中國醫(yī)院管理體制和醫(yī)療對外開放政策ManagementofChineseHospitals.ppt

1、中國醫(yī)院管理體制和醫(yī)療對外開放政策Management of Chinese Hospitals and the Opening up policy of Medical Care in China,醫(yī)政司 張宗久副司長 Vice director of Department of Medical Administration Mr. Zhang Zongjiu,提 要Outline,一、醫(yī)院管理體制 Management of hospitals 醫(yī)院管理 Hospital management 醫(yī)護人員管理 Medical staff management 醫(yī)療技術(shù)臨床應(yīng)用管理 Manag

2、ement of Clinical application of medical techniques 建立和完善國家醫(yī)療質(zhì)量保障和持續(xù)改進體系 Establish and develop national medical quality and continuous improvement system 二、醫(yī)療對外開放政策 Opening up policy of medical care 中外合資、合作醫(yī)療機構(gòu)管理 Management of Sino-foreign equity joint and cooperative joint medical institutions 外籍醫(yī)師

3、在華行醫(yī)管理 Management of foreign doctors working in China,一、中國醫(yī)院管理體制Management of Chinese Hospitals,（一）醫(yī)院管理Hospital management,醫(yī)院管理法規(guī)和制度 Rules and regulations of hospital management 醫(yī)院準入 Hospital certification 醫(yī)院類別 Hospital classification 醫(yī)院基本標準 Hospital basic standards 醫(yī)院功能和任務(wù) Hospital functions and ta

4、sks 醫(yī)院執(zhí)業(yè)規(guī)則 Hospital Professional Rules for doctors 目前中國醫(yī)院數(shù)量、分布和構(gòu)成概況 Number, distribution and structure of Chinas hospitals.,（一）醫(yī)院管理 Hospital management,1、 醫(yī)院管理法規(guī)和制度 Rules and regulations of hospital management 醫(yī)療機構(gòu)管理條例及其實施細則 Regulation on management of medical institutions and Detailed rules for imp

5、lementation 中外合資合作醫(yī)療機構(gòu)管理暫行辦法 Interim measures for management of Sino-foreign equity joint and cooperative joint medical institutions 醫(yī)院工作制度 Rules and regulations for hospitals 醫(yī)院工作人員職責 Responsibilities for medical staff in hospital 實驗室管理辦法 laboratory management 放射診療管理規(guī)定 Management of Radiotherapy,（一

6、）醫(yī)院管理Hospital management,2、 醫(yī)院準入制度-規(guī)劃設(shè)置審批制度 Hospital Certification-Examination and approval system 縣級以上地方人民政府衛(wèi)生行政部門根據(jù)本行政區(qū)域內(nèi)的人口、醫(yī)療資源、醫(yī)療需求和現(xiàn)有醫(yī)療機構(gòu)的分布狀況，制定本行政區(qū)域醫(yī)療機構(gòu)設(shè)置規(guī)劃 Health administration department above county levels shall make the plans for establishing medical institutions according to the popula

7、tion, medical resources, needs and the distribution of existing medical institutions in the region 設(shè)置醫(yī)院應(yīng)當符合醫(yī)療機構(gòu)設(shè)置規(guī)劃和醫(yī)療機構(gòu)基本標準，經(jīng)縣級以上地方人民政府衛(wèi)生行政部門審查批準，并取得設(shè)置醫(yī)療機構(gòu)批準書 The establishment of hospitals shall meet the criteria of medical institution standards, shall be approved by the Health administration depa

8、rtment above county levels and shall obtain the Approval Certificate for the Establishment of Medical institutions,（一）醫(yī)院管理 Hospital management,2、醫(yī)院準入制度-執(zhí)業(yè)登記制度 Hospital Certification-Practice registration 醫(yī)院執(zhí)業(yè)，應(yīng)申請執(zhí)業(yè)登記，領(lǐng)取醫(yī)療機構(gòu)執(zhí)業(yè)許可證 Practice registration is required and the practice shall be obtained. 申

9、請執(zhí)業(yè)登記，必須具備相應(yīng)條件 For practice registration, the following is necessary 設(shè)置批準書 Approval certificate 符合醫(yī)院的基本標準 Meeting the basic standards of hospitals 名稱、組織機構(gòu)、場所 Name, organizer and location 經(jīng)費、設(shè)施、設(shè)備、人員 Fund, facilities, equipment and staff 規(guī)章制度 Rules and regulations 獨立承擔民事責任 Ability to independently be

