At that time, there were three main sources: one was the medical family; Two, graduated from high school, a little understanding of medical pathology; Third, some of them are young intellectuals who go to the countryside. Barefoot doctors have made positive contributions to alleviating the urgent need for medical treatment and medication in some rural areas of China. According to the Regulations on the Management of Rural Doctors, which came into effect on June 65438+1 October1,2004, rural doctors have passed the corresponding registration and training examinations and are licensed to practice under their official names. At present, there are nearly one million rural doctors in China, but they are closely connected with the 800 million rural population.
National policies:
Rural doctors are health workers with China characteristics, who are rooted in the vast rural areas. For a long time, they have played an irreplaceable role in ensuring the health of rural residents. With the deepening of rural economic system reform and medical reform, the development of rural doctors has encountered new situations and problems. In order to ensure that the "net bottom" of rural medical and health services is not broken, and to ensure the fairness and accessibility of basic medical and public health services for rural residents, according to the spirit of deepening the reform of medical and health system, with the consent of the State Council, the following guiding opinions are put forward on further strengthening the construction of rural doctors:
I. General requirements
In accordance with the requirements of ensuring basic conditions, strengthening grass-roots units and building mechanisms, starting from reality, we should clarify the responsibilities of rural doctors, improve the practice places, and achieve full coverage of village clinics and rural doctors; Village clinics will be included in the basic drug system and the new rural cooperative medical care (hereinafter referred to as the new rural cooperative medical system) outpatient co-ordination scope, improve the compensation and pension policies for rural doctors, improve the training system, standardize the practice behavior, strengthen management guidance, improve the service level of rural doctors, and provide rural residents with safe, effective, convenient and cheap basic medical and health services.
Second, clarify the responsibilities of rural doctors.
Rural doctors (including rural practicing doctors and assistant doctors, the same below) mainly provide public health and basic medical services for rural residents, including basic public health services under the guidance of professional public health institutions and township hospitals in accordance with service standards and norms; Assist professional public health institutions to implement major public health service projects, report infectious diseases and poisoning incidents in a timely manner in accordance with regulations, and handle public health emergencies; Use appropriate drugs, appropriate technologies and traditional Chinese medicine methods to provide general diagnosis and treatment of common diseases and frequently-occurring diseases for rural residents, and timely refer patients who exceed the ability of diagnosis and treatment to township hospitals and county-level medical institutions; Entrusted by the administrative department of health, fill in statistical statements, save relevant information, carry out publicity and education and assist in raising the new rural cooperative medical fund.
Third, achieve full coverage of village clinics and rural doctors.
(1) Defining the planning and construction standards of village clinics. The health administrative department at the county level shall, according to the regional health planning and the establishment planning of medical institutions, comprehensively consider the factors such as serving population, residents' needs and geographical conditions, and rationally plan the establishment of village clinics. In principle, each administrative village has 1 village clinic, and administrative villages with large population or scattered residence can be increased as appropriate; In principle, there is no village clinic in the administrative village where the township health center is located.
Village clinics can be jointly run by rural doctors, individuals, governments, collectives or units, and established with the approval of health administrative departments at the county level. The houses and basic equipment of village clinics are equipped according to the standards set by the state. All localities should adopt various ways, such as public construction and private operation and government subsidies, to support the housing construction and equipment purchase of village clinics.
(2) Rational allocation of rural doctors. Rural doctors can practice in village medical and health institutions (including village clinics and other medical and health institutions run in accordance with relevant state regulations). Rural doctors practicing in village clinics shall be determined by the county-level health administrative department in conjunction with relevant departments. In principle, there should be 1 village doctor per thousand people, and the number of administrative villages with scattered residence can be appropriately increased; There are at least 1 village doctors in each village clinic.
All localities should conduct a comprehensive survey of village clinics and rural doctors. For administrative villages where there are no village clinics and village doctors at present, the government should actively encourage qualified personnel to hold village clinics, or the government should build village clinics; Actively take directional training, commissioned training, and township health centers to send people to the station to guide rural doctors to practice in village clinics, and ensure that each administrative village should have 11village clinics before the end of 201,and each village clinic has rural doctors.
Fourth, strengthen the management of village doctors and village clinics.
