深化公立医院公益性，关键在于激励机制调整
在当前中国深化医药卫生体制改革的大背景下，公立医院的公益性回归成为焦点。本月召开的二十届三中全会再次对医药卫生体制改革作出重要部署，强调了深化以公益性为导向的公立医院改革，构建以医疗服务为主导的收费机制，完善薪酬制度，并建立编制动态调整机制。
上海市卫生和健康发展研究中心主任金春林向中新健康表示，三中全会的决定旨在纠正公立医院可能存在的趋利行为。医疗服务价格作为医疗机构的主要收入来源，是决定其能否弥补医疗支出的关键。三中全会提出的建立以医疗服务为主导的收费机制，旨在优化医疗服务价格体系，通过合理定价，鼓励医疗机构提供高质量的医疗服务，避免过度医疗和资源浪费。
《深化医疗服务价格改革试点方案》的实施，为医疗服务价格改革提供了明确的方向。该方案通过3至5年的试点，旨在探索形成可复制可推广的改革经验，到2025年，医疗服务价格机制将成熟定型，价格杠杆功能得到充分发挥。金春林指出，政府应适当增加对公立医院的财政投入，并合理制定医院的收费标准，确保投入能有效促进公立医院公益性的回归。
金春林还强调了薪酬制度改革的重要性。合理分配医疗资源、提高医生的工作积极性，同时避免过度医疗，是公立医院改革亟待解决的问题。薪酬制度改革应明确投入标准、投入方式和投入领域，确保投入能促进医疗服务的高质量发展。工资总额应设定合理标准，并区分固定工资和浮动工资的比例，浮动工资部分应与服务质量、治疗效果和医疗资源的有效利用相挂钩，以激励医生提供高质量的医疗服务。
除了薪酬改革，金春林还提出，评价公立医院和院长的绩效时，应从内涵发展的角度出发，关注医院的临床技能提升、治疗效果改善、患者满意度提升等方面，而非仅仅看重规模扩大、设备更新和收入增长。政府应通过医保基金和财政补助等手段，激励医院和医生实现政府期望的健康目标，如减少疾病发生率、提高治疗成功率等。
综上所述，深化公立医院公益性，关键在于激励机制的调整，包括医疗服务价格改革、薪酬制度优化以及绩效评价体系的创新，这些措施将共同推动公立医院向更高质量、更公平、更可持续的方向发展。
英语如下：
News Title: “Deepening Public Hospital Reform: The Key Lies in Adjusting Incentive Mechanisms and Service Orientation”
Keywords: Public hospital reform, incentive mechanism, salary system
News Content: Deepening the Public Nature of Public Hospitals: The Key Lies in Adjusting Incentive Mechanisms
In the current context of deepening the medical and health reform in China, the return of public nature to public hospitals has become a focal point. The Third Plenary Session of the Twentieth Central Committee, held this month, reiterated the importance of deepening the reform of public hospitals that are oriented towards public welfare. It emphasized the establishment of a fee mechanism dominated by medical services, the improvement of salary systems, and the establishment of a dynamic mechanism for personnel allocation.
According to Jin Chunlin, the director of the Shanghai Health and Development Research Center, the decisions from the Third Plenary Session aim to correct any profit-seeking behavior that public hospitals might exhibit. The revenue of hospitals, primarily derived from the prices of medical services, is crucial in determining their ability to cover their expenses. The proposal to establish a fee mechanism dominated by medical services is intended to optimize the pricing system for medical services, encouraging hospitals to provide high-quality medical services through reasonable pricing, and discouraging overmedicalization and resource wastage.
The implementation of the Pilot Program for Reforming Medical Service Pricing provides a clear direction for the reform of medical service pricing. Through a pilot phase lasting 3 to 5 years, the program seeks to explore and establish a replicable and scalable reform model. By 2025, the pricing mechanism for medical services is expected to mature, fully utilizing the function of price levers. Jin Chunlin stressed that the government should appropriately increase its fiscal investment in public hospitals and rationally set the fees for hospitals, ensuring that these investments effectively promote the return of public nature to public hospitals.
Furthermore, Jin Chunlin emphasized the importance of reforming the salary system. The rational distribution of medical resources and the enhancement of doctors’ motivation are crucial issues in public hospital reform. The reform of the salary system should clarify standards, methods, and fields of investment, ensuring that these investments promote the high-quality development of medical services. The total salary should be set with reasonable standards, distinguishing between fixed and variable salaries, with the variable component tied to service quality, treatment outcomes, and the effective utilization of medical resources to incentivize doctors to provide high-quality medical services.
In addition to salary reforms, Jin Chunlin proposed that when evaluating the performance of public hospitals and their directors, the focus should be on the enhancement of clinical skills, improvement of treatment outcomes, and patient satisfaction, rather than merely on the expansion of scale, updating of equipment, and revenue growth. The government should incentivize hospitals and doctors to achieve the government’s health objectives, such as reducing disease incidence and improving treatment success rates, through means such as the health insurance fund and fiscal subsidies.
In conclusion, deepening the public nature of public hospitals hinges on adjusting incentive mechanisms, including reforms in medical service pricing, salary system optimization, and innovation in performance evaluation systems. These measures will collectively drive public hospitals towards higher quality, greater fairness, and more sustainable development.
【来源】http://www.chinanews.com/life/2024/07-25/10257046.shtml
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