11陕西03娄勤常务副省长郑小明副省长在全省深化医药卫生体制改革工作会议上讲话

　 娄勤俭常务副省长郑小明副省长在全省深化医药卫生体制改革工作会议上的讲话

　陕政通报 第62期

　（2011年3月11日）

　2011年4月29日 省政府办公厅 【字体：大 中 小】 【 打印本页 】 【 关闭本页 】

　 娄勤俭常务副省长的讲话

　 今天的全省医改工作会议，是省政府决定召开的一次重要会议。主要任务是贯彻落实全国医改工作会议精神，总结我省前一阶段医改工作，对全省医改工作进行再动员、再部署、再推进。借此机会，我向长期工作在全省医疗系统的全体医务工作者致以诚挚的问候和衷心的感谢！刚才，小明同志总结了我省医改工作情况，对今年医改工作进行了安排部署，并代表省政府与各市签订了《2011年医改工作目标责任书》，卫生部医管司副司长周军同志也作了重要讲话，我都赞成。会上表彰了2010年度医改工作先进市县和全省村卫生室规范化建设先进集体、先进个人，进行了大会交流发言。希望大家认真学习先进经验，坚决抓好贯彻落实，把我省的医改工作开展得有声有色，继续为全国医改探索经验。下面，我再讲三点意见。

　 一、提高认识，统一思想，进一步增强推进医改工作的坚定性和主动性

　 深化医药卫生体制改革是深入贯彻落实科学发展观的重大实践活动，是一项关系到千家万户健康福祉的重大民生工程。党中央、国务院对此高度重视。去年5月28日，胡锦涛总书记主持政治局集体学习时指出，要有效解决当前医药卫生领域存在的突出问题，明显提高基本医疗卫生服务的可及性，使群众看得上病、看得起病、看得好病。温家宝总理多次主持国务院常务会议，专题研究医改工作。李克强副总理亲任国务院医改领导小组组长，并多次主持召开会议研究部署医改工作，上个月主持召开了全国医改工作会议，并作出重要指示。可以说，对这次医改，中央决心之大、政策出台之密集、采取措施之有力、社会关注程度之高，都前所未有。省委、省政府一直高度关注医改工作进展情况。一年多来，我省上下认真贯彻落实中央决策部署，各级各部门齐心协力，紧紧围绕五项重点任务，扎实工作，精心实施，推进有序。总体来看，我省医改工作方向明确、思路正确、措施得力、成效显著。今年是“十二五”开局之年，也是医改工作的攻坚之年。各级各部门要进一步提高认识，统一思想，切实增强工作的坚定性和主动性，继续推进全省医改工作不断深入。

　 第一，要深刻认识推进医改是贯彻落实科学发展观的必然要求。科学发展观的核心是以人为本，发展的根本目的在于满足群众日益增长的物质文化需求。健康属于生理和安全需求的范畴，是人的最基本的需求和实现全面发展的基础。医改的总体要求就是要坚持公共医疗卫生公益性质，把基本医疗卫生制度作为公共产品向全民提供，逐步实现人人享有基本医疗卫生服务，是贯彻科学发展观，坚持以人为本，推进城乡统筹发展、构建和谐社会的必然要求。“十二五”时期，陕西要实现富民强省。深化医改是富民强省的基本内容之一，是提高人民群众幸福指数的基础，是切实改善民生的着力点和落脚点。

　 第二，要深刻认识推进医改深入是转变经济发展方式的重大举措。转变经济发展方式贯穿于经济社会发展全过程和各个领域。医改的一个重要目的，就是要构建群众看病就医的安全网，这不仅有利于群众的健康，还能缓解群众的后顾之忧，增强居民群众的消费信心，有利于扩内需、转方式、促发展。健康是人生的第一财富，也关系国家和民族根本。“十一五”期间，我省的经济社会发展取得长足进步，全省生产总值年均增长148%，迈入了万亿元的俱乐部，上升到全国第17位，人民生活水平大幅度提升。居民的收入大幅度提升，又对医疗卫生提出了更高的要求。我省“十二五”规划中要求，到“十二五”末我省要进入中等发达省份行列。这个期间人们会越来越重视医疗和健康问题，对生活的水平和质量以及医疗卫生需求将会有更多的期待。但是，我省经济增长主要依赖投资拉动的格局没有变，消费和出口对经济增长的贡献率还比较低。从西部大开发的要求来看，我省正处于快速发展、高速发展的时期，在这个时期，我们要考虑到可持续发展，就须在高速发展的时期注重科学发展，注重协调发展。深化医药卫生体制改革能够减轻老百姓的经济负担，消除了后顾之忧，也就是说能增强老百姓的消费信心，扩大了消费需求，增强消费在经济发展中的作用，进而也会带动医药卫生领域投资的增长。而医药等相关产业的发展，又会反过来推动经济发展方式的转变。

