15省市县级公立医院综合改革试点进展及问题与建议

Progress and problems of county-level public hospitals reform in 15 provinces

基于我国南部15省市两年来县级公立医院综合改革的组织与开展,探讨了当前县级公立医院综合改革的进展及存在的问题.15个省市开展的改革进度及内容不一,安徽、江苏等4省已全面铺开.各试点县均已取消药品加成,通过调整服务价格革新了医院补偿方式;建立现代医院管理体制、薪酬制度及人事制度改革也是改革的主要内容;上下服务协作以及医院监管制度,成为县级公立医院改革的新内容.同时也暴露出了当前县级公立医院改革体系关注不足、医院经济导向未发生根本转变、多部门协作困难、医院债务性问题难以突破等多个问题.

Based on the organization and implementation of the comprehensive reform of countylevel public hospitals in 15 provinces （municipalities）in southern China,the research discussed the progress and problems of such reforr.The progress made and areas of the reform vary among provinces and municipalities.For example,the reform has completely covered all the counties in four provinces such as Zhejiang and Jiangsu province.Medicine markups have been canceled in all the pilot counties by adjusting the service prices to pave the way for hospital compensation.Contemporary hospital management,remuneration system and personnel system reform are also main targets of the reform,while the collaboration between superiors and subordinates,and hospital regulatory system have recently been included.Problems are also found with the current reform：for example,lack of attention for the system reform,no fundamental changes in place in the business orientation of hospitals,as well as problems in collaboration among departments,and hospital debts.