杜颖　胡正东　周良荣　秦裕辉

〔摘要〕 2016年10月，湖南省14个市州全面启动公立医院综合改革，成效显著。以药补医局面已从根本上扭转，分级诊疗有序推进，医疗费用过快增长有所遏制，薪酬制度改革积极试点。但仍面临公立医院绩效管理不规范、居民个人医疗经济负担过重、医保资金浪费等问题。需以公益性为导向，严控公立医院规模扩张，硬化政策执行和责任追究，提高医保资金使用效率。

〔关键词〕 公立医院;综合改革;分级诊疗;薪酬制度

〔中图分类号〕R197.3       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.01.027

〔Abstract〕 The comprehensive reform of public hospitals in 14 cities of Hunan province had been pushed forward from Oct 2016， with remarkable results. Phenomenon of supplement the doctor's salary with the cost of medicine has been fundamentally reversed， hierarchical diagnosis and treatment pattern has been gradually formed， the excessive growth of hospitalization costs has been controlled， and the reform of salary system has been actively experimented. However， there are still some problems， such as the nonstandard performance management of public hospitals， the over burden of individual residents' medical care， and the waste of medical insurance funds. So it's necessary to take the public welfare as the guidance， strictly control the scale expansion of public hospitals， strengthen implementation of policy and responsibility investigation， so as to improve the efficiency of medical insurance funds use.

〔Keywords〕 public hospitals; comprehensive reform; hierarchical diagnosis and treatment; salary system

十九大报告指出：“人民健康是民族昌盛和国家富强的重要标志。”[1]公立医院是我国医疗卫生事业的主体，承载着维护广大人民群众健康的重要使命，其综合改革是全面深化医改的重中之重。根据《关于城市公立医院综合改革试点的指导意见》（国办发〔2015〕38号，以下简称《意见》）[2]，我国公立医院将逐步打破逐利动机，各级政府将加强保障、领导、监督与管理，力争形成分工明确、资源配置优化的卫生体系，有序推进分级诊疗，从根本上缓解广大人民群众看病难问题，减轻群众医疗经济负担。《意见》提出，到2017年，全国各城市公立医院应广泛推行综合改革试点，有效降低居民医疗费用负担，避免卫生总费用过快上涨，其增速应与GDP相协调;居民看病贵问题得到有效缓解，在卫生总费用中，个人卫生支出占比持续下降至30%以下。截至目前，综合改革已在全国各级公立医院实施。

公立医院改革是改善我省民生的要事、社会发展的实事，对深化医改至关重要。……