　 第三，要深刻认识深化医改是推进社会领域改革的重要内容。经济社会越是快速发展，我们越要重视加强社会建设和保障改善民生，越要加快推进社会领域的改革，特别是政府职能要向经济调节、市场监管、社会管理、公共服务转变。医药卫生就是最大的公共产品，看病就医难的问题，凸显了政府在社会管理和公共服务某些方面存在的不足。深化医药卫生体制改革，把医药卫生服务这一公共产品送到千家万户，就是要使政府提高科学管理的水平，提高政府公共产品的保障能力、公共服务均等化的能力。把基本医药卫生制度作为公共产品向全社会提供，实现全民医保，公立医院改革中管办分开、政事分开、营利性和非营利性分开等有效做法，就是社会管理体制的重大改革，也必将推动政府在教育、住房等其他领域的改革创新。改革的最大受益者是中低收入群众，实际上也是对收入分配结构的再调整，十分有利于促进社会的公平正义与和谐发展。

　 第四，要深刻认识推进医改是保障和改善民生的现实需要。生命是最宝贵的，没有健康就没有全面小康。不断深入推进医改，既是提高全省人民健康水平的着力点和落脚点，也是我们坚持以人为本、执政为民，不断满足人民群众健康需求的一项基本职责，更是我们保障和改善民生的现实需要。2009年以来，我省按照党中央、国务院的统一部署，认真开展医药卫生体制改革，取得了显著的阶段性成效。但是随着医改工作的深入推进，受到影响的利益主体逐步增多，一些长期积累的深层次矛盾开始暴露，利益格局的调整难度不断加大，医改的复杂性和困难又进一步凸现。如医务人员总量不足，基层卫生人员缺乏，地方政府财力有限，城乡、区域发展差距大等等。这就要求我们必须进行大胆的探索，把市场经济的利益驱动与公平正义的均等化服务进行有机结合，不断的深化医药卫生体制改革，有效缓解群众十分关心的“看病难、看病贵”的问题，最终才能不断满足群众日益增长的健康需要。要认真分析医改难的症结所在，把长期纠结难缠的问题真正解决好，全力以赴把医改工作推向深入，坚决兑现党和政府对人民群众做出的郑重承诺。我省已经进行大胆探索试点，做了很多有力的工作，为后续发展打下了很好的基础。

　 二、理清思路，明确重点，全力推进今年的各项医改工作

　 今年的医改工作，承前启后，十分关键，基本思路是：

　 一是保基本。保基本是政府的主要责任。政府要在经济社会发展水平和财力允许的前提下，让人民群众享有基本医疗保障、基本医疗和公共卫生服务，实现基本医药卫生制度的广覆盖，覆盖城乡全体居民，并可持续长期运行。随着经济发展水平的不断提高，要适当提高政府补助的标准、报销的比例。我们省在这方面有很好的经验，不但政府大量投入，而且通过企业赞助设立基金的方式，调动各种社会资源加以保证。对于非基本的医药卫生服务，要注重发挥市场机制的作用。

　 二是强基层。就是要全面增强基层医疗卫生机构的服务能力，形成有效提供基本医疗卫生服务的平台和网络。从世界上一些国家的经验看，把医疗卫生重点放在基层，既可以方便群众看病治病，也能够有效控制医药的费用，基层工作不扎实，改革推进的难度就很大，一定要把强基层放在优先位置，做好基层项目建设，把更多物力、财力投向基层，把更多的人才、技术引向基层，使基层医疗卫生机构成为群众看病就医的首选。

　 三是建机制。就是要建立保障医药卫生体系规范有效运转的体制机制。当前工作的重点，是健全基本药物招标采购机制，完善基层医疗卫生机构补偿机制，形成公立医院协作、运行和竞争机制，建立医改资金筹措机制等等。各级和有关部门都要坚持统筹兼顾，正确处理政府与市场、公平与效率、纪律与约束的关系，找准工作切入点，大胆突破体制机制的障碍，尽快建立有利于增加服务、提高效率的长效机制。对市以上的医院也要加大投资建设力度，提高其诊治疑难杂病的能力。

　 医改是一项庞大的系统工程，只有坚持基本思路，按照统筹安排、突出重点、循序渐进的工作方法，才能确保人民群众得到实惠。今年的医药卫生体制改革工作中，要突出抓好以下三个重点：

　 一要推进五项任务。按照国家和我省签订的目标责任书的要求，我省医改主要任务共分五项重点10个大类、67项具体工作任务。这些具体工作指标中有的是医改启动以来就已经部署的，需要进一步巩固完善；有的是要新调整、新增加的项目，需要在今年启动实施；还有的是我省结合自身工作进展，开展的探索性工作。各市各部门要依据自身任务，明确工作重点，进一步细化工作方案，抓好工作落实，努力实现全民基本医保，人人享有基本的医疗卫生服务。

　 二要落实目标责任。刚才省政府与各市签订了责任书，省委省政府已经把医改工作作为年度目标责任考核的一项重要内容。各级各部门要形成政府主管领导负总责，分管领导具体负责，相关部门各负其责的工作机制，各级政府主要负责同志是本地区医改工作的第一责任人。各有关部门、各市要层层分解任务、层层落实责任，实行包干负责制。牵头部门对所牵头任务的完成情况负总责，要及时将任务分解到各地，制定进度计划，加强督促指导，配合部门要大力支持牵头部门工作，并完成分解到的具体任务。各级政府要把任务的实施进度细化到每个月，做到既有“时间表”，又有“路线图”。

