The de -administrativeization is still the reform door of public hospitals

Liang Jialin/Wen recently, the Hainan Provincial Government issued the "Implementation Plan for High -quality Development of Public Hospitals in Hainan Province". The document proposes to promote the reform of administrativeization of public hospitals, cancel the administrative level of public hospitals, gradually implement the professionalization and appointment system of the dean, comprehensively implement the autonomy of the management and management of public hospitals, and implement all employment and management. This policy has repeatedly mentioned "de -administrativeization" after many years, causing heated discussions in the medical and policy community.

There are many forms of manifestations in public hospitals: one is "official president". Taking officials who have been removed from time to time due to poor prevention and control of the epidemic in the near future, some leading cadres of the municipal (district) Health and Health Commission are also the president of the municipal (district) public hospital. Due to the two positions of both positions, and the lack of medical or public health professional skills, the "official dean" often travels internal management, and the result is that it is not motivated or bad. In this regard, the Hainan Provincial Government clearly stipulates that the person in charge of the administrative department shall not serve as a leader in public hospitals.

The other is the administrative level of public hospitals in the country. For example, the provincial/ministries and commissions hospitals are generally the office level. In some places, officials of the Health and Health Commission admitted to the author that they dare not "control too strict" about the local hospital, and worry that in case the dean will be airborne to the Health Commission as one or two leaders and become their own leadership. You may be "wearing small shoes".

For a long time, the phenomenon of "rotating doors" between the director of the Health and Health Committee (deputy) and the president of the hospital has actually weakened the supervision of the Health Commission and caused the health system in individual regions The problem of corruption and the deterioration of doctors and patients to investigate and deal with external forces such as the Discipline Inspection Commission and the Medical Insurance Bureau. Recently, Liu Xiangfeng, a doctor of Xiangya Second Hospital of Hunan Province, was investigated for serious violations of laws and disciplines. The China Discipline Inspection and Supervision News published an article and asked: "Why did not be resolved early internally? Is the daily supervision and management of the regulatory authority strong and in place? "

正是意识到医院过度行政化的弊端，早在2007年，中共十七大报告就对医改提出“四个分开”要求，其中，政事分开、管办分开是指行政部门（卫健委）与The public institutions (hospitals) are separated, and the government's management medical department (Health and Health Commission) and medical departments (such as: the medical management center) are separated. In 2016, the "Guiding Opinions on Establishing a Modern Hospital's Management System" issued by the General Office of the State Council first proposed: gradually cancel the administrative level of public hospitals.

On the one hand, de -administrativeization is conducive to fair competition in the medical market. If the excessive profit -seeking mechanism of public hospitals has not been reversed, administrativeization may actually form a privilege of "still official and business", which can not only use the hospital's administrative level to affect the medical resource planning and layout of the local Health and Health Commission, and the hospital level review policy. To the competition of the interbank industry of private medical institutions, the resources and patient resources of the lower -level siphon -level medical institutions can also realize these resources to achieve higher rewards in the "outside system". Only when the "official hat" is removed by a public hospital can patients really choose the appropriate medical institution with indicators such as medical skills and poor health effects, and different levels of medical institutions can break regional monopolies and achieve survival of the fittest.

On the other hand, de -administrativeization is also conducive to fair competition within the hospital. At present, facing the power checks and balances of the president of the public hospital, we must not only oppose the performance of the actual work, but also match the administrative level based on age qualifications and academicians. A hospital/university (college (school) head) has all the way to retire. The author believes that as Hainan and other places promote the employment system for the dean for the whole society, the "lifelong system" phenomenon of the hospital's person in charge is expected to be reversed.

However, the author reminds that as a professional and technical position, the term of office of the hospital cannot be copied by administrative officials. Otherwise, the short term may lead to short -term political achievements. In developed countries, on the premise of meeting experts to govern the hospital and power balance, many hospital presidents have a term of office for more than 10 years. To ensure the long -term development strategy of this hospital and the stability of the long -term interests of patients. It is recommended that the government implements a "long -term employment system" on the president of the public hospital. After the appointment period expires, the performance performance is qualified, and the continuous selection and continuous employment will be allowed. At the same time, the term of appointment within 5 years also competes for young and middle -aged managers to create opportunities.

As the dean's power is balanced, who should the vacuum of the power left to be given to? Chang Geng Hospital in Taiwan, China, pioneered the "Medical/Management division of labor" model. Medical management was borne by medical staff, and hospital management was borne by professional management staff. With the promotion of the professionalization of the dean and other places in Hainan, we have reason to expect that in the future, the dean of the medical profession and clinical positions in the future will give birth to more professional backgrounds and management positions from operational, finance, legal affairs and other professional backgrounds and management positions. "They not only specialize in specialty construction and clinical services, but also contribute to the hospital's compliance and refined management to deal with the hospital losses of the hospital's downlink of the new crown epidemic.

Unfortunately, the new crown epidemic has been popular in the past few years, and "de -administrativeization" has talked less.This is because the local governments and its Health and Health Committee firmly control the property resources of public hospitals. The highly administrative public hospitals and their medical staff are more likely to be mobilized as the leading force of the epidemic prevention.The trend of "re -administration".As the situation of epidemic prevention is gradually stable, we still have to consider de -administrativeization as deepening medical reform, especially the life door of the reform of public hospitals, in -depth reshaping the power and interests of public hospitals, and finally facing more conducive to protecting patients' health and expert capabilities.The medical system is moving.(The author is the Secretary -General of the Value Medical Consultant and Expert Committee)

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