Rural Health Service Integrated Management Implementation Plan
Part 1: Implementation plan for integrated management of rural health services
To further deepen the reform of rural health work, rationally allocate and effectively use rural health resources, strengthen the construction of rural health service system and talent team, establish a lean and efficient rural health management system, comprehensively implement the integrated management of rural health services, and implement the basic drug system. Spread sales, implementation of the new rural cooperative medical outpatient co-ordination, according to the spirit of the Henan Provincial Government's "Implementation Opinions on Further Strengthening the Construction of Rural Doctors", combined with the actual situation of our district, specially formulated this program.
First, the guiding ideology
Guided by the scientific concept of development, the company aims to standardize village-level medical and health services, rationally allocate and integrate medical and health resources, and ensure that farmers enjoy safe, effective, convenient and inexpensive public health and basic medical services.
Second, the work objectives
Standardize the village clinics, establish a community service center as the main organization form in the whole district, take the "five unified, two independent" as the basic content, combine basic medical care, prevention and health care, and harmonize responsibility, rights and interests. The integrated management system of rural health services with standardization of physical facilities, standardization of operation management, systemization of supervision and supervision, and quality of service as the main goal. Further improve the rural health service network, improve the function of rural health services, standardize rural health service behavior, improve the quality of rural health services and service standards, protect the health of farmers, and promote the sustainable, stable and healthy development of the rural economy. The “Integrated Management of Rural Health Services” of Zhenlin Community Health Service Center is expected to achieve five specific goals:
1. Improve the three-level defense network, promote the implementation of primary health care work planning goals, and ensure the basic health needs of farmers.
2. Rationalize the allocation of health resources, rationalize the relationship between community health service centers and village health centers, ensure the coordinated development of the two, and effectively use rural health resources.
3. The infrastructure and service conditions of the village health center have been gradually improved, and the level of subsidies for rural doctors to carry out public health services has gradually increased and the team has become more stable.
4. Standardize the behavior of basic medical services, curb the occurrence of arbitrary charges and indiscriminate use of drugs, improve the quality of services, reduce medical accidents, and make farmers safe and effective on medical drugs.
5. Improve the technical level and overall quality of rural health technicians, enhance the overall service function, and achieve the goal of “providing relatively high-quality medical services at relatively low cost and striving to meet the basic medical service needs of the people” in rural areas. Achieve "small illness does not leave the village."
Third, the management model
The community health service center implements the standardized management of “two systems”, “four hass”, “five unified” and “two independents” for the village health clinics.
1. Two systems: personnel appointment system, floating salary system.
Personnel appointment system: According to the established quota, combined with the population status of the village, the size of the health center, and the operation situation, determine the number of recruiters. Based on the registered village doctors, all rural doctors will be re-evaluated and hired, competitively recruited, merit-based admissions, and optimized rural doctors. The rural doctors to be appointed must obtain the "Village Doctor" to allow the transition to the assessment of the existing rural doctors' qualifications for those who have not obtained the "Village Physician Certificate". Village health centers are not allowed to recruit people without authorization. The employed rural doctors shall practise in the practice of the village health clinics and shall not engage in individual practice activities. Once the village doctors are found to be treating patients outside the prescribed practice sites, they will be treated illegally according to the provisions of the Regulations on the Practice of Rural Doctors. And logged out of their qualifications. Those who disobey the management, or have major medical and preventive liability accidents, and voluntarily withdraw, shall be dismissed and reported to the Health Bureau for qualification.
Floating wage system: The rural doctors implement the target management responsibility system of fixed positions, fixed duties, fixed tasks, and rewards and punishments. According to the assessment of the tasks and tasks for completing the work, unified accounting and distribution, equal pay for equal work, more work and more work, less work and less work. Yes, no effort, personal income and task assessment, unit performance linked to the performance of the wage system. The village health center should follow the following principles when formulating the salary distribution plan: 1 according to the distribution of labor according to the distribution of production factors; 2 according to the number of days of rural doctors' attendance, the average distribution of 50% of the income can be distributed as the bottom salary; 3 according to the village doctor The prescription quantity, medical quality, service attitude, quality of the completion of the work of prevention and protection determine the performance salary of the rural doctor, and redistribute 50% of the distributable income as performance salary; 4 village health directors enjoy the post subsidy, the amount is 50-100 Yuan, in the performance of wages. The village health center salary distribution plan must be discussed by all rural doctors and reported to the community health service center for review and approval. After a period of operation, the allocation plan can be adjusted according to the situation.
2, five have
The village health center is the first clinic for peasant people to seek medical treatment and provide public health services. Establishing a sound management system and standardizing service behaviors is the key to strengthening the management of village health centers. Community health service centers should guide village health to register for medical treatment. There are prescriptions for medication, records for referrals, accounts for public health services, and bills for fees. Its outpatient journals, prescriptions and notebooks and bills are printed by the Unified Community Health Service.
---- There are registrations for medical treatment: Rural doctors should carefully fill in the disease situation for medical treatment. The blood pressure system for the first diagnosis of 35 years old or above, especially to fill in the infectious disease situation, and timely grasp the epidemic dynamics.
----Prescription with medication: Village doctors must prescribe a prescription for medical treatment for the public, in order to prepare for superior diagnosis and treatment, whether the medication is reasonable and reasonable, and provide medical treatment for medical disputes. For patients who are difficult to handle, promptly refer to the patient and fill in a detailed referral record.
---- There are bills for charging: Rural doctors must collect receipts for collecting medical expenses from the public, so that the public can understand consumption. This is also the basis for implementing unified financial management.
---- Public health services have a ledger: Providing public health services is an important duty of rural doctors. It establishes public health service management accounts such as disease prevention, public emergency handling, maternal and child health care, health education, etc. And the basis for financial assistance for public services.
3. Five unification
Unified machine build system:
The standardized village health clinic implements the “five unified, two independent” rural health service integrated management model. The establishment of the village health clinic follows the principle of “optimized structure and reasonable layout”. Each village committee only sets up one health center in principle. The name of the health center shall be uniformly formulated by the community health service center and shall not be changed at will. The treatment room, observation room, diagnosis room, data room, duty room and pharmacy are separated.
Unified business management:
Implement a comprehensive target management responsibility system. The community health service center is responsible for the unified management of people, finances and materials in standardized village health centers; it provides unified guidance for medical and health services, and urges standardized village health clinics to actively undertake disease prevention and control, women and children in the jurisdictions. Health care, health education and diagnosis and treatment of common diseases and frequently-occurring diseases. Do a good job in the new rural cooperative medical care. Complete other tasks arranged by the health administrative department to provide residents with high-quality, inexpensive, convenient and safe integrated health services. Regularly conduct business training and reserve power reserve for rural doctors.
Unified financial management:
Before being hired, the employed rural doctors paid a risk of 10,000-20,000 yuan for the fundraising of the village health center. The village health office shall implement self-employment, independent accounting, distribution according to work, and self-financing, and any unit or individual may not adjust the balance of income and expenditure. The financial revenue and expenditure is separately established by the community health service center and the village health center, and the fixed assets account, income and expenditure, and drug transfer detailed accounts are established. The community health service center establishes a general ledger, sets up a special account, special funds, sound accounts, account money, and unified supervision and management. The village clinic establishes a sub-account. The village health office has a part-time accountant and a cashier. The village health office will intercept the account on the 25th of each month. Before 30 days, the income statement of the current month must be reported to the community health service center for review. After the money account matches, the community health The service center approves the payment of the rural doctor's salary.
Unified medical device management:
The standardized village health clinic implements the basic drug system, and the required drugs and equipment are uniformly purchased online by the community health service center, unified distribution, and zero-rate sales. The Community Health Service Center has established a “central drug storehouse” and adheres to the principle of “good quality, reasonable price, close purchase of drugs, accelerated turnover, and guaranteed supply”, unified procurement of drugs, equipment and sanitary materials, unified distribution, and unified implementation. Management, allocated at the wholesale price, does not allow rural doctors to privately sell and buy drugs. The “central drug storehouse” of the community health service center must set up an auxiliary account to strengthen management, conduct regular inventory, and identify the reasons for the surplus and loss of drugs, and handle the accounts in accordance with the regulations. Drugs within the scope of compensation for new rural cooperative medical care shall be organized by the Health Bureau to conduct centralized bidding and unified distribution according to the Catalogue of Basic Medicines. The winning bidder shall directly distribute the medicines to the hospitals. The community health service centers shall be reasonable according to the actual medications. Drugs, regular checkout. According to the actual drug use situation in the village, the village health clinic reports the drug use plan to the community health service center on a monthly basis, and maintains a certain amount of drugs, but it cannot cause backlog waste. Due to the irresponsible work, the drug expired enzyme is bad, according to the principle of who is responsible for the drug, the relevant personnel are treated.
Unified staff access:
According to the Regulations on the Administration of Rural Doctors, the staff of the village health clinics are employed from those who have the qualifications of rural doctors or practicing assistants and above. The practitioners of standardized and standardized village clinics can coordinate with each other.
4. Two independent
Responsibility
According to the relevant policies and regulations, the standardized and standardized village clinics, as independent legal entities, independently assume the civil and related responsibilities for conducting business.
The financial independent accounting standardization and standardization village clinics operate independently, in accordance with the policies and regulations and the regulations of the health administrative department, independently accounting, and are responsible for their own profits and losses. The creditor's rights and debts formed by conducting business activities shall be borne by the operating personnel.
Fourth, work steps
The first stage: the main task of the publicity and mobilization stage is to do a good job in organizing the organization, strengthen publicity, and create a good atmosphere. We convened a mobilization meeting for the “Integrated Management of Rural Health Services” to do a good job in mobilizing and mobilizing. Formulate the “Implementation Plan for Integrated Management of Rural Health Services” and establish a Leading Group for “Integrated Management of Rural Health Services”.