　 三要勇于创新工作。由于我省各地经济社会发展水平差异较大，各地、各部门要坚定不移地贯彻落实省上已经确定的原则，因地制宜，创造性地开展工作。要在整合医疗卫生资源、基层医疗卫生机构人才培养和留用、提高基层医疗人员业务素质和待遇、政府购买服务等方面积极尝试符合本地区、本部门实际的新办法。要鼓励各类医院、各级部门不等不靠，大胆实践，总结完善。省医改办和各有关部门要认真分析当前医改工作中存在的困难和共性的问题，积极探索研究那些涉及面广、情况复杂、政策性强的问题，及时总结各地好的经验，制定好的办法来系统性地加以指导。

　 三、加强领导，加大投入，确保顺利完成今年各项医改任务

　 深化医改是重大民生工程，社会各界高度关注，人民群众充满期盼。各级各部门要高度重视，齐抓共管，勇往直前，确保顺利完成好各项改革任务。

　 一是加强领导，强化互动协调。各级政府医改领导小组要切实加强对医改工作的组织领导，及时研究、协调解决工作中遇到的各种困难和问题，确保领导到位、工作到位、措施到位。要进一步加强医改办的工作力量，切实保障医改工作的稳定性、持续性和深入性。各市县政府要尽快设立医改专职机构，组建医改专职队伍，不断提高其统筹协调医改工作的能力和水平。卫生、财政、人力资源和社会保障、物价、药监等部门，要坚持医改工作“一盘棋”思想，建立上下联动、部门协调、各方参与的工作机制，形成齐抓共管的良好局面。

　 二是加大投入，强化资金保障。尽快建立健全医改经费投入长效机制，统筹利用国家下达的基本公共卫生服务经费和各级财政投入，确保卫生投入增长高于经常性财政支出的增长幅度，要积极向上汇报衔接，充分发挥主观能动性，来争取国家的差异性政策支持。要建立政府主导的多元化投入机制，注重发挥市场机制作用，鼓励和引导社会资本发展医药卫生事业，努力形成投资主体多元化、投资方式多样化的办医方式。要健全资金使用管理办法，加大对医改资金的审计监督和对违法违纪案件查处的力度。

　 三是及时评估，强化信息报送。医改信息不仅是各级政府制定相关政策的基础和依据，还关系到国务院医改办对我省医改工作进展的准确判断和在全国的整体排序，直接影响到国家医改以奖代补资金的拨付。各级各部门要严格按要求做好医改信息的月报、季报工作，要及时将各地各部门的工作动态、典型经验、进展形势等相关信息上报省医改办，省医改办要定期进行公布，通报表扬典型，追究问责后进。近期要高度重视国家医改中期评估活动，全力做好评估所需信息的上报工作。

　 四是理顺机制，强化医患和谐。广大医务人员是推进医改的主力军。各级政府要切实关心和爱护医务人员，广泛听取医务人员对医改的意见和建议，切实维护他们的合法权益。要加快建立绩效工资制度，建立体现医务人员劳动价值的激励机制，稳步推动医务人员的合理流动。要倡导构建和谐的医患关系，为医务人员执业服务创造良好的环境，凝聚推进医改的智慧和力量，调动各方参与推动医改的积极性。

　 五是营造氛围，强化舆论宣传。要坚持正确的舆论导向，既要广泛宣传医改的方针政策，使改革深入基层、深入人心，又要科学引导社会预期，消除群众疑虑，增强群众信心，使社会各界和人民群众更加理解、支持、参与医改。要及时公布医改工作进展情况，认真推广好经验、好做法、好点子，主动接受媒体和社会监督，及时回应社会各界关心的问题，为深化改革创造良好的舆论氛围和社会环境。我省很多县区开展了很多有益的探索，希望新闻媒体要关心支持各个地方医改工作的大胆创新。

　 同志们，做好医改工作任务艰巨、责任重大、使命光荣，希望大家迎难而上，把这项社会各界广泛关注的重大民生工程抓紧抓好，为党和政府、为人民群众交上一份满意的答卷！

　 郑小明副省长的讲话

　 这次会议是一次规模比较大、规格比较高的会议，因为医改是一项关系老百姓切身利益的重大改革。大家都知道，医改是一个世界性的难题，在我国又是一个最大的民生问题，而且还没有一个成功的模式可以借鉴，是在实践中用试点的方法不断向前推进。国家对基层医药卫生体制改革提出了五项重点任务，要求从2009年开始到今年要基本完成。三年来，国务院每年都将年度任务专门分解下达，2009年提出了10个大类、35项具体工作任务，2010年提出了10个大类、60项具体工作任务，今年提出了10个大类、67项具体工作任务。从国家这三年的部署来看，每年都在不断地深化和细化医改工作，今年更是攻坚之年。

　 今天我主要讲两个问题，一是陕西的医改进展情况，二是今年医改的主要任务。后面，娄省长还要作重要讲话，我们要共同抓好贯彻落实。

　 一、陕西的医改进展情况

　 我省的医改在省委、省政府主要领导的亲自推动下，在卫生部的指导下，经历的是一个不断探索、不断改革、不断解决问题的过程，也是一个分层次、从下向上推进的过程。在实践的过程中，我们一直围绕着解决老百姓“看病难、看病贵”这一总体目标，本着遇到问题就解决问题的态度，一切从实际出发，一切从解决具体问题入手。两年多来，我省的医改在基层具体做了六件事情，也可以称为第一阶段的任务，主要是制度、框架和内容的完善。