10、ar civil liability 醫(yī)院改變名稱、場所、負責人、診療科目、床位的，辦理變更登記手續(xù) If the following items, such as name, location, legal person, business scope is changed, such changes shall also be made in the business license.,（一）醫(yī)院管理Hospital management,3、醫(yī)院類別-根據(jù)醫(yī)院功能和任務(wù)、服務(wù)范圍等醫(yī)院分為 Hospital classification-according to functions, t

11、asks and scopes of services 綜合醫(yī)院 Comprehensive hospitals ?？漆t(yī)院 Specialized Hospitals 口腔醫(yī)院、腫瘤醫(yī)院、 兒童醫(yī)院、精神病醫(yī)院、傳染病醫(yī)院、皮膚病醫(yī)院、整形外科 醫(yī)院、美容醫(yī)院、康復(fù)醫(yī)院等 Dental Hospital, Tumor hospital , Childrens hospital, mental hospital, Infectious diseases hospital, dermatosis hospital, plastic surgery hospital, Cosmetic surger

12、y hospital, Rehabilitation hospital 中醫(yī)醫(yī)院、民族醫(yī)院醫(yī)院等 Hospitals of Chinese Medicine, Minority Hospital,（一）醫(yī)院管理 Hospital management,4、醫(yī)院基本標準-不同級別、類別的醫(yī)院有不同基本標準，包括事項 Hospital standards-different standards for hospital of different levels, including 床位 bed 科室設(shè)置（臨床、醫(yī)技） departments（clinical ,technical） 人員 staf

13、f 房屋 building 設(shè)備 equipments 規(guī)章制度、崗位責任、醫(yī)療護理技術(shù)操作規(guī)程 rules and regulations, position responsibilities, procedures for medical care techniques 注冊資金 registered capital,（一）醫(yī)院管理Hospital management,5、醫(yī)院功能和任務(wù) Hospital functions and tasks 開展診療服務(wù)活動，完成一定的預(yù)防、保健康復(fù)服務(wù) Offer diagnoses and treatments and other health

14、related services 接受轉(zhuǎn)診，開展疑難危重癥診療服務(wù)；接受基層醫(yī)療人員進修，指導(dǎo)、培訓基層醫(yī)務(wù)人員，完成衛(wèi)生支農(nóng)任務(wù)；遇特殊災(zāi)害、重大事故、疫情等，派出專家醫(yī)療隊進行緊急救援；承擔臨床教學、實習任務(wù)，開展臨床醫(yī)學研究，追蹤國際先進的臨床醫(yī)學領(lǐng)域 Accept transferred patients, research of difficult diseases, training of medical staff, fulfilling medical care tasks in the country side, sending medical team to acciden

15、t sites, internship, research of clinical techniques, learning international advanced techniques,（一）醫(yī)院管理 Hospital management,6、醫(yī)院執(zhí)業(yè)規(guī)則 Hospital practice rules 醫(yī)院必須按照核準登記的診療科目開展診療活動 Offer treatment according to the registered treatment scope 加強醫(yī)療質(zhì)量管理，確保醫(yī)療質(zhì)量和醫(yī)療安全 Strengthen medical quality management f

16、or the assurance of medical safety 定期檢查、考核各類人員崗位責任制執(zhí)行和落實情況 Examine, evaluate medical staff regularly 對醫(yī)務(wù)人員進行“三基”、“三嚴”的培訓與考核 Train and evaluate medical staff according to Three fundamentals and three musts 嚴格執(zhí)行無菌消毒、隔離制度，預(yù)防和減少醫(yī)院感染 Exercise sterilization and isolation rules, Prevention and control of n

17、osocomial infection,（一）醫(yī)院管理 Hospital management,6、醫(yī)院執(zhí)業(yè)規(guī)則 Hospital practice rules 加強病歷書寫與管理 Strengthen the management of medical records 加強醫(yī)務(wù)人員職業(yè)道德建設(shè) Promote professional ethics 對患者實行保護性醫(yī)療措施 Protective measures for patients 尊重患者的權(quán)利 Respect the rights of patients 被吊銷或注銷執(zhí)業(yè)許可證后不得繼續(xù)開展診療活動 Stop offering t