The second stage: the main task of clearing the capital and standard management stage is to complete the production and verification of the village health center. The community health service center will take the lead, and the reserve and property protection personnel will form a task force to assist the village health center in the existing houses, equipment and medicines. The funds will be fully enumerated and registered separately. At the same time, the unqualified personnel will be retired, the leave procedures for doctors who have reached the age of the village will be handled, the newly added personnel will be examined and approved, the address of the health center will be selected, the director of the health center will be appointed, the medical clinics for disguised individuals will be banned, and the management system of the village health center will be improved and improved. For rural doctors who refuse to obey the integrated management, the health center will report it to the district health bureau in time for verification, and the district health bureau will seriously deal with it according to relevant regulations.
The third stage: the inspection and acceptance stage is organized by the “Village Health Service Integrated Management” leading group to conduct self-inspection and self-examination and acceptance of the village health center and “integrated management of rural health services”, and write self-inspection self-inspection report and acceptance. Apply for the “Regional Health Service Integrated Management” Leading Group in the reporting area.
Part 2: Implementation plan for integrated management of rural health services
In order to speed up the development of rural health in our town, strengthen the functions of township hospitals, give full play to the role of village-level health organizations in preventive health care at the primary level, standardize the medical market order, and better provide medical care, prevention and health care for the majority of farmers. And the multi-faceted services such as health education, to effectively protect the health of the people of the town and the safety of medical treatment, and promote the development of rural economy, the implementation of these Regulations:
First, the basic principles
The implementation of integrated rural health management is mainly to rationally plan and allocate the human, financial and material health resources of rural health institutions in accordance with the actual needs of rural health services in the new era. Reform the management system of the village clinic, implement the “institutional management of the hospital” in the village clinic, and promote the coordinated development of the two levels of health organizations in the village, and gradually form a “reasonable structure, optimized team, standardized work, complete functions, convenient people, service The economics of rural health care.
Second, institutional setting and construction
Institutional setting
The organization is uniformly set. According to the existing number of administrative villages, according to the principle of “one village, one room”, on the existing basis, the method of withdrawal is adopted. Each village only has one health room. The administrative village where the health center is located does not have a health room. The administrative village of the room, whose basic medical, preventive, and health services are provided by the health center or adjacent health room.
Institutional building
1. Housing: The sanitary room covers an area of not less than 150m2, and the business room area of the health room is not less than 80 square meters. The new construction must be constructed in strict accordance with the unified design drawings of the city. At least a diagnosis room, a treatment room, an observation room, and a pharmacy are provided, and each room must be separated, and a preventive health room and a Chinese medicine room can be separately established under conditions.
Cylinder, covered square plate, dirt bucket, UV disinfection lamp, autoclave, inoculation bag, outpatient box, refrigerated bag, disposable syringes of various specifications, debridement and suturing instruments, medicine cabinets, data cabinets, health bulletin boards Basic equipment such as the public display column, the observation bed is not less than two. have to
It is equipped with the current “Injection Drug Compatibility Taboo” and is hung on the wall.
3. Drugs: Drugs prescribed by the pharmaceutical factory designated by the Qijian Health Bureau, medicines from the town hospitals, and Chinese herbal medicines suitable for conducting business.
Third, staffing
The practitioners of the integrated health room must have the qualifications of a rural doctor or a practicing assistant doctor. It is strictly forbidden to use non-health technicians to engage in medical activities.
Uniform selection of personnel. In accordance with the principle of streamlining and high efficiency, the health room will be fixed and fixed.
When township hospitals are equipped with health room practitioners, they should fully consider the proportion of women's village doctors and those who are good at traditional Chinese medicine.
Fourth, management methods
The main content of the integration of rural health service management is "three systems, four and five uniforms"
Full implementation of the staff recruitment system, pay-for-work and pension insurance
Standardize the service behavior of village clinics and achieve "four haves"
1. There is registration for medical treatment.
2, medication has a prescription.
3. The fee has a basis.
4. Public health services have a ledger.
Management of the village clinic, to achieve "five unification"
1. Unified administrative management.
2. Unified business management.
3. Unified financial management.
4. Unified drug and device management.
5. Personnel are hired in a unified manner.
V. Strengthen the integrated management of rural health services and strive to achieve six goals
The allocation of rural health resources is more reasonable, and rural health resources are effectively utilized;
The infrastructure and service conditions of the village clinics have gradually improved;
The quality of rural doctors’ business has been continuously improved, and basic medical and health services have been further regulated;
The skills of rural doctors in carrying out public health services such as basic medical care, disease prevention, and maternal and child health care are further improved;
The level of subsidies for rural doctors to carry out public health services has gradually increased and the team has become more stable;
The basic health needs of farmers have been further protected, serving the sustainable economic and social development of the town and the construction of a new socialist countryside.
Six, organizational leadership
In order to ensure the implementation of the integration of rural health service management, strengthen the organization and leadership of the implementation of this work, and establish a six-child town rural health service management integration leading group.
Team leader: Dean of Guo Zhisheng Health Center
Deputy leader: Lin Shouyi, team leader
Member: Tang Jun, Vice President of the Hospital
Liu Mingguo Member of the defense team.
Leading group work responsibilities: leadership, coordination, and supervision of the implementation of the work.
The leading group has an office, and the director of the office is concurrently appointed by Lin Shouyi, the leader of the township health protection team, and is responsible for the daily work of this work.
Part 3: Implementation plan for integrated management of rural health services
According to the "Guiding Opinions on the Implementation of Integrated Management of Rural Health Services" of the Shaanxi Provincial Health Department, in order to rationally allocate and utilize health resources, effectively carry out the reform of the medical and health system, effectively strengthen the supervision and management of the village clinics, and stabilize the rural doctors. Teams, improve business ethics, standardize medical and health service behaviors, establish and improve the integrated management system of rural health services in our county, and formulate this implementation plan based on the actual conditions of our county.
First, the meaning of purpose
purpose
In order to better meet the growing health service needs of the people, rationalize the relationship between township hospitals and village clinics, clarify their responsibilities, rights and interests in rural health services, and maximize the services of rural health organizations. Function, improve the utilization rate of health resources, and gradually establish a new mechanism of powerful macro-control and orderly operation.
significance
Implementing rural integrated management is the need of rural health reform and development. It is conducive to consolidating the rural tertiary health care prevention and care network; it is conducive to the rational allocation and effective use of rural health resources; it is conducive to the improvement of rural doctors' business. It is conducive to promoting the consolidation and development of new rural cooperative medical care; it is conducive to regulating rural medical and health service behaviors, maintaining the order of rural medicine market, and ensuring farmers' medical and drug safety.
Second, organizational leadership
The county people's government was established to take charge of the deputy head of the county as the leader of the county, and the head of the relevant department of the county is the member of the rural integration work leading group. The leading group has an office under the county health bureau, which is responsible for the organization and coordination of the county's rural integration work. Guidance, supervision and inspection, assessment and acceptance work. All townships and towns set up corresponding organizations to implement work related to rural integration.
Third, work steps and goals
The first stage
1. All towns and villages should attach great importance to rural integration work, earnestly strengthen leadership, establish a rural integration leading group and its office, and the president of the health center as the director, clarifying that more than two full-time and part-time personnel are responsible for the daily work management within their respective jurisdictions.
2. The township health centers that implemented the first batch of rural integration pilot projects in 20XX were 7 towns and towns including Gaotang Town, Daming Town, Chishui Town, Lianhuasi Town, Xiamiao Town, Xinzhuang Township and Liuzhi Town. On the basis of this, we will strive to fully implement it by June 20XX.
3. In accordance with the requirements of “five unifications and two independences”, complete the rural integration work within the jurisdiction and organize and implement them. In the process of implementation and difficulties encountered in the implementation of the organization, it is necessary to promptly report back to the county and village integration office.
4. The uniform layout of the village clinics ensures that the indoor and outdoor sanitation of the village is clean, the indoor office equipment, medicines and medical equipment are placed in a unified manner. The village doctors dress neatly, wear the employment certificate, and complete the medical equipment configuration according to the standard set by the Grade A village clinic. .
5. Establish and improve the assessment and reward and punishment system for rural integration work by township hospitals and rural doctors, and sign responsibility books at all levels to ensure the smooth implementation of rural integration work.
second stage
1. Pilot townships and towns organize the implementation of the “five unification” and “two independent” management of rural integration, and organize and archive all kinds of materials, and the information is neat, unified and orderly.
2. The pilot township hospitals will check and fill the gaps according to the work situation, analyze and report various reports, and further improve the work of rural integration.
The third phase
The county and village integration office organizes relevant personnel to evaluate and accept this work, and investigates the responsibility of the responsible person in accordance with the signing of the responsibility letter for the units and individuals who have not completed the work.
Fourth, the establishment and construction of the village clinic
In strict accordance with the planning of the county clinics in our county, the village clinics should be set up on the principle of facilitating the public and rational allocation of health resources. In principle, an administrative village has a village clinic; a neighboring administrative village with a small population can also jointly set up a health room; an administrative village with a large population can set up a health room in a large remote natural village as appropriate. The County Health Bureau re-issued the "Certificate of Practice for Medical Institutions" for the village clinics that implement rural integration, unified the name of the organization, and unified the identification plates and seals of the production organizations. The village clinic requires a “three rooms and one room” with a use area of not less than 60 square meters.
V. Strengthen supervision of the rural medical market and ban illegal medical practice
In accordance with the requirements of the socialist market economy and the state's policy of encouraging multiple forms of medical treatment, those who meet the conditions for entry and exit in accordance with the regulations should support and encourage them to guide them to the rural grassroots to carry out medical and health services. The illegal conduct of medical treatment activities must be resolutely cracked down and banned in order to purify the rural medical service market.
Sixth, improve and improve various rules and regulations, and implement work target management
Township hospitals should strengthen the management of the clinics under their jurisdiction according to the requirements of medical and health work, establish and improve various rules and regulations, implement work target management, and grasp the unified management of finance, medicine and wages in rural integration. The core and key content makes the rural integration work practical.
Administrative unified management
The county and village integration work leading group and its office are responsible for the county's rural integration work. The main duties of the township and village integration office are: responsible for the organization and implementation of the rural integration plan in the area under its jurisdiction, signing the target management responsibility book with the village clinic; implementing unified planning and layout, unified standard construction, unified management and unification for the village clinic Centralized procurement and supply of drugs and materials, unified assessment; assist county health bureaus in supervision and management, stop and ban illegal medical practices, and crack down on illegal medical institutions.