(1) Strict qualification of rural doctors. Rural doctors must have a rural doctor's practice certificate or a practicing (assistant) doctor's certificate, and be registered by the health administrative department to obtain the relevant practice license. Personnel engaged in nursing services in village clinics should also have corresponding legal qualifications. Health administrative departments at the county level should strengthen access management in strict accordance with the Law on Medical Practitioners and the Regulations on the Administration of Rural Doctors. In principle, new personnel who enter the village clinic to engage in prevention, health care and medical services should have the qualifications of practicing assistant doctors and above. Prohibit and resolutely crack down on illegal medical practice by unqualified personnel.
(2) Strengthening the management responsibilities of county-level health departments. The health administrative department at the county level shall bring rural doctors and village clinics into the scope of management, and supervise their service behavior and the use of drugs and devices. It is necessary to establish and improve the rules and regulations and business technical processes that meet the functional orientation of village clinics, and organize the training of rural doctors. It is necessary to scientifically divide the functions of township hospitals and village clinics, rationally allocate basic public health service tasks, and strengthen performance appraisal. The assessment results are publicized in the administrative village where they are located as the basis for financial subsidy accounting and dynamic adjustment of rural doctors' practice in village clinics. County-level health, finance, price and other departments should strengthen supervision over the use of subsidy funds for rural doctors and village clinics, urge them to standardize accounting and financial management, and disclose the items and prices of medical services and drugs, so as to ensure well-documented charges, well-documented accounts and well-documented expenditures.
(three) to strengthen the business guidance and management of township hospitals to village clinics. Encourage all localities to actively promote the integrated management of township hospitals and village clinics without changing the status of rural doctors and the legal person and property relationship of village clinics. The county-level health administrative department entrusts township hospitals to provide technical guidance, business and medical equipment supply management and performance evaluation to rural doctors and village clinics. Township health centers should strengthen their professional guidance to rural doctors through business lectures, regular meetings, etc., conduct daily supervision on the supply and use of medicines and equipment and financial management of rural doctors and village clinics, and assess the service quality and quantity of rural doctors and village clinics under the unified organization of county-level health administrative departments.
(4) Improve the informatization level of village clinics. Incorporate village clinics into the information construction and management scope of primary medical and health institutions, make full use of information technology to strengthen the management and performance evaluation of their service behavior, supply and use of drugs and equipment, and improve the service ability and management level of rural doctors and village clinics. According to the functional orientation of village clinics, relevant software is designed to establish a unified and standardized electronic health record for residents, so as to realize the unified electronic bills and prescriptions for township hospitals and village clinics.
V. Incorporate village clinics into the implementation scope of relevant systems.
(a) the implementation of the basic drug system in the village clinic. Village clinics will be included in the scope of implementation of the basic drug system, and the basic drug system policies will be implemented. The basic drugs will be purchased centrally, equipped and used, and sold at zero rate. Rural doctors practicing in village clinics should all use basic drugs, which are supplied by township hospitals.
(2) Actively bring village clinics into the overall implementation scope of the new rural cooperative medical system. The eligible village clinics will be included in the management of the designated medical institutions of the new rural cooperative medical system, and the general medical fees and basic drugs collected by the village clinics will be included in the payment scope of the new rural cooperative medical system, and the payment ratio will not be lower than the payment ratio for medical treatment in township hospitals. It is necessary to give full play to the regulatory role of the new rural cooperative medical system in the medical expenses and service behaviors of rural doctors and village clinics. Encourage local governments to promote outpatient co-ordination of the new rural cooperative medical system, simultaneously carry out the reform of payment methods of the new rural cooperative medical system, explore various payment methods such as per capita payment and total prepayment, and use payment policies to guide rural doctors and village clinics to change service behaviors and improve service quality. It is necessary to strengthen the supervision of the payment of medical and drug expenses by the new rural cooperative medical system in village clinics, and prevent the fraudulent issuance of documents to defraud the new rural cooperative medical system funds.
Sixth, improve the rural doctors' salary and pension policy.
(1) Improve the multi-channel compensation policy. According to the quantity and quality of services provided by rural doctors, compensation is made through multiple channels.
The basic public health services provided by rural doctors are mainly subsidized by the government through the purchase of services. The health administrative department at the county level shall, according to the responsibilities, service ability and service population of rural doctors, clarify the specific contents of the basic public health services that rural doctors should provide, reasonably verify their tasks, and ensure that they are compatible with their functional orientation and service ability. According to the actual workload, the corresponding proportion of national basic public health service funds shall be allocated to rural doctors, and shall not be misappropriated, withheld or misappropriated.