18、reatment after the license is suspended 醫(yī)院不得使用非衛(wèi)生技術(shù)人員從事醫(yī)療衛(wèi)生技術(shù)工作 Non medical staff are not allowed to be hired in medical care work,（一）醫(yī)院管理 Hospital management,7、實行醫(yī)院工作評價制度-醫(yī)院管理評價指南（試行） Hospital evaluation system- Hospital Management Evaluation Guide （for trial implementation） 2005年3月衛(wèi)生部發(fā)布醫(yī)院管理評價指南（試行

19、） Hospital Management Evaluation Guide issued by the Ministry of Health in March, 2005 目標：為人民群眾提供優(yōu)質(zhì)、安全、經(jīng)濟的醫(yī)療服務(wù) Goal：provide good, safe and economical medical service 核心內(nèi)容：持續(xù)改進醫(yī)療質(zhì)量和保障醫(yī)療安全 Core content：improve medical quality and safety 重點突出 目標明確 Clear goals and key points 突出“質(zhì)量、安全、服務(wù)、費用、績效”等內(nèi)容 Emphas

20、ize quality, safety, service, fee and performance 注重內(nèi)涵建設(shè) Emphasize implementation,（一）醫(yī)院管理 Hospital management,7、實行醫(yī)院工作評價制度-主要內(nèi)容 Hospital evaluation system-Contents 評價指標 考核內(nèi)容 Evaluation index evaluation item 醫(yī)院管理 8 48 Hospital management 醫(yī)療質(zhì)量管理與持續(xù)改進 24 127 quality management 醫(yī)療安全 3 14 safety 醫(yī)院服務(wù) 4 2

21、7 Hospital service 醫(yī)院績效 3 15 Hospital performance 共計評價指標42 考核內(nèi)容231 evaluation index42 evaluation item231 部分統(tǒng)計指標（45項） Part of statistics（45） 三級綜合醫(yī)院指標參考值 Level one comprehension hospital as the reference,（一）醫(yī)院管理Hospital management,7、實行醫(yī)院工作評價制度-評價方式 Hospital evaluation system -method 自我評價 Self evaluati

22、on 同行評價（行業(yè)自律、自主監(jiān)控） Colleague evaluation（self discipline and self control） 社會評價：科學地利用社會調(diào)查方法評估醫(yī)療服務(wù)，力求客觀、公正、真實地 反映社會和群眾的意見，促進為患者提供更加優(yōu)質(zhì)的醫(yī)療服務(wù) Social evaluation：use social survey, take into consideration the opinions of people to promote the development of medical service 患者的評價（院內(nèi)、院外） Patients evaluation（

23、in hospital、outside hospital） 各省可以制訂細則，也可根據(jù)執(zhí)行情況適時進行修訂、完善 The provincial medical departments can make detailed rules or adapt this one,（一）醫(yī)院管理Hospital management,8、醫(yī)院校驗制度 Hospital examination regulation 醫(yī)院應(yīng)遵守國家醫(yī)療機構(gòu)檢驗制度 Hospitals shall abide by the national examination regulation 根據(jù)醫(yī)院規(guī)模和服務(wù)范圍，醫(yī)院校驗分為1年和

24、3年校驗 Hospital examination period is 1 year or 3 year according to the scale of hospitals 醫(yī)院應(yīng)當于檢驗期滿前三個月向登記機關(guān)申請辦理校驗手續(xù) Hospitals shall apply for the examination certificate three months before the end of the examination period,（一）醫(yī)院管理Hospital management 2005年中國各?。ㄊ校┽t(yī)院分布情況Hospital Distribution in 2005,（

25、一）醫(yī)院管理Hospital management 2005年 各 類 醫(yī) 院 構(gòu) 成Kinds of hospital in 2005,目前，中國共有醫(yī)院18703所，其中綜合醫(yī)院12982所，中醫(yī)醫(yī)院2620所，中西 醫(yī)結(jié)合醫(yī)院194所，民族醫(yī)院195所，?？漆t(yī)院2682所 Now, there are 18703 hospitals in China, including 12982 comprehensive hospitals, 2620 hospitals of Chinese medicine, 194 hospitals specialized in both Chinese

