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Policy for Health Care

In: Business and Management

Submitted By Renhq1991
Words 581
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国家层面:
1、政策利好 新医疗改革走向纵深发展
2014年4月15日,8部委出台《关于印发做好常用低价药品供应保障工作意见的通知》,正式取消低价药品最高零售限价,迈出药改新一步。
4月24日,2014年药交会在苏州召开。综合药交会上传递出的信息,我们拟从宏观政策动向、价改建言以及新近资本市场热炒的药房托管这三方面,探究新医改的必选项之一——药改的实际归途。
基本药物制度改革的过程中,药品流通行业将发生翻天覆地的变化,未来药品流通行业集中度会呈现几何式上升,流动集中度大,中小流通企业会进一步减少,这是因为村乡一体化等会拉长渠道,增加对覆盖率、保供率的要求,同时,渠道变宽拉长将成为不可逆转的趋势。
在有关部委适时启动行业法规修订工作的前提下,医药工业必须加快自身结构调整和转型升级,重点是加快技术进步开发,推动兼并重组和优化组织结构,提高国际化水平和培育新的出口增长点。

2、放开价格
2014年4月9日,国家发展和改革委员会、卫计委、人力资源社会保障部公布放开非公立医疗机构医疗服务价格、鼓励社会办医的一揽子政策措施,以充分发挥价格杠杆作用,引导和鼓励社会资本加快进入医疗卫生领域,增加医疗服务供给,推动多元化办医格局的形成,缓解看病难的矛盾。
根据三部门公布的《关于非公立医疗机构医疗服务实行市场调节价有关问题的通知》,各省(区、市)今年6月底前向社会发布本辖区内公立医疗机构名录,名录之外的所有医疗机构为非公立医疗机构,其提供的医疗服务价格实行市场调节。非公立医疗机构可结合自身特点,向社会提供多元化的医疗服务。 * 6月底前发布公立医疗机构名录,其余为非公立医疗机构 * 将符合相关规定的非公立医疗机构纳入医保,执行与公立医院相同的报销支付政策

3、生部2012年5月21日发布《卫生部关于社会资本举办医疗机构经营性质的通知》明确社会资本可以按照经营目的,自主申办营利性或非营利性医疗机构。通知称,为深化医药卫生体制改革,各地积极鼓励和引导社会资本举办医疗机构,但是部分地区未及时确定新设置审批医院的级别。为加强管理,确保设置审批医院按照规定开展诊疗活动,卫生行政部门在设置审批社会资本举办的医院时,应当根据《医疗机构管理条例》、《医疗机构设置规划》以及该医院的功能任务、服务半径等,及时确定其级别,并在《设置医疗机构批准书》“其他”栏目中予以明确。对于未定级的社会资本举办的医院,卫生行政部门要按照规定尽快完成定级工作。

4、(2010.12)为鼓励和引导社会资本发展医疗卫生事业,发改委、卫生部等五部委《关于进一步鼓励和引导社会资本举办医疗机构意见》3日发布。 意见提出了6条措施放宽社会资本举办医疗机构的准入范围,包括鼓励和支持社会资本举办各类医疗机构,自主申办营利性或非营利性医疗机构;调整和新增医疗卫生资源优先考虑社会资本;合理确定非公立医疗机构执业范围,确保与其具备的服务能力相适应;鼓励社会资本规范参与公立医院改制;进一步扩大医疗机构对外开放,将境外资本举办医疗机构由目前的限制类调整为允许类外商投资项目,逐步取消对境外资本举办医疗机构的股比限制,对外商独资医疗机构先行试点、逐步放开;中外合资、合作医疗机构的设立审批权限由国家下放到省一级,外商独资医疗机构的设立由卫生部和商务部审批。 国务院医改领导小组办公室负责人表示,《关于进一步鼓励和引导社会资本举办医疗机构的意见》(以下简称《意见》)着力于消除阻碍非公立医疗机构,即俗称“民营医院”发展的政策障碍,使民营医院在准入、执业、发展等方面享受与公立医疗机构同等待遇。