Unified business management
The tasks and tasks of the village clinics shall be uniformly arranged by the township hospitals, and the target management shall be implemented to unify the technical procedures for public health services and medical services. The rules and regulations shall be uniformly formulated by the township hospitals, and unified supervision and management shall be implemented, and the outpatient registration and medical documents shall be unified, so that “eight has a wall”: 1 registration for medical treatment; 2 prescription for medication; 3 for evidence; 4 There are account certificates; 5 work has a system; 6 posts have responsibilities; 7 reports of epidemic situation; 8 business has assessment; 9 main work system, job responsibilities, defense data, charts, service price announcements, etc.
Unified financial management
The township hospitals have unified accounting subjects and unified accounts for the village clinics, set up general ledgers and sub-accounts, and the village clinics also set up account books. Village clinics must strictly implement the national price policy, implement relatively uniform charging items and standards, and must use the special bills for non-profit medical institutions in Guizhou Province. Township hospitals shall register and build the property and materials of each village clinic, and establish and improve fixed assets, drug allocation, and business receipts and accounts. Each village clinic carries out independent accounting, and all financial revenues and expenditures must be included in the unified management of township hospitals. The village clinics uniformly extracted the health care development and overall management fund from the business income for the development of rural health undertakings, and the county health bureau set up a special account for special account management.
Unified drug management
The medicines of township hospitals and village clinics use the national essential medicines catalogue, and implement the province's unified online bidding procurement. The medicines are distributed from the distribution center to the township health centers, the village clinics to the health centers, and the township and village level medical treatments are implemented. Institutional medicines are sold at a uniform price. The township hospitals are responsible for the allocation of medicines according to the drug use plans of the village clinics, and do a good job in the management of medicines in and out of the warehouse to ensure the needs of medical drugs. For those who do not seriously implement the private price increase of prescribed drug sales, once found, the county health bureau reported that the price management department will impose penalties according to relevant regulations; rural doctors may not purchase drugs privately. Once discovered, the county health bureau shall report to the drug supervision, industry and commerce departments. Seriously investigate and deal with the relevant laws and regulations, and at the same time cancel the qualification of rural doctors.
Unified payroll
The income of rural doctors consists of two parts: the income of public health services and the profit of medical treatment activities. The compensation part of the new rural cooperative medical care is approved by the county medical office and then transferred to the township hospitals. The income of the new rural cooperative medical compensation is not included. Jiaoxiang Township Health Center unified accounting.
The public health service income, according to the content and completion of the arranged public health service, the individual's work ability, business technology level, and performance appraisal, shall be calculated and distributed by the county health bureau according to regulations.
The profit of the medical treatment activities is extracted proportionally as the salary of the rural doctors, and the rest is used as the accumulation of the village clinics for the development of the village clinics. The monthly profit of the village clinic is less than 300 yuan and does not participate in the overall planning.
Part 4: Implementation plan for integrated management of rural health services
To further deepen the reform of rural health work, rationally allocate and effectively use rural health resources, strengthen the construction of rural health service system and talent team, establish a lean and efficient rural health management system, comprehensively implement the integrated management of rural health services, and implement new rural cooperative medical care. Outpatient consultation, according to the Ministry of Health's "Opinions on Promoting Integrated Management of Rural Health Services" and the spirit of the Autonomous Region People's Government's "Implementation Opinions on the Comprehensive Reform of Grassroots Medical and Health Systems", combined with the actual situation of our flag, this implementation plan is specially formulated.
First, the guiding ideology is guided by the important thinking of the "Three Represents" and the scientific development concept, with the goal of standardizing village-level medical and health services, rational allocation and integration of medical and health resources, and ensuring that farmers are safe, effective, convenient and inexpensive. Public health and basic medical services.
II. Work Objectives According to the planning plan of the flag medical institution, the establishment of the standardization inspection village clinic and the standardization inspection village clinic, the establishment of the Sumu Town Health Center “Hospital Construction Hospital Management” as the main organization form "Eight unification, two independence" is the basic content. It combines basic medical care, prevention and health care, unified responsibility, rights and interests, standardization of hardware facilities, standardization of operation and management, systemization of guidance and supervision, and quality of service. The target is the integrated management model of health services in the village. Further improve the health service network of the village, improve the health service function of the village, regulate the behavior of the village health service, improve the quality of health services and service standards of the village, ensure the health of farmers and herdsmen, and promote the economic sustainability of the village. Stable and healthy development.
Third, the operation mode Organization form The inspection organization of the village health service integration management is based on the Sumu Town Health Center “Hospital Construction Hospital Management”, that is, all the standardization inspection village clinics and the standardization inspection village clinics are The construction of the Sumu Town Health Center is carried out. The property rights of the village clinics are standardized and the property of the village clinic is owned by the Sumu Town Health Center. The standardization of the village clinic is carried out by the local Sumu Town Health Center. The standardization inspection village clinic and the standardization inspection village clinic are under the unified management of the Sumu Town Health Center, and the doctors of the village are responsible for the operation and assume corresponding duties. After passing the assessment, the standardized village inspection clinic and the standardization inspection village clinic will be identified as the designated agencies for the new rural cooperative medical clinic.
The management model standardization inspection village clinic and the standardization inspection village clinic have implemented the “eight unified, two independent” rural health service integrated management model.
1. Establishment of a unified organization: Strictly follow the archives of the “Setting Construction Plan for the Public Health Village of the Public Welfare Village of Yuexi County”, and set up a standardized village clinic or a standardized village clinic.
2. Unified housing construction: The county standardized village clinic will be constructed by the local township health center according to the “Anhui Provincial Village Health Center Construction Standard”. The construction area is not less than 80 square meters or 100 square meters, which is divided into 6 rooms; standardized village The health room is organized and organized by the local township health center. The building area is not less than 60 square meters, and the four rooms are separated.
3. Uniform personnel access: According to the Regulations on the Administration of Rural Doctors, the standardization and standardization of village clinic staff shall be employed by township health centers from those who have the qualifications of rural doctors or practicing assistants and above. In a township, practitioners of standardized and standardized village clinics can be deployed to each other.
4, unified drug purchases and sales: standardized and standardized village clinics of drugs, equipment by the township hospitals under the "quality and cheap" principle, open procurement from the legal supply channels, unified deployment, unified prices.
5. Unified financial management: Standardized and standardized village clinics must strictly implement the national price policy, publicize regular fee items, establish a sound financial system, regularly report to the township health centers, and accept the financial management of township health centers.
6. Unified business management: Township hospitals are responsible for the unified management of people, finances and materials in standardized and standardized village clinics; unified guidance on medical and health services, and urges village clinics to seriously perform basic medical care, prevention, health care, and health education. Responsibilities such as planning for childbirth propaganda, and regular business training for rural doctors. 7. Unified system construction: The county health bureau shall uniformly formulate the administrative, business, pharmaceutical, and financial management systems for the standardized and standardized village clinics in the county. The township health centers shall formulate specific management measures and be responsible for the implementation of various systems.
8. Unified file specification. Standardized and standardized village clinics should establish and improve various accounts, books, certificates, cards, books, etc., use all kinds of uniformed printed bills and medical documents, and use uniform seals.
9. Financial independent accounting. The standardized and standardized village clinics shall operate independently, in accordance with the policies and regulations and the regulations of the competent administrative department of health, independently account, and be responsible for their own profits and losses. The creditor's rights and debts formed by conducting business activities shall be borne by the operating personnel.
10. Responsibility and independent commitment: According to the relevant policies and regulations, the standardized and standardized village clinics as independent legal entities shall independently undertake the civil and related responsibilities for conducting business.
Fourth, work requirements to strengthen organizational leadership. The integrated management of rural health services is an important part of the reform of rural health management system. It is an effective form of rural health management under the new situation, which is conducive to the optimal allocation of rural health resources and is conducive to the improvement of rural health service quality. It is conducive to ensuring the sustainable development of rural economy and society and the realization of the goal of building a new socialist countryside. The county government set up the Yuexi County Rural Health Service Integration Management Leading Group, which is responsible for the organization, coordination, supervision and guidance of this work. All localities and relevant departments should also set up corresponding organizations to effectively strengthen leadership and speed up organization and implementation.
Clear division of responsibilities. The county health bureau is responsible for guiding the county's rural health service integration management, and regularly organizes personnel to conduct inspection and guidance. The township government is responsible for the organization, leadership and work coordination of the integrated management of rural health services within its jurisdiction, providing land for the construction of village clinics free of charge, and assisting in the construction and management of village clinics. The county health, industry and commerce, drug supervision, public security and other departments have stepped up efforts to crack down on non-medical and illegal drug business practices and purify the market order of rural medical and health services. The county's development and reform, price, civil affairs, finance, construction, land, real estate, planning and other departments fully play their functional roles and actively assist in doing relevant work. Township hospitals strengthen the standardization construction and daily supervision of the village clinics in their respective jurisdictions, so that the "eight unified, two independent" integrated management mode can be effectively operated. If the village clinics are found to have irregularities, they will be dealt with in a timely manner; In time, report to the county health bureau and other law enforcement agencies for punishment.
Widely publicized and launched. All localities and relevant departments should adopt various forms to widely publicize the significance of implementing integrated management of rural health services, eliminate fears and misunderstandings, guide the active participation of cadres and rural doctors, and implement new types of integrated management of rural health services. Rural cooperative medical clinics co-ordinate to create a good environment.
Part V: Implementation Plan for Integrated Management of Rural Health Services
According to the “Notice on the Comprehensive Implementation of the Integrated Management of Rural Health Services” of the Shaanxi Provincial Health Department, in order to rationally allocate and utilize health resources, strengthen the supervision and management of the village clinics, stabilize the rural doctors, improve the business, and standardize medical and health care. Service behavior, establish and improve the integrated management system of rural health services in our county, and formulate this implementation plan based on the actual conditions of our county.