26、medicine and western medicine, 195 minority hospitals and 2682 specialized hospitals,（二）醫(yī)護人員管理Management of medical staff,1、醫(yī)院醫(yī)師管理 Management of doctors 執(zhí)業(yè)醫(yī)師和執(zhí)業(yè)助理 醫(yī)師 doctors and assistant doctors 醫(yī)師管理制度 management of doctors 醫(yī)院醫(yī)師概況 Overview of doctors in hospital 2、醫(yī)院護士管理 Management of nurses 護士管理制度

27、 Management of nurses 醫(yī)院護士數(shù)量和構(gòu)成 Number and structure of hospital nurses,（二）醫(yī)護人員管理Management of medical staff,1、醫(yī)師管理 Management of doctors 根據(jù) 中華人民共和國執(zhí)業(yè)醫(yī)師法 According to Law on Licensed Doctors of the Peoples Republic of China 醫(yī)師考試合后，獲得醫(yī)師資格證書，經(jīng)注冊領(lǐng)取醫(yī)師執(zhí)業(yè)證書后方可在注冊的執(zhí)業(yè)地點、執(zhí)業(yè)類別、執(zhí)業(yè)范圍內(nèi)執(zhí)業(yè) Doctors qualification ce

28、rtificates are issued to those who have passed the examination. After registration and getting the doctors license, they can work in the location registered. 醫(yī)師分為執(zhí)業(yè)醫(yī)師和執(zhí)業(yè)助理醫(yī)師 licensed doctors and doctor assistants 分為臨床類別、口腔類別、中醫(yī)類別、公共衛(wèi)生類別 classification: clinical, Stomatology, Chinese medicine, public

29、 health 臨床類別醫(yī)師可注冊為 17個專業(yè)等 there are 17 specialties available for registration for clinical doctors,（二）醫(yī)護人員管理 Management of medical staff,1、 醫(yī)師管理-管理制度 Management of doctorsrules and regulations 實行醫(yī)師資格考試制度 Examination for qualification 實行醫(yī)師執(zhí)業(yè)注冊制度 Registration 明確醫(yī)師權(quán)利和義務(wù) Rights and obligations 明確醫(yī)師執(zhí)業(yè)規(guī)則

30、Working rules 醫(yī)學處置規(guī)則 Medical practice 醫(yī)學出證規(guī)則 Doctors license 醫(yī)療急救規(guī)則 Medical first aid 臨床用藥規(guī)則 Clinical medication,病情告知規(guī)則 Symptom inform 實驗醫(yī)學規(guī)則 Experimental medicine 職業(yè)道德規(guī)則 Professional ethic 服從調(diào)遣規(guī)則 Order abide-by 報告規(guī)則 Reporting regulation 助理醫(yī)師執(zhí)業(yè)規(guī)則 Assistant doctors working rules 醫(yī)師定期考核和培訓制度 Regulatio

31、n examination and training system,（二）醫(yī)護人員管理 Management of medical staff 2005年執(zhí)業(yè)（助理）醫(yī)師分布Distribution of doctors (doctors assistants) in 2005,（二）醫(yī)護人員管理Management of medical staff,2、醫(yī)院護士管理-管理制度 Management of nurses 根據(jù)中華人民共和國護士管理辦法 According to rules and regulations for the management of nurses in China

32、 護士執(zhí)業(yè)考試制度 Examination for nurses 考試合格者，發(fā)給中華人民共和國護士執(zhí)業(yè)證書 Issue Practice license to candidates who passed the examination 護士執(zhí)業(yè)注冊制度 Registration required for nurses 護士注冊的有效期為二年 Registration valid for 2 years,（二）醫(yī)護人員管理Management of medical staff醫(yī)院護士管理-注冊護士數(shù)量和構(gòu)成management of nursesnumber of registered nur

33、ses and structure,（三）醫(yī)療技術(shù)臨床應(yīng)用的管理Management of medial technology and clinical application,醫(yī)療技術(shù)迅速發(fā)展：新的診斷、治療設(shè)備和藥品不斷問世為了加強對特殊醫(yī)療 技術(shù)臨床應(yīng)用的管理，規(guī)范特殊醫(yī)療技術(shù)在臨床的應(yīng)用，提高醫(yī)療技術(shù)水平和 醫(yī)療質(zhì)量，保障醫(yī)療安全，衛(wèi)生部正在制定： Fast development of medial technology: with the emergence of new diagnosis, treatment equipment and medicine, to promote