地方层面:
上海
1、既要强化政府责任和投入,确立政府在保障基本医疗卫生服务中的主导地位,又要发挥市场机制作用,鼓励社会参与,提高运行效率,满足不同层次的医疗卫生需求,实现公平和效率的统一。

2、完善医疗资源规划和配置。坚持非营利性医疗机构为主体,营利性医疗机构为补充,公立医疗机构为主导,非公立医疗机构共同发展的办医原则,形成多种所有制并存,功能分工明确,医疗、康复、护理等门类齐全的医疗服务体系。营造公平的政策环境,引导社会资金进入医疗服务领域,形成公立医疗机构和非公立医疗机构有序竞争的格局。

3、2011年,上海市启动医师多点执业试点工作,截至目前,共有703人次医师申请并通过审批到社会医疗机构执业,占全市医师申请多点执业总数的70%。

4、完善社会医疗机构纳入医保定点的相关政策。完善医保定点相关规定,逐步扩大社会医疗机构纳入医保定点。

5、203年4月,上海市政府印发由14个部门联合制定的《关于进一步促进本市社会医疗机构发展的实施意见》,提出促进社会医疗机构发展的28项具体举措,在金融政策、土地政策、医保政策、财政政策、用人政策、设置审批等各方面进一步全力支持社会办医。 1)通过完善和落实支持政策,鼓励和引导社会资本举办医疗机构,优化本市医疗资源配置结构,力争到2015年,上海社会医疗机构床位数和服务量占全市总量的比例、办医质量和办医水平比2012年有明显提高,在全市建成和发展一批有一定规模、一定社会影响、一定品牌特色的社会医疗机构,为上海建设亚洲医学中心城市奠定基础。 2)将社会医疗机构统一纳入区县区域卫生规划,需要调整和新增医疗卫生资源时,在符合医疗机构的设置要求、医疗机构和床位调控标准及准入标准的条件下,优先考虑由社会资本举办医疗机构。鼓励有实力的企业、慈善机构、基金会、商业保险机构等社会力量举办医疗机构。 3)要以上海国际医学园、上海新虹桥国际医学中心为主要平台,鼓励和吸引社会资本以多种形式举办具有一定规模,以先进技术、优质服务和先进管理为特征的高端医疗机构和特色专科医疗机构。鼓励本市公立医疗机构充分利用优势学科和技术,与社会资本在两个国际医学园区内合资合作举办社会医疗机构。
(注:浦东新区的上海国际医学园,规划占地面积近12平方公里,截至2012年年底,园区已引进10家医疗机构、2家康复体检机构和3所高职院校;位于虹桥商务区的上海新虹桥国际医学中心,一期规划范围42.38公顷,预留拓展用地60公顷,已实施两轮社会融资,并与多家国际医疗机构签订引进协议。)
4)鼓励社会资本举办老年医疗护理、康复、精神卫生、儿科、产科等医疗服务供给不足的专科医疗机构。鼓励社会资本举办中医或中西医结合医疗机构、有条件的医药企业开设中医坐堂诊所。
湖南
1、省开展医师多点执业试点的医疗机构与地区为省部直医疗机构及株洲、衡阳两个地级市。

2、医师已注册的执业地点为第一执业地点,增加注册的执业地点依次为第二、第三执业地点,最多只能注册三个执业地点。

深圳
1、一是改革创新是深圳的根、是深圳的魂,市委市政府对举办民营医院的态度是非常开放的,有民营医院的创业者、投资者这样一支队伍,还有具有开放思想的领导班子和团队,深圳民营医院的发展会越来越好。二是政府发展民营医疗机构的规划为民营医院发展提供了很大的空间。三是政府鼓励支持高起点办医的政策会让民营医院大有可为,市委市政府近期研究了针对民营资本办医的方案,从土地、产业、财政、税收优惠、人才、住房保障、医保定点、药品和设备采购、创三甲奖励政策等九个方面给予优惠办医政策。深圳未来民营医院的发展大有作为,深圳民营医疗卫生事业的明天会更加美好。
2、2011年,市卫人委出台的《推进公立医院改革工作方案》明确提出,2015年,民营医疗机构占全市医疗服务市场份额提高到30%。