First, the meaning of purpose
In accordance with the overall deployment of deepening the reform of the medical and health system, we will actively promote the management of rural integration. Through the implementation of rural integrated management, rational planning and allocation of rural health resources, standardizing service behaviors, improving service capabilities, promoting the consolidation and improvement of the new rural cooperative medical system, promoting the healthy and sustainable development of rural medical and health services, and meeting the health needs of rural residents. . Rationalize the relationship between township hospitals and village clinics, clarify their responsibilities, rights and interests in rural health services, maximize the service functions of rural health organizations, improve the utilization of health resources, and gradually establish a giant view A new mechanism for regulating powerful and microscopic operations.
Second, organizational leadership
In order to strengthen the organization and leadership of rural integration work, the Fengxian County Rural Health Service Integrated Management Leading Group was established.
Team leader: Zhang Jiwen County Health Bureau Director
Deputy Team Leader: Deputy Director of Li Huaicheng County Health Bureau
Secretary of the Disciplinary Committee of Luochao County Health Bureau
Member: Director of Liu Huijun County Health Bureau Office
Ma Jinhai County Health Bureau
Zhu Shuangqiang County Health Bureau Business Unit Chief
Dean of each town health center
The office of the leading group is located in the county health bureau, and is responsible for the organization and coordination, technical guidance, supervision and inspection, and inspection and acceptance of the county's rural integration work. All townships and towns set up corresponding organizations to implement work related to rural integration. Comrade Li Huaicheng is also the director of the office.
Third, the work content
Rural integration management Under the unified planning and organization of the county health bureau, the town health center is entrusted by the county health bureau to undertake the management and guidance functions of the village clinic. The village clinic bears the public health services and general diseases of the administrative village. Primary care work.衛生院要根據實施鄉村“十統一”和“兩獨立”的管理要求，使鄉村一體化工作落到實處。
“十統一”即：
行政統一管理縣鎮村一體化工作領導小組及其辦公室負責全縣鄉村一體化工作。鎮村一體化辦公室的主要職責是：負責本轄區鄉村一體化方案的組織實施和管理，與村衛生室簽訂目標管理責任書；對村衛生室實行統一規劃布局、統一標準建設、統一操作規範、統一製度管理、統一葯品及材料集中採購供應、統一考核；協助縣衛生局進行監督管理，製止和取締非法行醫行為，嚴厲打擊非法醫療機構。
機構統一管理。嚴格按照全縣區域衛生規劃，以方便民眾、合理配置衛生資源為原則，一個行政村設立一所村衛生室。人口少的鄰近行政村也可以聯合設定衛生室；人口較多的行政村可酌情在較大的偏遠自然村設定衛生室。衛生院所在地的行政村原則上不設立村衛生室。縣衛生局對實行鄉村一體化的村衛生室重新核發《醫療機構執業許可證》，統一機構名稱，統一製作機構標識牌、印章。村衛生室要求做到“三室一房”，使用面積不得少於60平方米。
人員統一管理。按照《鄉村醫生從業管理條列》規定，在村衛生室執業的在崗人員應取得鄉村醫生執業證書或執業助理醫師以上資格，由鄉鎮衛生院統一聘用管理。按照市場經濟要求和國家鼓勵多種形式辦醫的政策，支持和鼓勵符合法規規定準入條件的人員到農村基層開展醫療衛生服務。對非法開展診療活動的行為，要堅決打擊和取締，以凈化農村醫療服務市場。
業務統一管理。加強村衛生室業務和規範管理，建立健全基層規章製度和業務技術流程，嚴格規範診療行為，做到規範服務，記錄完整。明確鄉村兩級醫療衛生機構服務功能，逐步建立起業務統一，分級服務，相互協作及鄉村兩級合理轉診的工作機製。鄉鎮衛生院採取工作例會、病例討論、業務培訓等多種方式，加強對村衛生室的業務指導和管理。村衛生室的靜脈輸液、外傷處理等重大業務活動接受鄉鎮衛生院監管；各項預防保健、醫療、康復、健康教育、人員培訓、醫德醫風等業務活動，由鄉鎮衛生院按照縣衛生局要求統一管理，並負責檢查指導、考核評價。建立健全鄉鎮衛生院和村衛生室衛生技術人員繼續教育和培訓製度。支持鄉村醫生參加醫學學歷教育，鼓勵符合條件的鄉村醫生參加執業醫師資格考試。鄉鎮衛生院和村衛生室衛生技術人員應當定期到上級醫療衛生機構進修學習，積極參加崗位培訓，不斷更新知識，提高專業技術水準。鄉鎮衛生院要製定村衛生室從業人員培訓計畫，通過業務講座、臨床帶教和例會等多種方式加強對村衛生室的業務指導，切實提高村衛生室從業人員的業務技術水準。
規範統一管理。村衛生室的各項工作目標任務，由鎮衛生院統一安排，實行目標管理，統一公共衛生服務、醫療業務技術操作規程。規章製度由縣衛生局統一製定，鎮衛生院實行統一的監督管理，統一門診登記、醫療文書，做到“十有一上牆”，即“十有”：①看病有登記；②用葯有處方；③收費有憑據；④收支有賬證；⑤工作有製度；⑥崗位有職責；⑦疫情有報告；⑧業務有考核；⑨合療有台賬⑩轉診有記錄；“一上牆”即：主要工作製度、崗位職責、防保資料、圖表、服務價格公示等上牆。
葯械統一管理。鎮衛生院、村衛生室的葯品，使用國家基本葯物目錄，實行全省統一網上招標採購，葯品由配送中心配送到鄉鎮衛生院，各村衛生室到衛生院領取，實行鄉鎮、村級醫療機構葯品按統一價格銷售。鄉鎮衛生院根據各村衛生室用葯計畫負責葯品的調撥，做好葯品的進出庫管理，保證醫療用葯需要。對於不認真執行規定葯品銷售私自加價的，一經發現，由縣衛生局報物價管理部門按相關法規進行處罰；鄉村醫生不得私自進購葯品，一經發現，由縣衛生局報葯監部門按相關法規嚴肅查處外，同時取消其鄉村醫生聘用資格。
合療統一政策。新農合政策向達到規範化標準的村衛生室延伸。在達到規範化建設標準，執行國家基本葯物製度，有服務條件的衛生室，開展新農合門診統籌直通車報銷定點，為民眾就近服務，實現小病不出村。
統一財務管理。村衛生室的財務工作實行獨立核算，由鄉鎮衛生院參照國家製定的財務會計製度統一管理。鄉鎮衛生院對村衛生室統一會計科目、統一賬號，設立總賬與分賬，村衛生室同時設立賬簿。收費要嚴格執行國家物價政策，實行相對統一的收費項目和標準，診療收入必須統一使用醫療機構收費專用票據。鄉鎮衛生院對各個村衛生室的財產、物資要進行登記造冊，建立健全固定資產、葯品調撥、業務收支賬冊。所有財務工作必須納入鄉鎮衛生院統一管理。縣衛生局負責對村衛生室財務統一管理情況進行監督檢查，同時定期開展對鄉、村衛生人員財務管理有關規定的教育和培訓，提高財務管理水準。
績效統一考核。建立以公共衛生服務和基本醫療服務為核心的鄉、村衛生機構績效考核機製，製定具體考核辦法。由縣衛生局統一組織定期對鄉鎮衛生院的業務技術和醫德醫風等進行考核，主要考核公共衛生服務、基本醫療服務、崗位職責、民眾滿意度等內容，每半年考核一次，考核結果記入個人業務檔案。鄉鎮衛生院具體組織實施對所在轄區村衛生室的考核工作，考核結果作為鄉村醫生勞務補助經費的發放依據。
工資統一核算。鄉村醫生收入由公共衛生服務收入、葯品零差率補助和診療活動的利潤三部分組成，其中屬新型農村合作醫療補償部分的村衛生室由縣合療辦審核後逐級撥付到鄉鎮衛生院，由鄉鎮衛生院再撥付給村衛生室。公共衛生服務性收入，根據安排的公共衛生服務內容及完成情況，個人的工作能力、業務技術水準、兼顧績效考核，由縣衛生局委託鎮衛生院按規定進行核算發放。對於當月未完成公共衛生任務的，當月的村醫補助一律按50%懲扣，當年未完成公共衛生任務的，下年度不再聘用。葯品零差率補助按照葯品銷售額的15%給予補償，半年考核結算一次。診療收入原則歸個人工資所得。
“兩獨立”即：
1、法律責任獨立：村衛生室的人員在開展診療及其他活動時，產生的風險和責任由村衛生室及相關人員承擔。
2、財務核算獨立：村衛生室的業務開展實行財務獨立核實，自負盈虧的經營管理。
四、工作機製
1、實行競爭上崗、擇優選聘鄉村醫生。鄉村醫生的選聘由鄉鎮衛生院從轄區範圍內取得執業助理醫師及以上資格或《鄉村醫生執業證書》的人員中，按照公平、公正、公開的原則，通過考試考核等方式擇優聘用，並簽訂聘用契約，聘用期限為一年。鄉鎮衛生院建立鄉村醫生人事檔案，對其聘用、考核、獎懲等情況建檔管理。聘用人員報縣衛生局審核備案後，統一辦理註冊或變更註冊手續。聘期屆滿經考核合格者可繼續聘任，不合格者予以解聘。村衛生室新進從業人員必須經崗前培訓後，方可上崗。在崗村衛生室從業人員每兩年培訓一次，由縣衛生局負責組織。
2、建立目標管理工作考核製度。縣衛生局與衛生院院長按鄉村一體化工作職責簽訂責任書，年底對衛生院院長進行考核，按合格、基本合格、不合格進行獎懲；鄉鎮衛生院對村衛生室實行年度目標責任考核。考核的主要內容包括：①公共衛生服務指標的完成情況；②村衛生室的醫療服務質量；③村衛生室的內部管理；④執行新型農村合作醫療管理規定的情況；⑤葯品零差率銷售情況；⑥民眾的滿意度。考核評分辦法按縣衛生局製定的《鄉村醫生目標管理考核辦法》執行；年度考核分值達90分以上者，兌現全額的公共衛生服務費。年度考核分值80分以上90分以下者按分值比例兌現公共衛生服務費。年終考核分值80分以下者，兌現80%的公共衛生服務費等。
To further deepen the reform of rural health work, rationally allocate and effectively use rural health resources, strengthen the construction of rural health service system and talent team, establish a lean and efficient rural health management system, comprehensively implement the integrated management of rural health services, and implement the basic drug system. Spread sales, implementation of the new rural cooperative medical outpatient co-ordination, according to the spirit of the Henan Provincial Government's "Implementation Opinions on Further Strengthening the Construction of Rural Doctors", combined with the actual situation of our district, specially formulated this program.
