北京市属公立医院改革的实践与体会

公立医院改革是我国医改最难啃的硬骨头和绕不开的深水区,而公立大医院的改革由于涉及面更广、利益关系更复杂,老百姓反映强烈的"看病贵"、"看病难"问题表现得更为突出。在新一轮医药卫生体制改革背景下,北京市在针对解决"低收入者看不起病、社区看不好病、大医院看不上病"三个问题和前期医改取得成效的基础上,以北京市属公立大医院作为改革的先锋,先后启动了医药分开、法人治理、绩效分配和创新服务模式等一系列改革举措,实施一年以来,使门诊患者次均个人自付费用下降55.2元(降幅达到28.1%),有效降低了患者的负担;试点医院医务人员收入较改革前增长均达到31%以上,调动了医务人员的积极性;并带来了试点医院管理体制更加科学与运行机制更加有效等深层次的变化。北京市公立医院试点改革的初步成效对全国公立医院改革具有一定的借鉴意义,它带来诸多启示:即公立医院改革必须是在一定基础上进行的综合改革,需要顶层设计、统筹谋划、扎实有序推进,需要政策配套和各部门的大力配合,需要坚强完善的组织保障体系和社会的广泛理解与参与。

Practice and Experience of Beijing Public Hospital Reform

Public hospital reform is inevitably the most intractable issue of our national medical reform. Poor access and high fee are more serious problems in general public hospitals, as the public general hospitals are more extensive, and more complex in interest relation. In the new round of medicine and healthcare system reform, on the basis of preliminary results of medical reform, and dealing with the problems that low-income people could not afford medical services, patients could not be treated well in community hospitals, and patients could not access to general hospital services, Beijing municipal general public hospitals, as vanguards of reform, successively launched a series of reform actions, including separation of clinic from pharmacy, corporate governance, performance distribution and innovative service model. Over the past year of the new reform, average individual payment of outpatients every time falls by 55.2 RMB （a drop of 28.1%）, effectively reducing the burden on patients;medical staff income in all pilot hospitals grows 31%more than that before the new reform, which mobilizes their enthusiasm;in-depth changes are that management system of pilot hospitals becomes more scientific, and operation mechanism more effective. Preliminary results of the pilot reform of Beijing public hospitals have some reference for public hospitals nationwide and bring a lot of revelation：public hospital reform should be a comprehensive reform on some basis, which needs top-level design, overall planning and solid advance in an orderly manner, and requires the supporting policies and the vigorously cooperation of all departments, as well as the strong and＆amp;nbsp;perfect organizational security system and a wide range of public understanding and participation.