广东省
1、早在2010年,广东省就在国内率先颁布了《广东省卫生厅关于医师多点执业的试行管理办法》,规定具有副高级医学专业技术职务及以上任职资格、并在该技术职务上连续工作两年以上的医生可在省内选择三个执业地点。(含深圳)

浙江省(温州)
1、2012年9月,温州获得国务院医改办批准开展社会资本办医试点,成为医疗市场开放民间投资首个“吃螃蟹”的城市。当年10月中旬,已有10多家民资、外资企业与温州市政府及卫生部门签订16个社会办医意向书和协议书,涉及用地563亩,签约金额达55亿元。

2、 根据温州市出台的《关于加快推进社会资本举办医疗机构的实施意见》(下简称《意见》),全市民营医院不仅可以在审批准入、医保定点上与公立医院一样享有平等待遇,医生可以享受公立医院标准的事业单位社会保险和住房公积金,而且在用人、用地以及税收减免等方面也有了更多优惠。 1)在平等准入方面,《意见》规定,社会资本可以自主决策举办营利性或非营利性医疗机构,也可以通过合资合作、收购兼并、融资租赁等多种方式参与公立医院的改制重组。对于符合规定的民营医院,执行与公立医院相同的医保报销政策。 2)对于民营医院困扰已久的用人政策,《意见》提出,要力争通过3年探索实践,打破卫生技术人员身份限制,鼓励医生在公立医院和民营医院之间合理流动。其中,民营医院医生可以按照公立医院标准参加事业单位社会保险,享受同等住房公积金待遇,并在职称评聘、科研立项、参加学术活动、评先评优等方面,享受与公立医院医生同等的待遇 3)《意见》还落实了民营医院的用地和财税优惠政策。非营利性民营医院经县级以上人民政府批准,可以通过行政划拨的方式获得土地使用权,享受与公立医院同等的财税优惠政策。营利性民营医院则可以通过有偿使用方式取得土地使用权,医疗服务收入也可免征营业税

江西省
2014.4,省卫生计生委出台《关于加快推进社会资本举办医疗机构的若干意见》(以下简称《意见》),鼓励社会资本举办医疗机构,力争到2015年社会办医疗机构床位数和服务量均达到总量的20%,到2020年社会办医疗机构床位数和服务量均达到总量的30%,加快形成多元化办医格局。
http://www.jxwst.gov.cn/wsyw/201404/t20140409_319668.htm
1、我省在新建医疗机构时,将优先考虑符合标准的社会资本。(社会办医疗机构可自主申办营利性或非营利性医疗机构,科学制定本地区大型医用设备配置规划,按照社会办医疗机构设备配备不低于20%的比例,预留规划空间。鼓励社会资本举办儿童医院、康复医院、老年病医院、护理院、临终关怀医院等紧缺型医疗机构;鼓励社会资本包括外资合资、港澳台独资举办特色专科医院、中医医院和医疗旅游康复医疗机构;鼓励有资质的中医特别是名老中医开办中医诊所。)
2、《意见》明确了民营医院在医保定点、人才、学科建设方面享受与公立医院一样的平等待遇,实现公平竞争,并支持将符合条件的社会办医疗机构纳入新农合、医疗救助、大病免费救治、疾病应急救助等各类社会保障定点范围,执行同级别政府办医疗机构相同政策。
(将社会办医疗机构纳入当地人才引进总体规划,享有当地政府规定的引进各类人才的同等优惠政策。社会办医疗机构在技术职称评定、继续医学教育、全科医生培养、院长职业化培训等方面与政府办医疗机构享受同等待遇。协调支持具备较高管理能力和专业技术水平的社会办医疗机构成为医学院校的教学医院或临床教学基地。社会办医疗机构在临床重点学科、临床重点专科建设和科研课题申请、科研成果申报方面,享受政府办医疗机构同等待遇。)
3、鼓励社会资本参与国有企业所办医院、公立医院资源丰富地区和公立医院新建院区改制试点,优先选择并支持具有办医经验、社会信誉好的社会资本通过合作、兼并、收购等形式,参与公立医院改制。
4、在医师多点执业方面,允许和鼓励医务人员在不同举办主体医疗机构之间有序流动,探索政府办医疗机构卫生专业技术人员与所在单位通过签订有偿协议等方式,每周固定时间到社会办医疗机构执业。
云南
《云南省医疗机构管理条例》于2014年1月1日起实施。该条例用专门章节规定了医疗纠纷预防和处置的办法,并明确医疗机构应支持医师个人和技术团队到基层医疗机构和社会举办的医疗机构多点执业。
1、医疗机构应当支持医师个人和技术团队到基层医疗机构和社会举办的医疗机构多点执业。多点执业的管理办法由省卫生行政部门制定。
2、 社会举办的医疗机构与政府举办的医疗机构,在技术准入、医院等级评审、学科建设、人才引进、科研立项、基本医疗保险定点、卫生技术人员职称评定、继续教育等方面,享受同等待遇。
3、社会举办的非营利性医疗机构在扣除办医成本、预留发展基金以及按照国家有关规定提取的其他必需费用后,出资人可以从办医结余中取得合理回报。
4、各级政府应当通过购买服务、定额补助等方式,对社会举办的营利性医疗机构承担公共卫生等非营利性服务项目时给予补偿。

