In order to further promote the construction of public health system and the development of community health in our district, and alleviate and solve the problems encountered by the masses in the current health work, under the support and guidance of the district party committee and the district government, and under the unified organization and coordination of the district CPPCC, the Political and Legal Committee of CPPCC and the district government health bureau formed a research group to conduct a special investigation activity on the development of health in our district for more than three months. The research team visited relevant health service institutions, organized some CPPCC members to conduct special inspections on the construction and use of public health hardware in our district, held a forum for CPPCC members, experts and scholars, heads of community health service institutions, health service management departments and institutions, and went to Chongqing, Chengdu and other sister cities for study and investigation, and extensively collected opinions and suggestions from relevant parties. The basic situation of the investigation is now reported as follows.

I. Basic information

In the survey, we focused on the health resources, population structure, insurance participation, the number of chronic diseases and the ratio of doctors and patients in our district, and initially found out some basic information related to health services in our district.

1, basic situation of health service resources. As of the first quarter of this year, there are 18 hospitals in * * *. According to the ownership, there are 0/3 public hospitals, accounting for 94.3% of the total number of beds. There are 5 non-public hospitals, accounting for 5.7% of the total number of beds. According to the affiliation, provincial 1, municipal 3, district 1, army 2, enterprises and institutions 6 and individuals 5. In addition to hospitals, there are 1 Maternal and Child Health Hospital, 1 1 Community Health Service Center and 3 community health service stations in the area. Among the community health service centers, 4 are public and 7 are jointly organized by the society. In addition, there are 139 outpatient departments and clinics in the jurisdiction, all of which are non-public medical institutions. Relatively dense medical institutions have kept the number of beds and doctors in our district at a high level. At present, the number of hospital beds and medical practitioners per 1,000 population in our district are 12.9 and 5.97 respectively, which are higher than the overall level of 4.46 and 2.48 in other urban areas and the whole city, and also greatly exceed the standard of "in principle, the whole city should control 6.5 hospital beds and 3.0 doctors per 1,000 population" put forward in the Relevant Provisions on the Implementation of the Management of Medical Institutions in Liaoning Province.

2. Residents enjoy medical insurance. The participation in insurance is an important index to measure the basic medical security level of residents and the vital interests of the people. Xigang District has a registered population of 336,700, including 70,000 elderly people over 60 years old, accounting for 20.8% of the total registered population. 2 1.36 million people participated in the basic medical insurance, accounting for 63.4% of the total registered population; 49,000 people participated in commercial medical insurance, accounting for14.6% of the total registered population; There are 74,000 self-funded medical treatments, accounting for 22% of the total registered population. There are 8,400 low-income people, including 0.630 people who participate in medical insurance, accounting for 75% of the total low-income people; The number of people who did not participate in medical insurance was 1.8 million, accounting for 2 1.5% of the total number of people with minimum living allowance. Foreign resident population 1.9 million, of which 0. 1.8 million were insured, accounting for 9.5% of the total foreign resident population; There are 17200 people who have not participated in medical insurance, accounting for 90.5% of the total resident population. There are 28,000 people suffering from nine common chronic diseases, among which 22,900 people participate in medical insurance, accounting for 81.4%; 5200 people did not participate in medical insurance, accounting for 18.6%.

3. Develop community health services. Community health service is an important way to increase the supply of medical services, improve the quality of medical services and alleviate and solve the problem of "difficult and expensive medical treatment". In recent years, in this regard, the district party committee and the district government have continuously strengthened leadership and increased investment, and relevant departments have innovated ideas and paid close attention to implementation, and have done a lot of fruitful work. First, strive to build a "service network" system. According to the principle of "scientific planning, rational layout, optimal allocation and convenience for residents", the medical institutions in our district have been merged, reformed and adjusted, and the 1 1 community health service center has been planned and built, and health and epidemic prevention stations have been set up in various streets, providing resource guarantee for community health services. 1 1 The community health service center and three community health service stations have basically achieved the goal of "convenient medical treatment within ten minutes" within their respective service radius. As of the first quarter of this year, the community health service institutions in our district have established 35 family beds/kloc-0 and 78,000 family health records. Last year, the number of family beds was 86 1 bed, and the number of outpatient and patrol visits was 336,000, accounting for 14% of the total medical outpatient visits in the jurisdiction. At present, the average daily visit of each community has reached 83.6. The second is to continuously increase the intensity of "standardized" management. Strengthen connotation construction, improve management mechanism, and implement integrated and standardized management. Strictly supervise according to law, implement quantitative management, and urge all community health service institutions to practice medicine according to law and standardize their practice. Strengthen quality management, improve service efficiency, and promote the quality of community health care services through various means and forms. At the same time, focus on the three links of "introduction, training and management" and actively promote the construction of community health service talents. At present, there are 343 employees in community health service, with an average of 3.6 doctors and 4 nurses per 10,000 people. The third is to carry out in-depth "healthy into the community" activities. While actively improving medical services, we should strengthen publicity and guidance, go out of the house and go deep into the community to send health and services to the masses. We have carried out "health intervention, disease prevention, maternal and child health care, medical rehabilitation, Red Cross service into the community, medical return visit, intensive care, hospice care, family sickbed, health investigation, rehabilitation guidance, immunization, postpartum visit and warm assistance into the family". Fourth, we have continuously improved the "preferential service" measures. In order to reduce the cost of medical treatment for the masses, the "four exemptions" measures were introduced. In order to improve the quality of medical services, the "Ten Commitments" measures have been introduced. With the goal of reducing or exempting the medical expenses of low-income residents, the "Ten Preferential Measures" were introduced. At the same time, the implementation of "one certificate and one card" and the implementation of "medical assistance" services for special groups such as low-income households, disabled households, marginal households and migrant workers have alleviated the problem of "difficult and expensive medical treatment" for residents to some extent. The fifth is to continuously strengthen the "health management" measures. Adhere to the principle of "education first, prevention first", give full play to the role of community health service institutions, and actively strengthen the health education and management of residents in the area. The establishment of residents' health records in the jurisdiction provides a basic basis for health management. Strengthen community health education and publicity, hold lectures on health knowledge and disease prevention knowledge in communities and public places, and improve the awareness rate of health knowledge and the formation rate of health behavior among residents in the jurisdiction.