　 一是完成了村卫生室标准化建设。近两年多来，我们对全省近三万个村卫生室进行了标准化建设，做到了“七个统一”，并选定了村医，提高了村医的报酬，去年从每月60元—120元增加到每月500元，今年还要提高到每月900元，也就是说村医的补助今年将不少于1万元。同时，全面提高了村卫生室的业务水平，增加了公共卫生和基本医疗服务的能力，基本实现了“疫情有人报、防病有人管、小病有人治、大病有人送”。

　 二是推进了乡镇卫生院的改革。对乡镇卫生院全部实行了财政全额拨款，用国债资金基本改造了所有业务用房，更新和配备了医疗设备。到去年年底，全面完成了乡镇卫生院人事制度改革和内部分配制度改革，做到了“院长全县统一竞选、公开竞争，工作人员全部聘用、能进能出，收入分配按岗计酬、能高能低”，初步建立了一套能最大限度调动每个人积极性的乡镇卫生院管理新机制。

　 三是全面实施了药品“三统一”。我们在全省乡镇、村和社区医疗机构中全面实施了药品“三统一”，做到了“统一采购、统一价格、统一配送”，到去年年底已经实现了全覆盖，并实行零差率销售，极大地降低了药费。两次集中采购的结果，中标品规零售价格与国家零售指导价和政府限价相比，平均降幅为4614%和5084%。今年药品“三统一”将进一步向县级延伸，但县级暂不实行零差率。

　 四是实施了“人才强乡”工程。重点做了两件事，一是实施“基层万名医生培训项目”。从去年9月开始全面启动，准备用5年的时间在第四军医大学等五所医学院，为每个乡镇和社区脱产一年培训5名（其中1名中医），共计1万名基层全科医生，每人省财政补助1万元，共计投资1亿元；今年开始对县一级培训，在三甲以上医院培训一年，每个县培训10名，每人补助两万元，也准备用5年的时间，为每个县培养50名医务人员，包括中医、口腔和妇幼专业；今年还要选三所医学院作为培养全科医生的基地，实行定向培养。前面两项是培训，后面一项是定向培养全科医生。老百姓“看病难”主要是没有好的医生，所以才舍近求远去看病，我们培养医生的目的就是要解决这个问题。二是全面推行了县镇两级医疗机构的人、财、物一体化管理，从体制上解决医生能上得来、下得去，整体解决基层全科医生短缺问题，进一步缓解老百姓“看病难”问题。

　 五是加快实施了“安心工程”。从去年开始解决乡镇医务人员有地方住、有地方吃、有地方洗澡和冬天取暖的问题，使乡镇医务人员能够安心在基层工作；今年要加大工作力度，50%的乡镇卫生院要完成这个任务。

　 六是医疗保障实现了全覆盖。目前，我省的农民、城镇居民（包括学生儿童）、职工全部纳入了医保范围，从政策上做到了应保尽保。去年各级财政对新农合、城镇居民的医保补助实现了统一标准，达到了每人每年120元，今年要提高到200元；去年在乡村、社区的门诊量已占到总门诊量的50%，在统筹区域内的报销比例占到了医疗总费用的60%，今年还要提高报销比例，达到70%；去年全省城乡人均基本公共卫生服务费达到了215元（全国平均是175元），我们做到了城市和农村一个标准，都是215元，今年还要提高到人均25元，公共卫生服务均等化水平将进一步提升。

　 二、今年医改的任务

　 2011年是“十二五”规划的开局之年，也是完成医药卫生体制五项重点改革三年任务的攻坚之年。今年的医改任务，全国医改会议已经明确，国务院办公厅也专门下发了“8号文件”。我把这个文件归纳为一句话：就是要全面完成五项重点改革任务，也就是10大类67项具体工作今年要全部完成。

　 今天，我省开这么大规模的会，就是要进一步动员起来，实行上下联动，一定要完成好这些任务。为落实好国家的会议和文件精神，3月1日赵省长专门主持召开了省医改领导小组第五次会议，审定了我省医改2011年度主要工作安排意见。这个意见也就是我省今年医改的主要目标和任务，已经印发给大家，并用签订责任书的办法来推动抓好落实。

　 今天，我着重讲一讲公立医院改革的事。医改有两大难题：一是基本药物制度的实施，二是公立医院的改革。我们已经用药品“三统一”实施了基本药物制度。

　 去年底以前，我们在基层医改做了六件事情，基本实现了“三个目的”：一是预防在基层，二是小病不出乡，三是强基层。但是还有两个问题在这个层次不能完全解决：一是治大病，二是保基本，这两个问题必须依靠县一级来解决。如果乡镇解决了50%的住院病人，县上再解决40%，县乡两级加起来就能解决90%的住院病人，这就能从医疗上实现“保基本”。我们去年在宝鸡市进行了试点，宝鸡市县乡两级解决了80%的住院病人，太白县达到了90%。如果县乡两级能解决90%，那就剩下10%的住院病人了，而这10%主要是难病、重病、杂病，县里也解决不了，必须再上一个层次，由三甲医院来解决。所以，现在来看，第二个阶段的任务就是改县、强县，改县和强县显得非常重要。这个重要性，陈竺部长讲得很透彻。今年春节前，腊月二十九，陈竺部长在榆林府谷调研时说：县医院改革的意义非常重大。县医院是我们国家广大农村区域的医疗中心，是县、乡、村三级卫生服务网络的龙头，又是公立医院系统最贴近人民群众的部分。县级医院覆盖了全国大概九亿多人口，占到了全国总人口的70%，公立医院改革如果在县级医院迈出重大一步的话，医改就大有希望。所以，县级公立医院改革是我省医改进行到今天必须走的路，是整个医改向前推进的必经阶段，是第二阶段的主要任务，也是我们今年的攻坚任务。