广西
该省几乎没有支持民营医院的政策,仍坚持公立为主导,少创新。

1、《广西壮族自治区医疗机构管理办法》2012年
县级以上人民政府应当将医疗机构建设纳入当地经济社会发展规划和城乡建设总体规划,整合和优化配置医疗资源;坚持公立医疗机构为主导、非公立医疗机构共同发展,非营利性医疗机构为主体、营利性医疗机构为补充;落实医疗机构政府补助、补偿政策,建立和完善覆盖城乡居民的医疗服务体系。

西藏
1、城乡医疗救助“一站式”即时结算,使符合医疗救助条件的城乡医疗救助对象在医疗救助“一站式”即时结算定点医疗看病就医时,可通过在各定点医疗机构设立的医疗救助即时结算平台申请即时结算服务,救助对象结账时,扣除城乡基本医疗保险报销补偿后,医疗机构按照民政部门规定的救助比例、救助金额等相关内容,计算并先行垫付救助对象应享受的医疗救助金额。救助对象出院时只需支付各种报销及补助后属于自付部分的医疗费用。定点医疗机构作为结算单位,医疗救助费用由定点医疗机构垫支、民政部门定期结算。

福建
(泉州和莆田是民营医院改革前沿)
1、民营医院人才建设方面:
1)2013年,福建已确定设立民营医院专项事业编制。创新民营医院引才机制,设立专项事业编制,性质与公立医院的编制性质相同,根据人才意愿,允许引进人才直接挂靠到高校、科研院所以及公立医疗机构等平台,退休前纳入事业单位编制管理,退休后享受事业单位同类人员同等待遇。
2)2014年开始,福建将有更多公立医院医生可到民营医院执业,享有民营医院事业编制的医疗人才范围也将扩大(福州、厦门、漳州、泉州、莆田等5市已开展医师多点执业试点工作)。自深化医药卫生体制改革工作全面铺开后,福建着力出台并落实一系列鼓励医疗人才流动、支持民营医院引进人才的政策,为民营医院解决发展瓶颈。
3)入闽执业的台湾医师也为民营医院发展注入了力量。
4) 泉州,公立医院选派业务骨干和管理人员助理民营医院。二甲及以上综合或专科民营医院,可向所在县(市、区)卫生局或市卫生局提出书面申请,由公立医院选派业务骨干,到民营医院挂职业务副院长,助理民营医院规范管理。与此同时,公立医院还可向民营医院派出管理人员,帮助民营医院完善医院各项工作制度,通过临床带教、接收人员进修、开展住院医师规范化培训等方式,帮助协作医院建立人才梯队。民营医院开展的医学科研项目,泉州市卫生局也将参照公立医院的程序和标准予以补助。