Second, the existing problems

Although great achievements have been made in the construction of public health service system and community health service in our district, there are still some difficulties and problems due to the limitations of subjective and objective conditions, which have affected the construction of public health service system and residents' medical treatment. The main manifestations are as follows: First, the problem of difficult and expensive medical treatment for the masses still exists. Although the allocation of medical resources in the jurisdiction is relatively saturated, it is relatively convenient to see common diseases and frequently-occurring diseases, but there are still long queues in some large hospitals in terms of expert consultation and hospitalization. Some difficult diseases are difficult to complete diagnosis and treatment in the local area, and the problem of difficult medical treatment still plagues the people in the jurisdiction to some extent. In order to alleviate the problem of expensive medical treatment for the masses, although the municipal and district governments have implemented medical assistance measures for some people in need, the problem of expensive medical treatment for the masses is still outstanding due to the slow development of macro-system and medical insurance, especially for some chronic patients who have not participated in medical insurance and urban fringe people. In addition, the problem of population aging in our region is more serious, with the elderly over 60 accounting for 20.9%, which is higher than the average level of Dalian 15.6%, which objectively leads to a higher prevalence rate of chronic diseases and higher medical expenses in our region, which aggravates the problem of expensive medical treatment for people in our region. Second, there are still weak links in community health services. Due to the limitation of service facilities, medical equipment and technical strength, and the imperfection of medical insurance and other policies and systems, the habit and process of "minor illness in the community, serious illness in the hospital" have not yet been formed, and the two-way referral mechanism between community service institutions and large hospitals has not really been established, which has affected the healthy development of community health services. The existing community health service institutions in our district are mainly private. With the medical insurance policy, chronic disease management, access to collective and individual medical institutions, and the liberalization of drug prices, its original policy advantages have gradually weakened, and the pressure of survival has increased year by year. Due to the pressure of survival and the profit-seeking nature, the public service of community health service institutions has not been fully reflected, and the situation of "supporting doctors with medicine" is very prominent, and the public service functions that should be undertaken are not fully in place. Third, the construction of talent team is still insufficient. There is a serious shortage of professional and technical personnel in the health system, such as older, less educated and so on. The perfect employment mechanism has not really been established, which has affected the enthusiasm and initiative of employees. The lack of a reasonable talent flow mechanism makes it difficult to introduce outstanding talents and transfer existing personnel, which affects the overall vitality of the health system team. Due to the narrow source of community health service personnel, high work intensity, relatively low treatment, shortage of talents and unstable personnel, the service quality and level have been affected. Fourth, the policy input mechanism is not perfect. Although the subsidy policy of 40,000 yuan per 10,000 people is implemented in our district, compared with the development demand of community health services, the investment is still insufficient, which affects the public welfare of community health services.

Third, ideas and countermeasures

In view of the above problems, we aim to improve the public health service system and solve the problem of "difficult and expensive medical treatment" for the masses, learn from the experience and practices of sister cities, and synthesize opinions and suggestions from all sides, and put forward the following ideas and countermeasures for the construction of public health service system and the development of community health service in our district.