　 医改主要有三句话，叫作“保基本、强基层、建机制”。“强基层”我们这两年已经基本解决了，“保基本”我们正在解决，而“建机制”是整个医改过程中不断形成的制度体系。只有把县级问题解决好了，就能实现“小病不出乡、大病不出县、预防在基层”的医改总体目标，就能落实好李克强副总理提出的“保基本、强基层、建机制”的要求。从我省的改革过程来看，县乡村这三级卫生体系是保基本的，是公益性的，必须用政府行为来推进。市级以上医疗机构除了解决县乡两级剩余10%的难病、重病、杂病外，还要承担科研、教学、学科建设这些公益性任务，但还有能力承担非公益性的医疗工作，所以市级以上公立医院是以公益性为主、政府主导的医疗机构。这是我们近年来在实践中得出的基本看法，也是我们必须下大力气推动公立医院改革的主要原因。

　 公立医院改革可分两个层次，一是县级公立医院改革，二是市级以上公立医院改革。

　 （一）县级公立医院改革。

　 县级公立医院改革，去年8月份我们在子长县召开现场会进行了安排部署，并专门下发了两个指导性的文件。今年要全面进行试点和推动，共有三个方面：

　 一是县级公立医院综合改革试点。对县级公立医院综合改革试点，今年我们共确定了37个试点县，其中省级试点县5个。试点县要围绕两个指导文件和九项内容，在年内全部完成政策、制度、任务设计等工作。年底前，省卫生厅要对37个县级试点提出综合意见，为明年在全省全面推广做好准备。

　 二是县镇一体化管理改革试点。县上一般有三所公立医院，这三所医院和镇卫生院要做到人、财、物管理一体化。为什么要这么做呢？就是要实现医务人员上得去下得来，下得去也能上得来，要重新建立一套新的县镇一体化管理运行的新体制，解决基层卫生医疗技术薄弱的问题。

　 三是非试点县也要全面启动分项试点。试点内容按照《指导意见》自己选定，并将选定的内容上报备案。也就是说今年全省所有县级公立医院改革都要动起来。

　 （二）市级以上公立医院的改革。

　 宝鸡市作为全国16个公立医院综合改革试点城市之一，今年要进一步加大工作力度，完成基本制度和框架的设计，而且要全面实施；全省其余城市公立医院改革也要启动。重点从四个方面进行改革探索：

　 一是定位。要研究市级以上公立医院和县级公立医院的区别是什么？办市级公立医院主要解决什么问题？要办多少个？如何合理布局？都要进一步定位。

　 二是“四分开”。就是“政事分开、管办分开、医药分开、营利和非营利分开”。县以下公立医院主要是保基本的，医疗资源比较少，主要由政府举办，都是公益性的，暂时不探索“四分开”。市以上城市医疗资源比较多，而且又比较集中，另外三甲医院也不全都是公益性的，这一个特点比较明显，需要探索“四分开”。要在市一级探索什么问题？应该怎么分开？怎样建立法人治理结构？怎样进行集团化管理？这些都要进一步探索，在这些热点、难点问题上为全省公立医院改革总结出可借鉴的经验。

　 三是均等化。为什么要进行公立医院改革呢？尤其是市级以上的医院不改行不行，为什么要改它？其实，公立医院改革的最终目的，就是让生活在这个区域的人们都能均等地享受大医院的优质医疗资源。主要是通过改革，保证优质的资源能够在一定区域内实现均等化，从而能够进一步解决老百姓“看病难”的问题。大医院改革的目的主要是解决老百姓“看病难”的问题，基本药物制度主要是解决老百姓“看病贵”的问题。

　 四是借鉴县级公立医院改革内容。市级以上公立医院在改革的内容上要借鉴县级公立医院改革的经验，进行深入的研究、探索。去年，我在子长会上对县级公立医院改革讲了九个问题，但还有一个问题当时没有讲到，就是医院内部的管理。这个问题市、县都是共性的，陈竺部长在府谷调研时讲得非常清晰，他的讲话已专门印发给大家，要认真研究并落实好。

