How to do the economic management of public hospitals? DRG management system is the key
On June 29, the National Health Commission’s website issued the “Notice on Carrying out the “Economic Management Year of Public Medical Institutions” Activities (National Health Finance Letter [2020] No. 262, hereinafter referred to as the “Notice”), which quickly triggered widespread concern in the industry. focus on.
Especially in the post-epidemic era, at a critical moment when medical reform enters the deep water zone, the state has sounded the clarion call for "economic management" of public hospitals, and the need to strengthen economic management must be "1234567."
1 is a goal
One goal refers to “high-quality” development.
As the aging of the population accelerates and the demand for medical consumption is growing, the reform of the medical insurance DRG (diagnostic related grouping) payment system is accelerating. Paying for value, standardizing medical service behavior, controlling excessive medical treatment, and controlling expenses have become the main theme of "medical insurance". Hospitals must Adapt to changes in the general environment.
The "Notice" proposes that deepening medical reform has entered a deep-water zone and a critical period, and public medical institutions have also entered a period of opportunities for high-quality development. In order to better meet the people's growing demand for medical services, it is necessary to promote public medical institutions to speed up the filling of internal management shortcomings and weaknesses and promote high-quality development.
2 are two major changes
The two major changes refer to the transformation of the development model of public hospitals from scale expansion to quality and efficiency, and the transformation of management models from extensive to refined.
With the establishment of the universal medical insurance system, the medical insurance system has raised a large amount of medical insurance funds, which has greatly stimulated the explosion of medical demand. Hospitals have been newly built and rebuilt, hospital beds have been expanded, large-scale medical equipment has been expanded, and the scale expansion effect has become more prominent. The hospital has ushered in the "Golden Economic Decade" ".
During the period of scale expansion, the hospital management model was relatively extensive, causing medical expenses to increase too quickly. "Expensive medical treatment" aroused social concern, and medical reform efforts continued to increase. The "Notice" emphasizes the promotion of the transformation of the development model from scale expansion to quality and efficiency, and the transformation of the management model from extensive to refined.
3 topics
The three themes refer to standardizing management, improving quality and efficiency, and strengthening supervision.
The "Notice" requires that the economic management of public hospitals includes three themes: standardizing management, improving quality and efficiency, and strengthening supervision.
Standardizing management mainly focuses on the outstanding problems existing in the current economic management work and the major problems facing long-term development, rectifying the problems and improving the management system.
To improve quality and efficiency, we mainly focus on strengthening the internal control and supervision measures for the economic behavior of various business activities, and strive to improve operational efficiency and refined management levels.
To strengthen supervision, local health administrative departments and traditional Chinese medicine authorities at all levels and public medical institutions must firmly establish a sense of the overall situation and responsibility, adhere to bottom-line thinking, and start from the aspects of complying with laws and regulations, strengthening internal control, ensuring order, and serving the people. Pay attention to the use of comprehensive regulatory means, increase supervision, inspection and guidance, form a comprehensive regulatory atmosphere that combines institutional self-discipline, government supervision, and social supervision, promote the establishment of a long-term mechanism for economic management, and effectively ensure the safety of economic operations. After the problems are discovered and rectified, regions and units that again have violations of laws and disciplines during inspections by discipline inspection, auditing, market supervision, medical insurance and other departments will be severely dealt with according to laws and regulations.
4 major improvements
The four major improvements refer to efforts to achieve comprehensive improvements in management quality, management capabilities, management level and management efficiency.
Give full play to the role of cost management, operation management, internal control, and performance management, firmly establish the concept of "living a tight life", and combine daily business management with strict control of general expenditures and resource cost savings in the same deployment, implementation, supervision, and evaluation , ensuring full participation and full-process control.
Focusing on the weak links, we insist on making up for the weak points, improve the cost accounting system, operation management system measures, internal control full-process system, budget performance management target indicator orientation, etc., promote the formation of economic management value creation, and improve the efficiency of business activities and economic activities. Quality benefits.
Set up a separate operation management department, strengthen the integration of economic management, improve the functions of internal institutions, and form a joint force in economic management; strengthen the construction of economic management talent teams, and focus on cultivating and using professional and comprehensive management talents. Focusing on improving quality and efficiency, we should change the current situation of focusing on business but not on management, improve the awareness of all employees to implement the system and pay attention to internal control, and continuously improve the overall level of unit economic management.
5 principles
The five major principles are as follows.
