuously for the second time, the proportion that pay twice continuously is 30% and 40% respectively. On the premise of not finishing the basic goal, performance appraisal gets scores and divides 85% of the the above-mentioned ones into deservedly, pay 100% of the deserved fund to the pilot villages and towns; The score is 75%- 85%, 65%- 75% person, pay 85%, 70% separately; The score is 60%- 65% person, do not pay the fund; 60% of the under ones, will carry on the punishment of amount of money 30% of fund paid. This basic public health is served and bought the tactics of rewards and punishments of performance, has brought many kinds of effect. Make as example, manage the intersection of blood pressure and person who control of target as ultimate goal to serve the bag this county with the intersection of hypertension and the intersection of health and management service, the examination of the goal of paying attention to fruiting, hypertension of 25648 yuan is sifted, checked, subsidized, paid medicine to the village fully. And villager make launch the intersection of health and propaganda and education, the intersection of ward mate and the intersection of person who have an informal discussion and form in the course through the intersection of hypertension and the intersection of health and management service, initiative and enthusiasm of seeing the doctor are promoted greatly, to what state, when one's own body has produced it's time to go to the hospital to receive treatment clearer. Therefore, service quality criterias and examining in health organization of two grades in the village are paid the standard clearly, it has been known what should be done; Rural doctor improves in enthusiasm that the public health serve, begin to register and manage and offer service of notifying voluntarily, obtain corresponding remuneration; Masses' health care consciousness has been strengthened, the hypertension patient is higher by 40% in the going to a doctor rate of medical organization at village level than the prerequisite of launching a pilot project alone.

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