　 如果我们只提高医保标准，不抓医院内部管理，医院不控制医疗成本，检查不合理，用药不合理，我们提高的医保标准就有可能让不合理的支出给抵消掉了，也就等于花了冤枉钱，所以加强医院内部的管理、控制成本费用对解决老百姓“看病贵”就显得特别重要。我认为应该把这个问题作为第10个问题加进去，医院一定要研究内部的管理，这也是控制成本的重要问题。今年要提出一个要求：就是所有试点县都要扩大按病种付费。这是什么意思呢？现在卫生部在研究推广，比如做一个阑尾炎手术，从诊断、检查到手术、护理等需要哪些环节，这些环节都用什么、做什么、花费多少钱，要研究形成一个总的规范和标准，这就是按病种付费，也是合理控制成本。目前，府谷县推行了43个病种，镇安县推行了60多个病种。如果按病种付费能够达到我们看病总量的60—70%，我们增加的保障合理了，老百姓看病的费用也会逐步合理，这说明控制成本非常重要。所以，今天我们提一个要求，在各个县原来的基础上再增加10个病种，作为今年的考核指标。

　 这是我今天想给大家通报的两件事，一是我省医改的进展情况，二是今年的主要任务。我虽然讲的简单，但要真正做好并不容易，要把大病问题解决好，把保基本问题解决好，还需要付出更大的努力。

　 县级公立医院改革去年在子长会上安排后，一年来涌现出了8个不同类型的县级改革模式，这些典型都有一个明显的特点，就是这些地方的县委书记、县长都在积极主动地用心去抓这件事，所以才抓出了不同的模式和成效。大家都知道，看病对普通老百姓来讲就是天大的事，所以，我们必须带着感情去做好这一件事情，不要把它看成小事，要当作大事来做。什么叫带着感情？我经常在比喻，就像我们的父母在农村，看病还不十分方便；我们其实就是在给自己的“父母”做事情，有了这个感情，就一定能够克服困难完成任务。今天，让市、县政府一把手来开会，就是要明确一把手负总责，要亲自推动；分管领导要集中精力抓。我相信，同志们是有这个感情的，也是有这个能力，一定会把为人民的事情办好。

　the party. Focus on honesty and self-discipline standards of "four clean" "four consciousness", hold the work principle and various violations of party discipline punishment ...

　2. series spoke. To XI on ruling acting political XI General Secretary series important speech reading (2016 version) XI General Secretary important speech articles selected (leaders reading) and out poverty for basic textbook, in-depth learning understand XI General Secretary series important speech spirit and on Fujian work of series important indicates spirit, understand on reform development stable, and Interior diplomatic defense, and rule party ruling army of important discusses, understand throughout which of Marx doctrine position views method, Grasp the true faith through the pursuit of, historical sense, sincere feelings for the people, pragmatic style of thought. Should pay attention to the overall grasp and master relationship and prevent fragmentation. Address learning series, attention should be paid based on persisting and developing socialism with Chinese characteristics to the theme, focuses on understanding comrade XI Jinping as General Secretary of the CPC Central Committee on governance of the new concept of new ideas and new strategies. (1) the deep understanding we are carrying out the great struggle of history with many new features that China's development is an important period of strategic opportunities and the same connotation. (2) to grasp a firm system of socialism with Chinese characteristics theory of confidence, confidence, confidence, winning complete the building of a well-off society and realize "two 100 year" goal dreams, China and the great rejuvenation of the Chinese nation. (3) understand the domestic and international situations, coordination of "five in one" overall layout and four "comprehensive" strategy. (4) a deep understanding of innovation, coordination, development of green, open, shared ideas, adapt to new normal, grasp, leading economic development, greater emphasis on advancing the supply side structural reform, to lead the development of new development practices. Vigorous implementation of innovation-driven development strategy, strive to enhance the overall coordination of development to promote harmonious coexistence between man and nature, form the opening to the new system, focus on the practice of people-centred development. (5) in-depth understand full deepening reform, advance national governance system and governance capacity modern; makes market in resources configuration in the up decisive role and better play Government role; without shake insisted China basic economic system, promoted various ownership economic health development; advance "area way" construction, and Beijing Jin JI collaborative development, and Yangtze River economic with development; full law ruling, construction China features Socialist rule of law system; development Socialist democracy, insisted China features socialist political development road; Fostering and practicing the Socialist core values, enhance cultural values of confidence, self-confidence, building Socialist culture in China set up the overall national security concept, respect the sovereignty of networks, build global Internet governance system adhere to the correct view, building human fates. (6) to grasp the full strictness requirement, and strict adherence to the party's political discipline and rules, loyal, clean, play, strengthen the wind against corruption, adhere to the "Tigers" and "fly". (7) the

　the party. Focus on honesty and self-discipline standards of "four clean" "four consciousness", hold the work principle and various violations of party discipline punishment ...