First, adhere to the combination of supervisory responsibilities and territorial responsibilities. Health administrative departments and traditional Chinese medicine authorities at provincial level and below organize and implement specific activities of the budget management hospital economic management year at the same level, carry out guidance, inspection and evaluation, and implement supervisory responsibilities. Public medical institutions at all levels and types must implement the main responsibilities of the Economic Management Year activities, establish an organizational leadership working mechanism led by the main responsible comrades of the units, set up temporary working institutions with the participation of multiple departments, study and formulate specific activity plans, and ensure the achievement of substantial results .
Second, combine problem orientation with result orientation, focus on the outstanding problems existing in current economic management work and major issues facing long-term development, do a good job in rectifying problems, improve management systems, and focus on strengthening the internal control of economic behaviors embedded in various business activities. and regulatory measures, and strive to improve operational efficiency and refined management levels.
Third, combine business management with economic management, integrate various requirements of economic management into all aspects of business process control and quality control such as medical, teaching, research and production prevention, and promote the deep integration of business management and economic management.
Fourth, standardize management and improve quality and efficiency. Strengthen management around "standardizing charge management, standardizing medical service behavior, standardizing drug and device management, and standardizing hospital price behavior" to promote economic management to improve quality and efficiency.
Fifth, combine reform and innovation with long-term mechanisms, promote the construction of long-term mechanisms for internal management of medical service prices, conscientiously implement the task requirements of payment method reform, promote the quality of medical services, reduce costs, and increase benefits, give full play to the role of internal audit, and improve the long-term mechanism. effective regulatory mechanism.
6 types of activities
The six forms of activities refer to organizing and carrying out various activities such as on-site surveys on economic management, "lecture hall" training on health and economics, training of economic management talents, special actions on government procurement, special audits of project funds, supervision and evaluation, etc. It is strictly prohibited to go through the motions to ensure that Get real results.
The unit leadership team must conduct special research and formulate implementation plans; the main leaders must personally deploy and command from the front; each team member must implement the detailed division of responsibilities and various management requirements based on the departments and matters in charge; all business and management departments Various requirements should be implemented throughout every level, link and process of business and management work.
7 major institutional systems
The seven major systems refer to management systems such as budget, cost, procurement, assets, internal control, operations, and performance.
Establish and improve a comprehensive budget management system, including financial budget, scientific, educational and research budget, investment budget, and business budget management system, and give full play to the normative role of budget management in economic management.
Establish and improve the cost accounting management system, carry out full cost accounting, expand medical project cost accounting, disease cost accounting, DRG cost accounting, medical equipment cost accounting, etc., integrate daily business management with strict control of general expenditures, and save resource costs in the same deployment, Implement, supervise, and evaluate together to ensure full participation and full-process control.
Establish and improve the procurement management system, improve the government procurement management system, standardize the procurement process, and gradually form a management system that is compliant with the law, efficient in operation, and unified with rights and responsibilities, to achieve effective constraints on the internal exercise of power in government procurement activities, and ensure that government procurement is carried out in accordance with the law. Operate according to regulations.
Strengthen the construction of the procurement management system, standardize procurement management from the source, improve the government procurement management system, standardize the procurement process, and gradually form a management system that is compliant with law, efficient in operation, and unified with rights and responsibilities, and achieve effective constraints on the internal operation of power in government procurement activities. Ensure that government procurement work is carried out in accordance with laws and regulations; give full play to the role of hospital internal control to reduce procurement costs. Establish and improve the asset management system, focusing on strengthening the management of the secondary warehouse of consumables to block leaks and leaks; improve the investment and equipment purchase analysis and evaluation system to limit the financial risks caused by scale expansion.
Establish and improve the internal control system, target internal control risk points, refine and implement the internal control system and supervisory measures for economic behaviors in various business activities, establish a daily supervision mechanism for joint inspections of medical, price, financial and other management departments, and conduct regular and irregular inspections. Regularly carry out standardized management inspections of medical services to avoid violations of laws and disciplines; strengthen internal audit supervision, give full play to the role of internal audit, and improve long-term supervision mechanisms. Establish an operation management system, set up an operation management department, actively implement the operation assistant, price coordinator, cost accountant system, etc., to assist and collaborate with clinical business departments to strengthen the internal operations and price management of the department.
Improve the performance management system, break the performance model linked to income or projects, comply with the requirements of medical reform, establish the "DRG Performance Points Performance Evaluation Model" to motivate and mobilize enthusiasm, build a multi-dimensional performance evaluation model, improve medical service capabilities, and improve connotation quality the road.
Zhang Yue 