1, to further improve the level of public health system construction. First, pay attention to the integration of public health service resources in the jurisdiction. Fully sum up the experience of public health services, especially the construction of disease prevention and control system during the SARS period, strengthen cooperation with municipal prevention and health care institutions, adhere to the principle of not seeking everything, but seeking what is used, and rely on the advantages of centralized public health service institutions at the municipal level in the jurisdiction to further strengthen the integration of health resources in the jurisdiction, and strive to form a good situation of "resource sharing and regional linkage" among citizens in our district. The second is to fully improve the efficiency of the use of public health resources in the region. In recent years, our district has increased investment in public health hardware construction, and has rebuilt or reformed facilities such as district CDC, maternal and child health hospital and health supervision office. Therefore, we should adhere to the principle of paying equal attention to construction, management and use to ensure that good hardware produces good results. At the same time, internal sharing and paid rental can be adopted to improve the utilization rate of newly equipped equipment, prevent idle waste of resources, and give full play to the due role of these resources and facilities in public health services. Third, fully tap and mobilize the vitality of public institutions. Strengthen work guidance, refine work responsibilities, do a good job assessment, guide and urge all institutions of the health system to base themselves on their respective functions, do a good job in division of labor and cooperation, and assume the main role in the construction of public health service system. Explore the establishment of a vibrant and energetic employment mechanism. In accordance with the reform principle of public institutions and the requirements of being lean and efficient, we will deepen the reform of personnel and personnel management system, adopt two-way selection, competitive appointment, merit-based employment and contract management to stimulate the internal vitality of public institutions and establish an employment mechanism conducive to mobilizing work enthusiasm. Strict performance appraisal, linking the assessment results with income, adopting the practice of waiting for job training or transferring the unqualified personnel, making room for talent introduction, gradually solving the problem of orderly entry and exit of personnel, and providing talent protection for public health services.

2. Further deepen the work of community health services. First, further improve and implement supporting policies conducive to the development of community health. Our district should learn from the practices of Chongqing and other places, conscientiously implement the relevant provisions of Dalian on community health subsidies, arrange subsidy funds in full, and gradually establish a scientific policy compensation mechanism to reduce the survival pressure of community health institutions, so that they can fully undertake the functions of public health services. The second is to establish and improve the cooperation mechanism between community health institutions and other medical institutions. Continue to strengthen the publicity of community health service institutions, enhance the recognition and trust of the masses, and strive to guide the masses to form the habit of seeking medical treatment in the community for minor illnesses, so that community health service centers can play a basic role in the comprehensive health security of the whole region. Strengthen guidance and coordination, promote the establishment of long-term and stable two-way referral cooperation between community health institutions and large hospitals under their jurisdiction, make them rationally divide their work, misplace their services, closely cooperate and support each other, and strive to form a mechanism of graded medical care and two-way referral and a pattern of "minor illness" in the community and "serious illness" in the hospital. In view of the relatively weak strength of community health service talents, we can coordinate and guide community health institutions to cooperate with large hospitals to establish a talent training and exchange system, arrange medical staff from community hospitals to take turns to go to large hospitals for further training, and also arrange medical staff from large hospitals to practice in community health institutions to promote the overall quality of health service teams in our region. Third, we should continue to strengthen the standardized management of community health service institutions. Continue to strengthen the construction of software and hardware and the introduction of talents, further strengthen the standardization of community health services, optimize the medical environment and process, and strive to create convenient and family-friendly health services. On the basis of implementing service standards and consolidating existing service achievements, we will innovate service methods and take the form of community rounds and follow-up services to further improve the level of community services. Cultivate characteristics, create advantages, support the development of a number of community health service institutions featuring traditional Chinese medicine and rehabilitation, enhance competitive advantage and improve efficiency. Do a good job in supervision and inspection and business guidance, and urge community health service institutions to improve their service functions and improve their service level. Establish a system of government purchasing services, around the six functions of community health institutions, formulate an assessment plan for target responsibility system management of community health service institutions, quantify assessment indicators, especially take the satisfaction rate of the masses as an important basis for assessment, and combine the completion of public service functions with government investment. Establish an assessment and reward system, and extract a certain proportion of health funds from community health service institutions as assessment and reward funds. According to the assessment results, the way of replacing compensation with awards is adopted to mobilize the enthusiasm of community health service institutions to carry out public health services and promote their transformation from for-profit to public welfare and for-profit.

3. Solve the problem of expensive medical treatment for the masses within its power. First, focus on solving the problem of medical treatment for key groups. Focusing on women, children, the elderly, patients with chronic diseases, the disabled and poor residents, we will carry out in-depth medical treatment, prevention, health care, rehabilitation, health education and diagnosis and treatment services for common and frequently-occurring diseases. Second, we must continue to carry out Huimin medical services. We will continue to implement the existing medical assistance subsidy policies such as "four exemptions", "ten promises" and "ten concessions" in our district. On the basis of the medical assistance measures for urban residents with difficulties promulgated by the municipal government, we will increase the medical assistance for special groups according to the scope of our district's power and financial resources, and take outpatient medical assistance, partial fee reduction and one-time treatment for low-income households, urban fringe groups and chronic patients who have not participated in medical insurance. Third, explore the practice of centralized bidding and purchasing drugs. In view of the fact that drug prices account for a large part of people's medical expenditure, our district should explore ways to strengthen the unified supervision of drugs. Consideration can be given to coordinating medical institutions in the jurisdiction to form a drug procurement alliance, so as to reduce the drug procurement price as much as possible and provide benefits to residents.