　2. series spoke. To XI on ruling acting political XI General Secretary series important speech reading (2016 version) XI General Secretary important speech articles selected (leaders reading) and out poverty for basic textbook, in-depth learning understand XI General Secretary series important speech spirit and on Fujian work of series important indicates spirit, understand on reform development stable, and Interior diplomatic defense, and rule party ruling army of important discusses, understand throughout which of Marx doctrine position views method, Grasp the true faith through the pursuit of, historical sense, sincere feelings for the people, pragmatic style of thought. Should pay attention to the overall grasp and master relationship and prevent fragmentation. Address learning series, attention should be paid based on persisting and developing socialism with Chinese characteristics to the theme, focuses on understanding comrade XI Jinping as General Secretary of the CPC Central Committee on governance of the new concept of new ideas and new strategies. (1) the deep understanding we are carrying out the great struggle of history with many new features that China's development is an important period of strategic opportunities and the same connotation. (2) to grasp a firm system of socialism with Chinese characteristics theory of confidence, confidence, confidence, winning complete the building of a well-off society and realize "two 100 year" goal dreams, China and the great rejuvenation of the Chinese nation. (3) understand the domestic and international situations, coordination of "five in one" overall layout and four "comprehensive" strategy. (4) a deep understanding of innovation, coordination, development of green, open, shared ideas, adapt to new normal, grasp, leading economic development, greater emphasis on advancing the supply side structural reform, to lead the development of new development practices. Vigorous implementation of innovation-driven development strategy, strive to enhance the overall coordination of development to promote harmonious coexistence between man and nature, form the opening to the new system, focus on the practice of people-centred development. (5) in-depth understand full deepening reform, advance national governance system and governance capacity modern; makes market in resources configuration in the up decisive role and better play Government role; without shake insisted China basic economic system, promoted various ownership economic health development; advance "area way" construction, and Beijing Jin JI collaborative development, and Yangtze River economic with development; full law ruling, construction China features Socialist rule of law system; development Socialist democracy, insisted China features socialist political development road; Fostering and practicing the Socialist core values, enhance cultural values of confidence, self-confidence, building Socialist culture in China set up the overall national security concept, respect the sovereignty of networks, build global Internet governance system adhere to the correct view, building human fates. (6) to grasp the full strictness requirement, and strict adherence to the party's political discipline and rules, loyal, clean, play, strengthen the wind against corruption, adhere to the "Tigers" and "fly". (7) the

　grasp scientific methods of thinking and working, and view trends, patterns and events to strengthen strategic thinking and dialectical thinking, systems thinking, creative thinking, the bottom line thinking set up problem-oriented, focus on risk, fill the short Board; empty talks jeopardize national interests in mind, hard work and prosperous, a deployment, a nine-point implementation ... The content, comprehensively strengthen the ideological and political construction of the leading group, work style, and capacity-building. 3. the key to solve the problem. Seriously implement XI General Secretary on training created has iron general belief, and iron general faith, and iron general discipline, and iron General play of cadres team requirements, control acquisition General Secretary on "seven a has of" "five a must", important discusses, enhanced political consciousness, and overall consciousness, and core consciousness, and par consciousness, in thought political Shang action Shang with to XI comrade for General Secretary of Central keep height consistent, seriously practice line "three strict three real" requirements and good cadres standard, do heart has party, and heart has people, and heart has accountability, and Heart ring model. (1) the lead firm ideals and beliefs. For in "lift what flag, and go what road" Shang of fuzzy awareness, for belief lack, and faith missing, and spirit deficiency "calcium", problem, root, and guben culture Yuan, to upgrade Marx doctrine theory literacy, upgrade using party of theory innovation results observation and analysis problem of capacity, keep on Marx doctrine and Communist of firm belief, and on China features Socialist of firm faith, strengthened purposes consciousness, and practice line mass line, put ideal faith reflected to slim sets, and for political with right, and officer venture of aspects, Lofty ideals and the common ideal of exemplary practitioner. Clearly oppose and reject Western constitutional democracies, "universal values", neo-liberalism, the historical nihilism and questioned reform and opening up and building socialism with Chinese characteristics, such as erroneous. (2) lead to strict political discipline and rules. For political Shang of liberalism, not seriously implement implementation central decision deployment, not seriously actual implement implementation party of route approach policy, major problem important matters not asked not report, for dangmianyitao set, and Dang "on both sides people", for wind disciplinary make "four wind", for clique, and make mission groups guy, problem, seriously draw Zhou Yongkang, and Bo, and Xu caihou, and Guo boxiong, and makes plans and I province Su, and Xu gang, disciplinary illegal case of deep lessons, know fear, and Ming bottom line, and keep rules, Keep the political character of absolute loyalty to the party, political wise men, determined to uphold the authority of the Party Central Committee, maintaining the solidarity and unity of the party. (3) lead to set up the new development philosophy. For those not adapted, and not for even against new development concept of awareness, and behavior, and practices, for those blindly spell resources spell input, and first pollution Hou governance, and heavy city light rural, and heavy efficiency light fair, one-sided development, and deformity development of problem, insisted liberation thought, and times, set on new development concept of consciously confidence, do advocate innovation, and focused on coordination, and advocate green, and thick plant open, and advance shared. On