The basic medical services provided to rural doctors are mainly paid by individuals and the new rural cooperative medical fund. All localities should, in accordance with the requirements of the Opinions of the General Office of the State Council on Establishing and Perfecting the Compensation Mechanism of Primary Medical and Health Institutions (Guo Ban Fa [2010] No.62), reasonably formulate the general treatment fee standard of village clinics and the payment standard and method of the new rural cooperative medical system. Under the premise of comprehensively considering the affordability of the new rural cooperative medical fund and not increasing the personal burden of the masses, give full play to the compensation role of the new rural cooperative medical system for rural doctors.
After the implementation of the basic drug system in village clinics, in order to ensure that the reasonable income of rural doctors practicing in village clinics is not reduced, all localities should comprehensively consider the compensation for basic medical care and public health services and adopt special subsidies to give fixed compensation to rural doctors practicing in village clinics. The subsidy standard can be formulated after approval according to the number of serving population or rural doctors, and the subsidy level is connected with the subsidy level of local village cadres. The specific compensation policies shall be formulated by the governments of all provinces (autonomous regions and municipalities) in light of the actual situation.
Encourage qualified places to further improve the subsidy level for rural doctors who have long service life and practice in remote and difficult areas.
(2) Actively solve the problem of providing for the aged by rural doctors. All localities should combine the promotion of the new rural social endowment insurance system (hereinafter referred to as the new rural endowment insurance), actively guide eligible rural doctors to participate in the new rural endowment insurance, and issue pensions to rural doctors who meet the conditions for receiving the new rural endowment insurance benefits. Local governments can take various forms, such as subsidies, to properly solve the security and living difficulties of elderly rural doctors, and the specific measures shall be formulated by local governments in light of the actual situation.
Seven, improve the training system of rural doctors.
(1) Strengthen the training of rural doctors. The administrative departments of health of all provinces (autonomous regions and municipalities) should formulate a training plan for rural doctors reasonably, and adopt various methods such as clinical training, centralized training, and urban-rural counterpart support to send rural doctors to county-level medical and health institutions or medical colleges for training. The health administrative department at the county level shall provide free training for rural doctors practicing in village clinics at least twice a year, and the cumulative training time shall not be less than two weeks.
(two) to strengthen the construction of rural doctors reserve force. Health administrative departments at the county level should find out and dynamically grasp the practice of rural doctors within their respective administrative areas, focus on the long-term, formulate plans for the construction of rural doctors, establish rural doctors' reserves, select local personnel for directional training, and timely supplement them to village clinics. Where conditions permit, preferential policies should be formulated to attract urban retired doctors, practicing (assistant) doctors and medical college graduates to work in village clinics. All localities should explore the establishment of a general practitioner team and promote the contract service model, and actively do a good job in the connection between the construction of rural doctors and the construction of general practitioners.
Eight, seriously organize the implementation work.
(1) Strengthen organizational leadership. Local people's governments at all levels should attach great importance to the important role of rural doctors in the primary medical and health service system, put the construction of rural doctors as an important task of medical reform on the agenda, improve relevant supporting policies, and ensure the smooth implementation. All relevant departments should conscientiously perform their duties, strengthen cooperation and coordination, intensify supervision and guidance, and ensure the solid progress of all work.
(2) Formulating an implementation plan. Provinces (autonomous regions and municipalities) should further refine the implementation of relevant policies and measures in light of local conditions, formulate specific implementation plans within 30 working days after the release of this opinion, and report them to the State Council Medical Reform Office, Ministry of Health, Ministry of Finance and Ministry of Human Resources and Social Security for the record.
(3) Implementing capital investment. All regions should urge and guide the people's governments at the county level to actively adjust the fiscal expenditure structure, and incorporate the funds needed to improve the rural doctors' compensation and pension policy and the construction of village clinics into the fiscal year budget, and timely allocate them in place to ensure that the funds are earmarked and shall not be misappropriated or misappropriated. The people's governments at the provincial level should bear the responsibility of overall planning and further increase the transfer payment to difficult areas. The central government will increase support for difficult areas through transfer payments, give necessary subsidies to rural doctors practicing in village clinics, and implement the basic drug system. It is strictly forbidden to collect and apportion fees from rural doctors in any name other than those stipulated by the state, and it is necessary to create a good practice environment for rural doctors.