First, the guiding ideology
Guided by the scientific concept of development, the company aims to standardize village-level medical and health services, rationally allocate and integrate medical and health resources, and ensure that farmers enjoy safe, effective, convenient and inexpensive public health and basic medical services.
Second, the work objectives
Standardize the village clinics, establish a community service center as the main organization form in the whole district, take the "five unified, two independent" as the basic content, combine basic medical care, prevention and health care, and harmonize responsibility, rights and interests. The integrated management system of rural health services with standardization of physical facilities, standardization of operation management, systemization of supervision and supervision, and quality of service as the main goal. Further improve the rural health service network, improve the function of rural health services, standardize rural health service behavior, improve the quality of rural health services and service standards, protect the health of farmers, and promote the sustainable, stable and healthy development of the rural economy. The “Integrated Management of Rural Health Services” of Zhenlin Community Health Service Center is expected to achieve five specific goals:
1. Improve the three-level defense network, promote the implementation of primary health care work planning goals, and ensure the basic health needs of farmers.
2. Rationalize the allocation of health resources, rationalize the relationship between community health service centers and village health centers, ensure the coordinated development of the two, and effectively use rural health resources.
3. The infrastructure and service conditions of the village health center have been gradually improved, and the level of subsidies for rural doctors to carry out public health services has gradually increased and the team has become more stable.
4. Standardize the behavior of basic medical services, curb the occurrence of arbitrary charges and indiscriminate use of drugs, improve the quality of services, reduce medical accidents, and make farmers safe and effective on medical drugs.
5. Improve the technical level and overall quality of rural health technicians, enhance the overall service function, and achieve the goal of “providing relatively high-quality medical services at relatively low cost and striving to meet the basic medical service needs of the people” in rural areas. Achieve "small illness does not leave the village."
Third, the management model
The community health service center implements the standardized management of “two systems”, “four hass”, “five unified” and “two independents” for the village health clinics.
1. Two systems: personnel appointment system, floating salary system.
Personnel appointment system: According to the established quota, combined with the population status of the village, the size of the health center, and the operation situation, determine the number of recruiters. Based on the registered village doctors, all rural doctors will be re-evaluated and hired, competitively recruited, merit-based admissions, and optimized rural doctors. The rural doctors to be appointed must obtain the "Village Doctor" to allow the transition to the assessment of the existing rural doctors' qualifications for those who have not obtained the "Village Physician Certificate". Village health centers are not allowed to recruit people without authorization. The employed rural doctors shall practise in the practice of the village health clinics and shall not engage in individual practice activities. Once the village doctors are found to be treating patients outside the prescribed practice sites, they will be treated illegally according to the provisions of the Regulations on the Practice of Rural Doctors. And logged out of their qualifications. Those who disobey the management, or have major medical and preventive liability accidents, and voluntarily withdraw, shall be dismissed and reported to the Health Bureau for qualification.
Floating wage system: The rural doctors implement the target management responsibility system of fixed positions, fixed duties, fixed tasks, and rewards and punishments. According to the assessment of the tasks and tasks for completing the work, unified accounting and distribution, equal pay for equal work, more work and more work, less work and less work. Yes, no effort, personal income and task assessment, unit performance linked to the performance of the wage system. The village health center should follow the following principles when formulating the salary distribution plan: 1 according to the distribution of labor according to the distribution of production factors; 2 according to the number of days of rural doctors' attendance, the average distribution of 50% of the income can be distributed as the bottom salary; 3 according to the village doctor The prescription quantity, medical quality, service attitude, quality of the completion of the work of prevention and protection determine the performance salary of the rural doctor, and redistribute 50% of the distributable income as performance salary; 4 village health directors enjoy the post subsidy, the amount is 50-100 Yuan, in the performance of wages. The village health center salary distribution plan must be discussed by all rural doctors and reported to the community health service center for review and approval. After a period of operation, the allocation plan can be adjusted according to the situation.
2, five have
The village health center is the first clinic for peasant people to seek medical treatment and provide public health services. Establishing a sound management system and standardizing service behaviors is the key to strengthening the management of village health centers. Community health service centers should guide village health to register for medical treatment. There are prescriptions for medication, records for referrals, accounts for public health services, and bills for fees. Its outpatient journals, prescriptions and notebooks and bills are printed by the Unified Community Health Service.
---- There are registrations for medical treatment: Rural doctors should carefully fill in the disease situation for medical treatment. The blood pressure system for the first diagnosis of 35 years old or above, especially to fill in the infectious disease situation, and timely grasp the epidemic dynamics.
----Prescription with medication: Village doctors must prescribe a prescription for medical treatment for the public, in order to prepare for superior diagnosis and treatment, whether the medication is reasonable and reasonable, and provide medical treatment for medical disputes. For patients who are difficult to handle, promptly refer to the patient and fill in a detailed referral record.
---- There are bills for charging: Rural doctors must collect receipts for collecting medical expenses from the public, so that the public can understand consumption. This is also the basis for implementing unified financial management.
---- Public health services have a ledger: Providing public health services is an important duty of rural doctors. It establishes public health service management accounts such as disease prevention, public emergency handling, maternal and child health care, health education, etc. And the basis for financial assistance for public services.
3. Five unification
Unified machine build system:
The standardized village health clinic implements the “five unified, two independent” rural health service integrated management model. The establishment of the village health clinic follows the principle of “optimized structure and reasonable layout”. Each village committee only sets up one health center in principle. The name of the health center shall be uniformly formulated by the community health service center and shall not be changed at will. The treatment room, observation room, diagnosis room, data room, duty room and pharmacy are separated.
Unified business management:
Implement a comprehensive target management responsibility system. The community health service center is responsible for the unified management of people, finances and materials in standardized village health centers; it provides unified guidance for medical and health services, and urges standardized village health clinics to actively undertake disease prevention and control, women and children in the jurisdictions. Health care, health education and diagnosis and treatment of common diseases and frequently-occurring diseases. Do a good job in the new rural cooperative medical care. Complete other tasks arranged by the health administrative department to provide residents with high-quality, inexpensive, convenient and safe integrated health services. Regularly conduct business training and reserve power reserve for rural doctors.
Unified financial management:
Before being hired, the employed rural doctors paid a risk of 10,000-20,000 yuan for the fundraising of the village health center. The village health office shall implement self-employment, independent accounting, distribution according to work, and self-financing, and any unit or individual may not adjust the balance of income and expenditure. The financial revenue and expenditure is separately established by the community health service center and the village health center, and the fixed assets account, income and expenditure, and drug transfer detailed accounts are established. The community health service center establishes a general ledger, sets up a special account, special funds, sound accounts, account money, and unified supervision and management. The village clinic establishes a sub-account. The village health office has a part-time accountant and a cashier. The village health office will intercept the account on the 25th of each month. Before 30 days, the income statement of the current month must be reported to the community health service center for review. After the money account matches, the community health The service center approves the payment of the rural doctor's salary.
Unified medical device management:
The standardized village health clinic implements the basic drug system, and the required drugs and equipment are uniformly purchased online by the community health service center, unified distribution, and zero-rate sales. The Community Health Service Center has established a “central drug storehouse” and adheres to the principle of “good quality, reasonable price, close purchase of drugs, accelerated turnover, and guaranteed supply”, unified procurement of drugs, equipment and sanitary materials, unified distribution, and unified implementation. Management, allocated at the wholesale price, does not allow rural doctors to privately sell and buy drugs. The “central drug storehouse” of the community health service center must set up an auxiliary account to strengthen management, conduct regular inventory, and identify the reasons for the surplus and loss of drugs, and handle the accounts in accordance with the regulations. Drugs within the scope of compensation for new rural cooperative medical care shall be organized by the Health Bureau to conduct centralized bidding and unified distribution according to the Catalogue of Basic Medicines. The winning bidder shall directly distribute the medicines to the hospitals. The community health service centers shall be reasonable according to the actual medications. Drugs, regular checkout. According to the actual drug use situation in the village, the village health clinic reports the drug use plan to the community health service center on a monthly basis, and maintains a certain amount of drugs, but it cannot cause backlog waste. Due to the irresponsible work, the drug expired enzyme is bad, according to the principle of who is responsible for the drug, the relevant personnel are treated.
Unified staff access:
According to the Regulations on the Administration of Rural Doctors, the staff of the village health clinics are employed from those who have the qualifications of rural doctors or practicing assistants and above. The practitioners of standardized and standardized village clinics can coordinate with each other.
4. Two independent
Responsibility
According to the relevant policies and regulations, the standardized and standardized village clinics, as independent legal entities, independently assume the civil and related responsibilities for conducting business.
The financial independent accounting standardization and standardization village clinics operate independently, in accordance with the policies and regulations and the regulations of the health administrative department, independently accounting, and are responsible for their own profits and losses. The creditor's rights and debts formed by conducting business activities shall be borne by the operating personnel.
Fourth, work steps
The first stage: the main task of the publicity and mobilization stage is to do a good job in organizing the organization, strengthen publicity, and create a good atmosphere. We convened a mobilization meeting for the “Integrated Management of Rural Health Services” to do a good job in mobilizing and mobilizing. Formulate the “Implementation Plan for Integrated Management of Rural Health Services” and establish a Leading Group for “Integrated Management of Rural Health Services”.