　grasp scientific methods of thinking and working, and view trends, patterns and events to strengthen strategic thinking and dialectical thinking, systems thinking, creative thinking, the bottom line thinking set up problem-oriented, focus on risk, fill the short Board; empty talks jeopardize national interests in mind, hard work and prosperous, a deployment, a nine-point implementation ... The content, comprehensively strengthen the ideological and political construction of the leading group, work style, and capacity-building. 3. the key to solve the problem. Seriously implement XI General Secretary on training created has iron general belief, and iron general faith, and iron general discipline, and iron General play of cadres team requirements, control acquisition General Secretary on "seven a has of" "five a must", important discusses, enhanced political consciousness, and overall consciousness, and core consciousness, and par consciousness, in thought political Shang action Shang with to XI comrade for General Secretary of Central keep height consistent, seriously practice line "three strict three real" requirements and good cadres standard, do heart has party, and heart has people, and heart has accountability, and Heart ring model. (1) the lead firm ideals and beliefs. For in "lift what flag, and go what road" Shang of fuzzy awareness, for belief lack, and faith missing, and spirit deficiency "calcium", problem, root, and guben culture Yuan, to upgrade Marx doctrine theory literacy, upgrade using party of theory innovation results observation and analysis problem of capacity, keep on Marx doctrine and Communist of firm belief, and on China features Socialist of firm faith, strengthened purposes consciousness, and practice line mass line, put ideal faith reflected to slim sets, and for political with right, and officer venture of aspects, Lofty ideals and the common ideal of exemplary practitioner. Clearly oppose and reject Western constitutional democracies, "universal values", neo-liberalism, the historical nihilism and questioned reform and opening up and building socialism with Chinese characteristics, such as erroneous. (2) lead to strict political discipline and rules. For political Shang of liberalism, not seriously implement implementation central decision deployment, not seriously actual implement implementation party of route approach policy, major problem important matters not asked not report, for dangmianyitao set, and Dang "on both sides people", for wind disciplinary make "four wind", for clique, and make mission groups guy, problem, seriously draw Zhou Yongkang, and Bo, and Xu caihou, and Guo boxiong, and makes plans and I province Su, and Xu gang, disciplinary illegal case of deep lessons, know fear, and Ming bottom line, and keep rules, Keep the political character of absolute loyalty to the party, political wise men, determined to uphold the authority of the Party Central Committee, maintaining the solidarity and unity of the party. (3) lead to set up the new development philosophy. For those not adapted, and not for even against new development concept of awareness, and behavior, and practices, for those blindly spell resources spell input, and first pollution Hou governance, and heavy city light rural, and heavy efficiency light fair, one-sided development, and deformity development of problem, insisted liberation thought, and times, set on new development concept of consciously confidence, do advocate innovation, and focused on coordination, and advocate green, and thick plant open, and advance shared. On

　the party. Focus on honesty and self-discipline standards of "four clean" "four consciousness", hold the work principle and various violations of party discipline punishment ...

　2. series spoke. To XI on ruling acting political XI General Secretary series important speech reading (2016 version) XI General Secretary important speech articles selected (leaders reading) and out poverty for basic textbook, in-depth learning understand XI General Secretary series important speech spirit and on Fujian work of series important indicates spirit, understand on reform development stable, and Interior diplomatic defense, and rule party ruling army of important discusses, understand throughout which of Marx doctrine position views method, Grasp the true faith through the pursuit of, historical sense, sincere feelings for the people, pragmatic style of thought. Should pay attention to the overall grasp and master relationship and prevent fragmentation. Address learning series, attention should be paid based on persisting and developing socialism with Chinese characteristics to the theme, focuses on understanding comrade XI Jinping as General Secretary of the CPC Central Committee on governance of the new concept of new ideas and new strategies. (1) the deep understanding we are carrying out the great struggle of history with many new features that China's development is an important period of strategic opportunities and the same connotation. (2) to grasp a firm system of socialism with Chinese characteristics theory of confidence, confidence, confidence, winning complete the building of a well-off society and realize "two 100 year" goal dreams, China and the great rejuvenation of the Chinese nation. (3) understand the domestic and international situations, coordination of "five in one" overall layout and four "comprehensive" strategy. (4) a deep understanding of innovation, coordination, development of green, open, shared ideas, adapt to new normal, grasp, leading economic development, greater emphasis on advancing the supply side structural reform, to lead the development of new development practices. Vigorous implementation of innovation-driven development strategy, strive to enhance the overall coordination of development to promote harmonious coexistence between man and nature, form the opening to the new system, focus on the practice of people-centred development. (5) in-depth understand full deepening reform, advance national governance system and governance capacity modern; makes market in resources configuration in the up decisive role and better play Government role; without shake insisted China basic economic system, promoted various ownership economic health development; advance "area way" construction, and Beijing Jin JI collaborative development, and Yangtze River economic with development; full law ruling, construction China features Socialist rule of law system; development Socialist democracy, insisted China features socialist political development road; Fostering and practicing the Socialist core values, enhance cultural values of confidence, self-confidence, building Socialist culture in China set up the overall national security concept, respect the sovereignty of networks, build global Internet governance system adhere to the correct view, building human fates. (6) to grasp the full strictness requirement, and strict adherence to the party's political discipline and rules, loyal, clean, play, strengthen the wind against corruption, adhere to the "Tigers" and "fly". (7) the

　grasp scientific methods of thinking and working, and view trends, patterns and events to strengthen strategic thinking and dialectical thinking, systems thinking, creative thinking, the bottom line thinking set up problem-oriented, focus on risk, fill the short Board; empty talks jeopardize national interests in mind, hard work and prosperous, a deployment, a nine-point implementation ... The content, comprehensively strengthen the ideological and political construction of the leading group, work style, and capacity-building. 3. the key to solve the problem. Seriously implement XI General Secretary on training created has iron general belief, and iron general faith, and iron general discipline, and iron General play of cadres team requirements, control acquisition General Sec