2、对口帮扶政策
福建努力完善公立医院对口帮扶非公立医疗机构机制,推动公立医院在医院管理、医疗技术、人才培养等方面与非公立医疗机构进行对口帮扶工作。具体的对口帮扶协作方式及帮扶周期等细则,可由医院双方商定,只要报主管局备案即可。

3、其他扶持政策
我省要加快社会资本办医步伐,力争到2015年,全省社会资本举办医疗机构床位数、医疗服务量达到全省总量的20%。
为鼓励和引导社会资本举办医疗机构,放宽市场准入,下放医疗机构设置审批的部分权限;并督促尚未制定社会资本办医具体政策的设区市尽快出台,明确社会资本举办医疗机构发展目标和重点领域。 此外,完善公立医院对口帮扶非公立医疗机构机制,创新帮扶模式,积极推进省肿瘤医院对泉州德诚医院帮扶工作。号召大医院、老医院发挥品牌优势,以无形资产、管理团队、医疗技术入股形式,引领社会资本举办医疗机构,并支持莆田市纳入国家社会办医联系点。

贵州
1、(2011年6月)各地在制定医疗机构设置规划师,要充分考虑非公立医疗机构的合理空间,在符合准入标准的条件下,优先考虑由社会资本举办医疗机构。

海南
1、资本参与公立医院改制,积极稳妥地把部分公立医院转制为非公立医疗机构,适度降低公立医院的比重,促进公立医院合理布局,形成多元化办医格局。统一规划、合理布局:对区域内医疗卫生资源的总量、结构和布局进行统筹规划、资源整合,在符合准入标准的条件下,优先考虑由社会资本举办医疗机构。促进发展、规范管理:完善相关配套政策,强化政府监管职能,促进不同所有制医疗机构合理竞争、共同发展。
2、社会资本举办医疗机构享受的土地、税收等优惠政策。 1)社会资本举办的非营利性医疗机构在费用减免方面与公立医院享有同等待遇。社会资本举办的非营利性医疗机构在扣除办医成本、预留发展基金以及按国家有关规定提取其他必要费用后,出资人可从办医结余中取得合理回报。 2). 新建、改扩建社会资本举办的医疗机构纳入当地城乡发展规划,优先安排用地指标。
3).社会资本举办的非营利性医疗机构在报建立项、水电气供给、环境保护等方面与公立医院享有同等待遇。
3、放宽社会资本举办的医疗机构市场准入条件。非公立医疗机构的设置应符合本地区区域卫生规划和区域医疗机构设置规划(按照本市县有关规定,经评估论证符合高端医疗服务项目准入条件的,可不受区域卫生规划及医疗机构设置规划限制)。各市县卫生行政部门在制定本地区域卫生规划、医疗机构设置规划和其他医疗卫生资源配置规划时,要为社会资本举办医疗机构提供良好的发展空间,并重点支持其在农村、城乡结合部、城市新区等医疗资源相对薄弱的区域布局。凡符合区域卫生规划和医疗机构设置规划,法律法规未明确禁止,一律应准予设置。
4、鼓励社会资本举办各种类型的医疗机构。社会资本举办的医疗机构可根据市场需求自主选择开设与其医院类别和功能相适应的诊疗科目,并报卫生行政部门依法核准。鼓励社会资本举办的医疗机构做精做优,支持和引导规模小、层次低、专科特色不明显的社会资本举办的医疗机构调整办医思路,向专、精、优的方向发展,不断提高竞争力。
5、支持社会资本举办的医疗机构加大人才队伍建设和人才培养力度。
1)社会资本举办的医疗机构在人才引进、技术职称考评、参加学术组织及学术活动、进修培训、科研课题招标及成果鉴定、临床重点专科及医学院校实习医院资格、评优选优、政策知情等方面享有与公立医院平等的待遇。
2)在确保医疗服务质量的前提下,鼓励副高以上职称的医务人员或医疗技术团队在社会资本举办的医疗机构开展多地点执业。
3)鼓励社会资本举办的医疗机构科技创新。
4)支持社会资本举办的医疗机构加大人才队伍建设和人才培养力度。
5) 鼓励社会资本举办的医疗机构引进高层次的医疗团队及卫生人才。 社会资本举办的医疗机构引进的高层次留学回国人员首次申报我省专业技术资格评审,不受原有职称和任职年限的限制。.社会资本举办的医疗机构引进的留学回国人员在国外获得硕士、博士学位的,留学时间与出国前在国内的工作时间和来我省工作时间合并计算连续工龄。.社会资本举办的医疗机构应积极帮助调动来我省的高层次人才解决户口落户及配偶、子女就业和就学问题,按其学历、资历、能力安排适合的工作。单位自行安排有困难的,可提请政府有关部门协助解决。随调随迁配偶、子女的就业问题由用人单位与同级政府人事部门协调解决。
6、海南省鼓励社会资本投资医疗服务体系建设项目(2011-2015)
新建民营,营利或非营利医院:心血管糖尿病医院一所,肛肠医院一所,口腔医院一所,老年病或护理院一所,海南国际健康城一所,中俄旅游康复疗养基地。 营利或非营利医院,以合作方式参与公立医院改制:三级综合医院2所