The second stage: the main task of clearing the capital and standard management stage is to complete the production and verification of the village health center. The community health service center will take the lead, and the reserve and property protection personnel will form a task force to assist the village health center in the existing houses, equipment and medicines. The funds will be fully enumerated and registered separately. At the same time, the unqualified personnel will be retired, the leave procedures for doctors who have reached the age of the village will be handled, the newly added personnel will be examined and approved, the address of the health center will be selected, the director of the health center will be appointed, the medical clinics for disguised individuals will be banned, and the management system of the village health center will be improved and improved. For rural doctors who refuse to obey the integrated management, the health center will report it to the district health bureau in time for verification, and the district health bureau will seriously deal with it according to relevant regulations.
The third stage: the inspection and acceptance stage is organized by the “Village Health Service Integrated Management” leading group to conduct self-inspection and self-examination and acceptance of the village health center and “integrated management of rural health services”, and write self-inspection self-inspection report and acceptance. Apply for the “Regional Health Service Integrated Management” Leading Group in the reporting area.
Part 2: Implementation plan for integrated management of rural health services
In order to speed up the development of rural health in our town, strengthen the functions of township hospitals, give full play to the role of village-level health organizations in preventive health care at the primary level, standardize the medical market order, and better provide medical care, prevention and health care for the majority of farmers. And the multi-faceted services such as health education, to effectively protect the health of the people of the town and the safety of medical treatment, and promote the development of rural economy, the implementation of these Regulations:
First, the basic principles
The implementation of integrated rural health management is mainly to rationally plan and allocate the human, financial and material health resources of rural health institutions in accordance with the actual needs of rural health services in the new era. Reform the management system of the village clinic, implement the “institutional management of the hospital” in the village clinic, and promote the coordinated development of the two levels of health organizations in the village, and gradually form a “reasonable structure, optimized team, standardized work, complete functions, convenient people, service The economics of rural health care.
Second, institutional setting and construction
Institutional setting
The organization is uniformly set. According to the existing number of administrative villages, according to the principle of “one village, one room”, on the existing basis, the method of withdrawal is adopted. Each village only has one health room. The administrative village where the health center is located does not have a health room. The administrative village of the room, whose basic medical, preventive, and health services are provided by the health center or adjacent health room.
Institutional building
1. Housing: The sanitary room covers an area of not less than 150m2, and the business room area of the health room is not less than 80 square meters. The new construction must be constructed in strict accordance with the unified design drawings of the city. At least a diagnosis room, a treatment room, an observation room, and a pharmacy are provided, and each room must be separated, and a preventive health room and a Chinese medicine room can be separately established under conditions.
Cylinder, covered square plate, dirt bucket, UV disinfection lamp, autoclave, inoculation bag, outpatient box, refrigerated bag, disposable syringes of various specifications, debridement and suturing instruments, medicine cabinets, data cabinets, health bulletin boards Basic equipment such as the public display column, the observation bed is not less than two. have to
It is equipped with the current “Injection Drug Compatibility Taboo” and is hung on the wall.
3. Drugs: Drugs prescribed by the pharmaceutical factory designated by the Qijian Health Bureau, medicines from the town hospitals, and Chinese herbal medicines suitable for conducting business.
Third, staffing
The practitioners of the integrated health room must have the qualifications of a rural doctor or a practicing assistant doctor. It is strictly forbidden to use non-health technicians to engage in medical activities.
Uniform selection of personnel. In accordance with the principle of streamlining and high efficiency, the health room will be fixed and fixed.
When township hospitals are equipped with health room practitioners, they should fully consider the proportion of women's village doctors and those who are good at traditional Chinese medicine.
Fourth, management methods
The main content of the integration of rural health service management is "three systems, four and five uniforms"
Full implementation of the staff recruitment system, pay-for-work and pension insurance
Standardize the service behavior of village clinics and achieve "four haves"
1. There is registration for medical treatment.
2, medication has a prescription.
3. The fee has a basis.
4. Public health services have a ledger.
Management of the village clinic, to achieve "five unification"
1. Unified administrative management.
2. Unified business management.
3. Unified financial management.
4. Unified drug and device management.
5. Personnel are hired in a unified manner.
V. Strengthen the integrated management of rural health services and strive to achieve six goals
The allocation of rural health resources is more reasonable, and rural health resources are effectively utilized;
The infrastructure and service conditions of the village clinics have gradually improved;
The quality of rural doctors’ business has been continuously improved, and basic medical and health services have been further regulated;
The skills of rural doctors in carrying out public health services such as basic medical care, disease prevention, and maternal and child health care are further improved;
The level of subsidies for rural doctors to carry out public health services has gradually increased and the team has become more stable;
The basic health needs of farmers have been further protected, serving the sustainable economic and social development of the town and the construction of a new socialist countryside.
Six, organizational leadership
In order to ensure the implementation of the integration of rural health service management, strengthen the organization and leadership of the implementation of this work, and establish a six-child town rural health service management integration leading group.
Team leader: Dean of Guo Zhisheng Health Center
Deputy leader: Lin Shouyi, team leader
Member: Tang Jun, Vice President of the Hospital
Liu Mingguo Member of the defense team.
Leading group work responsibilities: leadership, coordination, and supervision of the implementation of the work.
The leading group has an office, and the director of the office is concurrently appointed by Lin Shouyi, the leader of the township health protection team, and is responsible for the daily work of this work.
Part 3: Implementation plan for integrated management of rural health services
According to the "Guiding Opinions on the Implementation of Integrated Management of Rural Health Services" of the Shaanxi Provincial Health Department, in order to rationally allocate and utilize health resources, effectively carry out the reform of the medical and health system, effectively strengthen the supervision and management of the village clinics, and stabilize the rural doctors. Teams, improve business ethics, standardize medical and health service behaviors, establish and improve the integrated management system of rural health services in our county, and formulate this implementation plan based on the actual conditions of our county.
First, the meaning of purpose
purpose
In order to better meet the growing health service needs of the people, rationalize the relationship between township hospitals and village clinics, clarify their responsibilities, rights and interests in rural health services, and maximize the services of rural health organizations. Function, improve the utilization rate of health resources, and gradually establish a new mechanism of powerful macro-control and orderly operation.
significance
Implementing rural integrated management is the need of rural health reform and development. It is conducive to consolidating the rural tertiary health care prevention and care network; it is conducive to the rational allocation and effective use of rural health resources; it is conducive to the improvement of rural doctors' business. It is conducive to promoting the consolidation and development of new rural cooperative medical care; it is conducive to regulating rural medical and health service behaviors, maintaining the order of rural medicine market, and ensuring farmers' medical and drug safety.
Second, organizational leadership
The county people's government was established to take charge of the deputy head of the county as the leader of the county, and the head of the relevant department of the county is the member of the rural integration work leading group. The leading group has an office under the county health bureau, which is responsible for the organization and coordination of the county's rural integration work. Guidance, supervision and inspection, assessment and acceptance work. All townships and towns set up corresponding organizations to implement work related to rural integration.
Third, work steps and goals
The first stage
1. All towns and villages should attach great importance to rural integration work, earnestly strengthen leadership, establish a rural integration leading group and its office, and the president of the health center as the director, clarifying that more than two full-time and part-time personnel are responsible for the daily work management within their respective jurisdictions.
2. The township health centers that implemented the first batch of rural integration pilot projects in 20XX were 7 towns and towns including Gaotang Town, Daming Town, Chishui Town, Lianhuasi Town, Xiamiao Town, Xinzhuang Township and Liuzhi Town. On the basis of this, we will strive to fully implement it by June 20XX.
3. In accordance with the requirements of “five unifications and two independences”, complete the rural integration work within the jurisdiction and organize and implement them. In the process of implementation and difficulties encountered in the implementation of the organization, it is necessary to promptly report back to the county and village integration office.
4. The uniform layout of the village clinics ensures that the indoor and outdoor sanitation of the village is clean, the indoor office equipment, medicines and medical equipment are placed in a unified manner. The village doctors dress neatly, wear the employment certificate, and complete the medical equipment configuration according to the standard set by the Grade A village clinic. .
5. Establish and improve the assessment and reward and punishment system for rural integration work by township hospitals and rural doctors, and sign responsibility books at all levels to ensure the smooth implementation of rural integration work.
second stage
1. Pilot townships and towns organize the implementation of the “five unification” and “two independent” management of rural integration, and organize and archive all kinds of materials, and the information is neat, unified and orderly.
2. The pilot township hospitals will check and fill the gaps according to the work situation, analyze and report various reports, and further improve the work of rural integration.
The third phase
The county and village integration office organizes relevant personnel to evaluate and accept this work, and investigates the responsibility of the responsible person in accordance with the signing of the responsibility letter for the units and individuals who have not completed the work.
Fourth, the establishment and construction of the village clinic
In strict accordance with the planning of the county clinics in our county, the village clinics should be set up on the principle of facilitating the public and rational allocation of health resources. In principle, an administrative village has a village clinic; a neighboring administrative village with a small population can also jointly set up a health room; an administrative village with a large population can set up a health room in a large remote natural village as appropriate. The County Health Bureau re-issued the "Certificate of Practice for Medical Institutions" for the village clinics that implement rural integration, unified the name of the organization, and unified the identification plates and seals of the production organizations. The village clinic requires a “three rooms and one room” with a use area of not less than 60 square meters.
V. Strengthen supervision of the rural medical market and ban illegal medical practice
In accordance with the requirements of the socialist market economy and the state's policy of encouraging multiple forms of medical treatment, those who meet the conditions for entry and exit in accordance with the regulations should support and encourage them to guide them to the rural grassroots to carry out medical and health services. The illegal conduct of medical treatment activities must be resolutely cracked down and banned in order to purify the rural medical service market.
Sixth, improve and improve various rules and regulations, and implement work target management
Township hospitals should strengthen the management of the clinics under their jurisdiction according to the requirements of medical and health work, establish and improve various rules and regulations, implement work target management, and grasp the unified management of finance, medicine and wages in rural integration. The core and key content makes the rural integration work practical.
Administrative unified management
The county and village integration work leading group and its office are responsible for the county's rural integration work. The main duties of the township and village integration office are: responsible for the organization and implementation of the rural integration plan in the area under its jurisdiction, signing the target management responsibility book with the village clinic; implementing unified planning and layout, unified standard construction, unified management and unification for the village clinic Centralized procurement and supply of drugs and materials, unified assessment; assist county health bureaus in supervision and management, stop and ban illegal medical practices, and crack down on illegal medical institutions.