34、 the management of medical technology and improve medical e quality, the Ministry of Health is stipulating 特殊醫(yī)療技術(shù)臨床應(yīng)用管理辦法（20個項目） Management of specialized medical technology and its clinical application (20 projects) 四項技術(shù)的整頓、規(guī)范 Standardization of 4 techniques 人類輔助生殖技術(shù)管理 Management of Assisted Reprod

35、uctive Technology 器官（臟器）移植診療管理 Management of organ transplant 人工關(guān)節(jié)植入診療管理 Management of artificial arthroplasty 介入診療管理 Management of intervention treatment,（四）建立和完善國家醫(yī)療質(zhì)量 保障和持續(xù)改進體系Establish and develop national medical quality and continuous improvement system,醫(yī)療服務(wù)直接關(guān)系到人基本的生存權(quán)和健康權(quán)。醫(yī)療質(zhì)量是醫(yī)院生存和發(fā)展的生命線和永恒

36、主題，是衡量醫(yī)院發(fā)展狀態(tài)的核心內(nèi)容 Medical service is closely related to people right of life and health. medical quality is essential to the survival and development of hospitals and it is the benchmark of hospitals 建立國家醫(yī)療質(zhì)量保障和持續(xù)改進體系，是實行“以病人為中心”，保障病人安全和人民群眾身體健康的需要；是衛(wèi)生行政部門義不容辭的責任 Establishing such a system is to mee

37、t the need of Patient orientedprinciple and the safety of patients and people. It is the responsibility of medical departments,準入體系,控制體系,評價體系,監(jiān)督體系,信息監(jiān)測預(yù)警,醫(yī)療風險保險制度,（四）、建立和完善國家醫(yī)療質(zhì)量保障和持續(xù)改進體系Establish and develop national medical quality and continuous improvement system,（四）建立和完善國家醫(yī)療質(zhì)量 保障和持續(xù)改進體系Establis

38、h and develop national medical quality and continuous improvement system,中國醫(yī)療服務(wù)體系龐大，醫(yī)療質(zhì)量保障與持續(xù)改進體系的各個部分發(fā)展不平衡，有的已相對完善，有的在逐步探索之中。提高醫(yī)療質(zhì)量、保障醫(yī)療安全是今后完善醫(yī)療服務(wù)體系的重要內(nèi)容。 China has a large medical care network and the development of the different parts of the network is not balanced. Some are more advanced while

39、others are still trying to find the best way for development. It is of great importance to improve medical quality and guarantee medical safety.,二、醫(yī)療對外開放相關(guān)政策Opening up policy of medical care,醫(yī)療對外開放相關(guān)政策 Opening up policy of medical care,中國將本著符合國家基本國情，有利于提高醫(yī)療服務(wù)質(zhì)量和水平 ，有利于滿足群眾醫(yī)療服務(wù) 需求，促進國民健康素質(zhì)提高的原則，按照入世承

40、諾逐步開放牙醫(yī)和醫(yī)療服務(wù)市場 China will open Dentistry Market and medical market gradually according to its WTO accession commitments in order to improve medical service and meet the needs of people 可以通過現(xiàn)代通訊手段等向其他國家購買醫(yī)療咨詢、診斷、治療和醫(yī)學教育等服 務(wù)，或到境外購買醫(yī)療服務(wù)和醫(yī)學教育。在市場準入和國民待遇方面對此沒有限 制 buy services such as medical consultation

41、, diagnosis, treatment from other countries through advanced communication technology or going to foreign counties to buy such services. There is no restriction in this respect 允許外資與中方合作伙伴合作設(shè)立中外合資合作醫(yī)院。在準入和數(shù)量方面有一定要 求和限制 Allow the establishment of foreign Chinese joint hospitals. There are certain req