湖北省(2011年)
1、放宽准入范围:鼓励和支持社会资本举办各类医疗机构,调整和新增医疗卫生资源要优先考虑资本社会,鼓励社会资本参与公立医院改制。支持公立医疗机构的卫生技术人员和管理人员在自愿解除与本单位的工作关系后,领办创办各类非公立医疗机构。允许有实力的非公立医疗机构托管公立医疗机构。简化和规范社会资本举办医疗机构市场准入程序。
2、创造良好的执业环境:支持非公立医疗机构加大人才队伍建设,加强对非公立医疗机构的技术指导。鼓励卫生人才在公立和非公立医疗机构之间合理流动,鼓励公立医疗机构注册医师选择包括非公立医疗机构在内的多点执业。支持非公立医疗机构加强临床科研和科技创新。支持非公立医疗机构废纸大型医用设备,在同等条件下应优先核准或审批。鼓励政府购买非公立医疗机构提供的服务。将符合条件的非公立医疗机构纳入医保定点范围。
3、加大政策支持力度。落实非公立医疗机构价格税收扶持政策。社会资本举办的非营利医疗机构按照国家规定享受税收优惠。非公立医院的用水用电用气用热与公立医疗机构同城同价。完善非公立医疗机构土地和金融政策。建立公共财政激励社会资本办医机制,对投资举办500张床位以上的综合医院或100张床位以上的专科医院的新建非公立医疗机构,属地政府给予一定的政策优惠或奖励。完善非公立医疗机构变更和退出的相关政策。
重庆
1、加大对非公立医院的财政支持。完善财税扶持,对非公立医疗机构医疗服务收入免征营业税。社会资本举办的非营利性医疗机构享受与公立医疗机构相同的土地使用政策。支持合理购置大型医用设备。
2、将符合条件的非公立医疗机构纳入医保定点范围,执行与公立医院相同的报销政策。
3、推行医师多点执业改革试点。非公立医疗机构医务人员在职称评聘、科研立项、参加学术活动、评先评优等方面享有与公立医疗机构同类人员相同待遇。
四川
1、放宽准入。鼓励和支持社会资本举办各类医疗机构,鼓励社会资本参与公立医院改制重组。
2、改善执业环境:落实非公立医疗机构价格和税收政策。将符合条件的非公立医疗机构纳入医保定点范围。支持非公立医疗机构配置大型医用设备。

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