Unified business management
The tasks and tasks of the village clinics shall be uniformly arranged by the township hospitals, and the target management shall be implemented to unify the technical procedures for public health services and medical services. The rules and regulations shall be uniformly formulated by the township hospitals, and unified supervision and management shall be implemented, and the outpatient registration and medical documents shall be unified, so that “eight has a wall”: 1 registration for medical treatment; 2 prescription for medication; 3 for evidence; 4 There are account certificates; 5 work has a system; 6 posts have responsibilities; 7 reports of epidemic situation; 8 business has assessment; 9 main work system, job responsibilities, defense data, charts, service price announcements, etc.
Unified financial management
The township hospitals have unified accounting subjects and unified accounts for the village clinics, set up general ledgers and sub-accounts, and the village clinics also set up account books. Village clinics must strictly implement the national price policy, implement relatively uniform charging items and standards, and must use the special bills for non-profit medical institutions in Guizhou Province. Township hospitals shall register and build the property and materials of each village clinic, and establish and improve fixed assets, drug allocation, and business receipts and accounts. Each village clinic carries out independent accounting, and all financial revenues and expenditures must be included in the unified management of township hospitals. The village clinics uniformly extracted the health care development and overall management fund from the business income for the development of rural health undertakings, and the county health bureau set up a special account for special account management.
Unified drug management
The medicines of township hospitals and village clinics use the national essential medicines catalogue, and implement the province's unified online bidding procurement. The medicines are distributed from the distribution center to the township health centers, the village clinics to the health centers, and the township and village level medical treatments are implemented. Institutional medicines are sold at a uniform price. The township hospitals are responsible for the allocation of medicines according to the drug use plans of the village clinics, and do a good job in the management of medicines in and out of the warehouse to ensure the needs of medical drugs. For those who do not seriously implement the private price increase of prescribed drug sales, once found, the county health bureau reported that the price management department will impose penalties according to relevant regulations; rural doctors may not purchase drugs privately. Once discovered, the county health bureau shall report to the drug supervision, industry and commerce departments. Seriously investigate and deal with the relevant laws and regulations, and at the same time cancel the qualification of rural doctors.
Unified payroll
The income of rural doctors consists of two parts: the income of public health services and the profit of medical treatment activities. The compensation part of the new rural cooperative medical care is approved by the county medical office and then transferred to the township hospitals. The income of the new rural cooperative medical compensation is not included. Jiaoxiang Township Health Center unified accounting.
The public health service income, according to the content and completion of the arranged public health service, the individual's work ability, business technology level, and performance appraisal, shall be calculated and distributed by the county health bureau according to regulations.
The profit of the medical treatment activities is extracted proportionally as the salary of the rural doctors, and the rest is used as the accumulation of the village clinics for the development of the village clinics. The monthly profit of the village clinic is less than 300 yuan and does not participate in the overall planning.
Part 4: Implementation plan for integrated management of rural health services
To further deepen the reform of rural health work, rationally allocate and effectively use rural health resources, strengthen the construction of rural health service system and talent team, establish a lean and efficient rural health management system, comprehensively implement the integrated management of rural health services, and implement new rural cooperative medical care. Outpatient consultation, according to the Ministry of Health's "Opinions on Promoting Integrated Management of Rural Health Services" and the spirit of the Autonomous Region People's Government's "Implementation Opinions on the Comprehensive Reform of Grassroots Medical and Health Systems", combined with the actual situation of our flag, this implementation plan is specially formulated.
First, the guiding ideology is guided by the important thinking of the "Three Represents" and the scientific development concept, with the goal of standardizing village-level medical and health services, rational allocation and integration of medical and health resources, and ensuring that farmers are safe, effective, convenient and inexpensive. Public health and basic medical services.
II. Work Objectives According to the planning plan of the flag medical institution, the establishment of the standardization inspection village clinic and the standardization inspection village clinic, the establishment of the Sumu Town Health Center “Hospital Construction Hospital Management” as the main organization form "Eight unification, two independence" is the basic content. It combines basic medical care, prevention and health care, unified responsibility, rights and interests, standardization of hardware facilities, standardization of operation and management, systemization of guidance and supervision, and quality of service. The target is the integrated management model of health services in the village. Further improve the health service network of the village, improve the health service function of the village, regulate the behavior of the village health service, improve the quality of health services and service standards of the village, ensure the health of farmers and herdsmen, and promote the economic sustainability of the village. Stable and healthy development.
Third, the operation mode Organization form The inspection organization of the village health service integration management is based on the Sumu Town Health Center “Hospital Construction Hospital Management”, that is, all the standardization inspection village clinics and the standardization inspection village clinics are The construction of the Sumu Town Health Center is carried out. The property rights of the village clinics are standardized and the property of the village clinic is owned by the Sumu Town Health Center. The standardization of the village clinic is carried out by the local Sumu Town Health Center. The standardization inspection village clinic and the standardization inspection village clinic are under the unified management of the Sumu Town Health Center, and the doctors of the village are responsible for the operation and assume corresponding duties. After passing the assessment, the standardized village inspection clinic and the standardization inspection village clinic will be identified as the designated agencies for the new rural cooperative medical clinic.
The management model standardization inspection village clinic and the standardization inspection village clinic have implemented the “eight unified, two independent” rural health service integrated management model.
1. Establishment of a unified organization: Strictly follow the archives of the “Setting Construction Plan for the Public Health Village of the Public Welfare Village of Yuexi County”, and set up a standardized village clinic or a standardized village clinic.
2. Unified housing construction: The county standardized village clinic will be constructed by the local township health center according to the “Anhui Provincial Village Health Center Construction Standard”. The construction area is not less than 80 square meters or 100 square meters, which is divided into 6 rooms; standardized village The health room is organized and organized by the local township health center. The building area is not less than 60 square meters, and the four rooms are separated.
3. Uniform personnel access: According to the Regulations on the Administration of Rural Doctors, the standardization and standardization of village clinic staff shall be employed by township health centers from those who have the qualifications of rural doctors or practicing assistants and above. In a township, practitioners of standardized and standardized village clinics can be deployed to each other.
4, unified drug purchases and sales: standardized and standardized village clinics of drugs, equipment by the township hospitals under the "quality and cheap" principle, open procurement from the legal supply channels, unified deployment, unified prices.
5. Unified financial management: Standardized and standardized village clinics must strictly implement the national price policy, publicize regular fee items, establish a sound financial system, regularly report to the township health centers, and accept the financial management of township health centers.
6. Unified business management: Township hospitals are responsible for the unified management of people, finances and materials in standardized and standardized village clinics; unified guidance on medical and health services, and urges village clinics to seriously perform basic medical care, prevention, health care, and health education. Responsibilities such as planning for childbirth propaganda, and regular business training for rural doctors. 7. Unified system construction: The county health bureau shall uniformly formulate the administrative, business, pharmaceutical, and financial management systems for the standardized and standardized village clinics in the county. The township health centers shall formulate specific management measures and be responsible for the implementation of various systems.
8. Unified file specification. Standardized and standardized village clinics should establish and improve various accounts, books, certificates, cards, books, etc., use all kinds of uniformed printed bills and medical documents, and use uniform seals.
9. Financial independent accounting. The standardized and standardized village clinics shall operate independently, in accordance with the policies and regulations and the regulations of the competent administrative department of health, independently account, and be responsible for their own profits and losses. The creditor's rights and debts formed by conducting business activities shall be borne by the operating personnel.
10. Responsibility and independent commitment: According to the relevant policies and regulations, the standardized and standardized village clinics as independent legal entities shall independently undertake the civil and related responsibilities for conducting business.
Fourth, work requirements to strengthen organizational leadership. The integrated management of rural health services is an important part of the reform of rural health management system. It is an effective form of rural health management under the new situation, which is conducive to the optimal allocation of rural health resources and is conducive to the improvement of rural health service quality. It is conducive to ensuring the sustainable development of rural economy and society and the realization of the goal of building a new socialist countryside. The county government set up the Yuexi County Rural Health Service Integration Management Leading Group, which is responsible for the organization, coordination, supervision and guidance of this work. All localities and relevant departments should also set up corresponding organizations to effectively strengthen leadership and speed up organization and implementation.
Clear division of responsibilities. The county health bureau is responsible for guiding the county's rural health service integration management, and regularly organizes personnel to conduct inspection and guidance. The township government is responsible for the organization, leadership and work coordination of the integrated management of rural health services within its jurisdiction, providing land for the construction of village clinics free of charge, and assisting in the construction and management of village clinics. The county health, industry and commerce, drug supervision, public security and other departments have stepped up efforts to crack down on non-medical and illegal drug business practices and purify the market order of rural medical and health services. The county's development and reform, price, civil affairs, finance, construction, land, real estate, planning and other departments fully play their functional roles and actively assist in doing relevant work. Township hospitals strengthen the standardization construction and daily supervision of the village clinics in their respective jurisdictions, so that the "eight unified, two independent" integrated management mode can be effectively operated. If the village clinics are found to have irregularities, they will be dealt with in a timely manner; In time, report to the county health bureau and other law enforcement agencies for punishment.
Widely publicized and launched. All localities and relevant departments should adopt various forms to widely publicize the significance of implementing integrated management of rural health services, eliminate fears and misunderstandings, guide the active participation of cadres and rural doctors, and implement new types of integrated management of rural health services. Rural cooperative medical clinics co-ordinate to create a good environment.
Part V: Implementation Plan for Integrated Management of Rural Health Services
According to the “Notice on the Comprehensive Implementation of the Integrated Management of Rural Health Services” of the Shaanxi Provincial Health Department, in order to rationally allocate and utilize health resources, strengthen the supervision and management of the village clinics, stabilize the rural doctors, improve the business, and standardize medical and health care. Service behavior, establish and improve the integrated management system of rural health services in our county, and formulate this implementation plan based on the actual conditions of our county.