42、uirements for the number of such hospitals 允許具有本國辦法的專業(yè)證書的境外醫(yī)師，在獲得我國省級以上衛(wèi)生行政部門的許 可后，在中國提供短期的醫(yī)療服務(wù) Allow foreign doctors provide medical services for short period of time after being approved by the medical department above provincial levels,醫(yī)療對外開放相關(guān)政策Opening up policy of medical care,（一）中外合資合作醫(yī)療機構(gòu)管理 M

43、anagement of Sino-foreign equity joint and cooperative joint medical institutions 設(shè)置要求 Requirements 設(shè)置審批和登記程序 Approval and registration procedurs 執(zhí)業(yè)規(guī)則 Practice rules 目前概況 Status quo （二）外籍醫(yī)師在華短期行醫(yī) Foreign doctors practice in China on a short term basis,醫(yī)療對外開放政策Opening up policy of medical care,（一）中外合

44、資、合作醫(yī)療機構(gòu)管理-設(shè)置要求 Sino-foreign equity joint and cooperative joint medical institutions establishment requirement 根據(jù)中外合資、合作醫(yī)療機構(gòu)管理暫行辦法 according to Interim Measures for the Administration of Sino-foreign Equity Joint and Cooperative Joint Medical Institutions 符合當?shù)貐^(qū)域衛(wèi)生規(guī)劃和醫(yī)療機構(gòu)設(shè)置規(guī)劃，并取得國家衛(wèi)生行政部門設(shè)置批準 Conform

45、to the local medical planning and has been approved by related medical administrative department 總額不得低于2000萬人民幣。合資、合作中方股權(quán)比例或權(quán)益不得低于30% At least 20 million RMB. The Chinese partner must have at least 30% of the shares 合作各方應(yīng)是能夠獨立承擔民事責任的法人；具有直接或間接從事醫(yī)療衛(wèi)生投資與管理的經(jīng)驗 The partners must have the ability to inde

46、pendently bear civil liability and experienced in medical care services directly or indirectly 合作各方能夠提供國際先進的醫(yī)療機構(gòu)管理經(jīng)驗、管理模式和服務(wù)模式；或提供具有國際領(lǐng)先水 平的醫(yī)學技術(shù)和設(shè)備；或可以補充或改善當?shù)卦卺t(yī)療服務(wù)能力、技術(shù)、資金和醫(yī)療設(shè)施方面的不 足 Able to provide advanced medical service, advanced management, or advanced technology and equipment to compensate for

47、 the lack of resources in the region. 合作期限不超過20年 Maximum cooperation period is 20 years,醫(yī)療對外開放政策Opening up policy of medical care中外合資、合作醫(yī)療機構(gòu)的管理-設(shè)置審批與登記程序approval and registration procedure of Sino-foreign equity joint and cooperative joint medical institutions,向所在地設(shè)區(qū)的市級衛(wèi)生行政部門提出申請,報所在地省級衛(wèi)生行政部門審核,報 衛(wèi)

48、生 部 審 批,向外經(jīng)貿(mào)部提出申請,到國家工商行政管理部門辦理注冊登記手續(xù),向所在地省級衛(wèi)生行政部門規(guī)定的衛(wèi)生行政部門申請執(zhí)業(yè)登記,中外合資、合作醫(yī)療機構(gòu)不得設(shè)置分支機構(gòu) Sino-foreign equity and cooperative medical institutions shall not establish subsidiary,申請在中國境內(nèi)設(shè)立外商獨資醫(yī)療機構(gòu)的，不予以批準 Applying to establish solely foreign-owned medical institution in China shall not be approved,醫(yī)療對外開放政

49、策Opening up policy of medical care,（一）中外合資、合作醫(yī)療機構(gòu)管理-執(zhí)業(yè)規(guī)則 Management of Sino-foreign equity joint and cooperative joint medical institutions-rules and regulations for practice 必須遵守國家有關(guān)法律、法規(guī) Abide by national laws and regulations 獨立法人實體，營利性醫(yī)療機構(gòu)，獨立承擔民事責任 Independent legal entity, profitable medical institution, able to bear independently civil liability 必須執(zhí)行醫(yī)療機構(gòu)執(zhí)業(yè)規(guī)定、醫(yī)療技術(shù)準入規(guī)范和臨床診療技術(shù)規(guī)范，遵守新技術(shù)、新設(shè)備及大 型醫(yī)用設(shè)備臨床應(yīng)用有關(guān)規(guī)定 Abide by the