First, the meaning of purpose
In accordance with the overall deployment of deepening the reform of the medical and health system, we will actively promote the management of rural integration. Through the implementation of rural integrated management, rational planning and allocation of rural health resources, standardizing service behaviors, improving service capabilities, promoting the consolidation and improvement of the new rural cooperative medical system, promoting the healthy and sustainable development of rural medical and health services, and meeting the health needs of rural residents. . Rationalize the relationship between township hospitals and village clinics, clarify their responsibilities, rights and interests in rural health services, maximize the service functions of rural health organizations, improve the utilization of health resources, and gradually establish a giant view A new mechanism for regulating powerful and microscopic operations.
Second, organizational leadership
In order to strengthen the organization and leadership of rural integration work, the Fengxian County Rural Health Service Integrated Management Leading Group was established.
Team leader: Zhang Jiwen County Health Bureau Director
Deputy Team Leader: Deputy Director of Li Huaicheng County Health Bureau
Secretary of the Disciplinary Committee of Luochao County Health Bureau
Member: Director of Liu Huijun County Health Bureau Office
Ma Jinhai County Health Bureau
Zhu Shuangqiang County Health Bureau Business Unit Chief
Dean of each town health center
The office of the leading group is located in the county health bureau, and is responsible for the organization and coordination, technical guidance, supervision and inspection, and inspection and acceptance of the county's rural integration work. All townships and towns set up corresponding organizations to implement work related to rural integration. Comrade Li Huaicheng is also the director of the office.
Third, the work content
Rural integration management Under the unified planning and organization of the county health bureau, the town health center is entrusted by the county health bureau to undertake the management and guidance functions of the village clinic. The village clinic bears the public health services and general diseases of the administrative village. Primary care work.衛生院要根據實施鄉村“十統一”和“兩獨立”的管理要求，使鄉村一體化工作落到實處。
“十統一”即：
行政統一管理縣鎮村一體化工作領導小組及其辦公室負責全縣鄉村一體化工作。鎮村一體化辦公室的主要職責是：負責本轄區鄉村一體化方案的組織實施和管理，與村衛生室簽訂目標管理責任書；對村衛生室實行統一規劃布局、統一標準建設、統一操作規範、統一製度管理、統一葯品及材料集中採購供應、統一考核；協助縣衛生局進行監督管理，製止和取締非法行醫行為，嚴厲打擊非法醫療機構。
機構統一管理。嚴格按照全縣區域衛生規劃，以方便民眾、合理配置衛生資源為原則，一個行政村設立一所村衛生室。人口少的鄰近行政村也可以聯合設定衛生室；人口較多的行政村可酌情在較大的偏遠自然村設定衛生室。衛生院所在地的行政村原則上不設立村衛生室。縣衛生局對實行鄉村一體化的村衛生室重新核發《醫療機構執業許可證》，統一機構名稱，統一製作機構標識牌、印章。村衛生室要求做到“三室一房”，使用面積不得少於60平方米。
人員統一管理。按照《鄉村醫生從業管理條列》規定，在村衛生室執業的在崗人員應取得鄉村醫生執業證書或執業助理醫師以上資格，由鄉鎮衛生院統一聘用管理。按照市場經濟要求和國家鼓勵多種形式辦醫的政策，支持和鼓勵符合法規規定準入條件的人員到農村基層開展醫療衛生服務。對非法開展診療活動的行為，要堅決打擊和取締，以凈化農村醫療服務市場。
業務統一管理。加強村衛生室業務和規範管理，建立健全基層規章製度和業務技術流程，嚴格規範診療行為，做到規範服務，記錄完整。明確鄉村兩級醫療衛生機構服務功能，逐步建立起業務統一，分級服務，相互協作及鄉村兩級合理轉診的工作機製。鄉鎮衛生院採取工作例會、病例討論、業務培訓等多種方式，加強對村衛生室的業務指導和管理。村衛生室的靜脈輸液、外傷處理等重大業務活動接受鄉鎮衛生院監管；各項預防保健、醫療、康復、健康教育、人員培訓、醫德醫風等業務活動，由鄉鎮衛生院按照縣衛生局要求統一管理，並負責檢查指導、考核評價。建立健全鄉鎮衛生院和村衛生室衛生技術人員繼續教育和培訓製度。支持鄉村醫生參加醫學學歷教育，鼓勵符合條件的鄉村醫生參加執業醫師資格考試。鄉鎮衛生院和村衛生室衛生技術人員應當定期到上級醫療衛生機構進修學習，積極參加崗位培訓，不斷更新知識，提高專業技術水準。鄉鎮衛生院要製定村衛生室從業人員培訓計畫，通過業務講座、臨床帶教和例會等多種方式加強對村衛生室的業務指導，切實提高村衛生室從業人員的業務技術水準。
規範統一管理。村衛生室的各項工作目標任務，由鎮衛生院統一安排，實行目標管理，統一公共衛生服務、醫療業務技術操作規程。規章製度由縣衛生局統一製定，鎮衛生院實行統一的監督管理，統一門診登記、醫療文書，做到“十有一上牆”，即“十有”：①看病有登記；②用葯有處方；③收費有憑據；④收支有賬證；⑤工作有製度；⑥崗位有職責；⑦疫情有報告；⑧業務有考核；⑨合療有台賬⑩轉診有記錄；“一上牆”即：主要工作製度、崗位職責、防保資料、圖表、服務價格公示等上牆。
葯械統一管理。鎮衛生院、村衛生室的葯品，使用國家基本葯物目錄，實行全省統一網上招標採購，葯品由配送中心配送到鄉鎮衛生院，各村衛生室到衛生院領取，實行鄉鎮、村級醫療機構葯品按統一價格銷售。鄉鎮衛生院根據各村衛生室用葯計畫負責葯品的調撥，做好葯品的進出庫管理，保證醫療用葯需要。對於不認真執行規定葯品銷售私自加價的，一經發現，由縣衛生局報物價管理部門按相關法規進行處罰；鄉村醫生不得私自進購葯品，一經發現，由縣衛生局報葯監部門按相關法規嚴肅查處外，同時取消其鄉村醫生聘用資格。
合療統一政策。新農合政策向達到規範化標準的村衛生室延伸。在達到規範化建設標準，執行國家基本葯物製度，有服務條件的衛生室，開展新農合門診統籌直通車報銷定點，為民眾就近服務，實現小病不出村。
統一財務管理。村衛生室的財務工作實行獨立核算，由鄉鎮衛生院參照國家製定的財務會計製度統一管理。鄉鎮衛生院對村衛生室統一會計科目、統一賬號，設立總賬與分賬，村衛生室同時設立賬簿。收費要嚴格執行國家物價政策，實行相對統一的收費項目和標準，診療收入必須統一使用醫療機構收費專用票據。鄉鎮衛生院對各個村衛生室的財產、物資要進行登記造冊，建立健全固定資產、葯品調撥、業務收支賬冊。所有財務工作必須納入鄉鎮衛生院統一管理。縣衛生局負責對村衛生室財務統一管理情況進行監督檢查，同時定期開展對鄉、村衛生人員財務管理有關規定的教育和培訓，提高財務管理水準。
績效統一考核。建立以公共衛生服務和基本醫療服務為核心的鄉、村衛生機構績效考核機製，製定具體考核辦法。由縣衛生局統一組織定期對鄉鎮衛生院的業務技術和醫德醫風等進行考核，主要考核公共衛生服務、基本醫療服務、崗位職責、民眾滿意度等內容，每半年考核一次，考核結果記入個人業務檔案。鄉鎮衛生院具體組織實施對所在轄區村衛生室的考核工作，考核結果作為鄉村醫生勞務補助經費的發放依據。
工資統一核算。鄉村醫生收入由公共衛生服務收入、葯品零差率補助和診療活動的利潤三部分組成，其中屬新型農村合作醫療補償部分的村衛生室由縣合療辦審核後逐級撥付到鄉鎮衛生院，由鄉鎮衛生院再撥付給村衛生室。公共衛生服務性收入，根據安排的公共衛生服務內容及完成情況，個人的工作能力、業務技術水準、兼顧績效考核，由縣衛生局委託鎮衛生院按規定進行核算發放。對於當月未完成公共衛生任務的，當月的村醫補助一律按50%懲扣，當年未完成公共衛生任務的，下年度不再聘用。葯品零差率補助按照葯品銷售額的15%給予補償，半年考核結算一次。診療收入原則歸個人工資所得。
“兩獨立”即：
1、法律責任獨立：村衛生室的人員在開展診療及其他活動時，產生的風險和責任由村衛生室及相關人員承擔。
2、財務核算獨立：村衛生室的業務開展實行財務獨立核實，自負盈虧的經營管理。
四、工作機製
1、實行競爭上崗、擇優選聘鄉村醫生。鄉村醫生的選聘由鄉鎮衛生院從轄區範圍內取得執業助理醫師及以上資格或《鄉村醫生執業證書》的人員中，按照公平、公正、公開的原則，通過考試考核等方式擇優聘用，並簽訂聘用契約，聘用期限為一年。鄉鎮衛生院建立鄉村醫生人事檔案，對其聘用、考核、獎懲等情況建檔管理。聘用人員報縣衛生局審核備案後，統一辦理註冊或變更註冊手續。聘期屆滿經考核合格者可繼續聘任，不合格者予以解聘。村衛生室新進從業人員必須經崗前培訓後，方可上崗。在崗村衛生室從業人員每兩年培訓一次，由縣衛生局負責組織。
2、建立目標管理工作考核製度。縣衛生局與衛生院院長按鄉村一體化工作職責簽訂責任書，年底對衛生院院長進行考核，按合格、基本合格、不合格進行獎懲；鄉鎮衛生院對村衛生室實行年度目標責任考核。考核的主要內容包括：①公共衛生服務指標的完成情況；②村衛生室的醫療服務質量；③村衛生室的內部管理；④執行新型農村合作醫療管理規定的情況；⑤葯品零差率銷售情況；⑥民眾的滿意度。考核評分辦法按縣衛生局製定的《鄉村醫生目標管理考核辦法》執行；年度考核分值達90分以上者，兌現全額的公共衛生服務費。年度考核分值80分以上90分以下者按分值比例兌現公共衛生服務費。年終考核分值80分以下者，兌現80%的公共衛生服務費等。
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