我国县级公立医院改革关键问题与路径选择

自县级公立医院改革试点以来，在各领域都有所探索并形成初步的改革思路。但是，在改革中仍有不少关键问题未得到解决，诸如：改革的多元顶层设计思路、补偿机制的持续性与稳定性、地方政府财政压力加重、医院管理体制机制改革未能协同进行、调动和保障医务人员积极性的机制亟待完善、医疗服务定价无法体现医疗服务价值、人才队伍建设滞后、医保基金的使用等。建议下一步县级公立医院改革应在多元化、多层次的顶层设计指导下，坚持公益性与医院经营效益相结合，建立县级公立医院的现代医院管理制度。改革要从创新人力资本管理机制、完善破除“以药补医”后的补偿机制和配套措施、推进法人治理和政事分开、加强医保基金对居民医疗需求的引导、加快医院信息化建设等方向上寻求突破。

Key Points and Pathway of County Public Hospital Reform in China

Since the reform of the county hospitals, primary reform pathway has been formed through the exploration of all fields. However, some critical issues about the reform still exist, such as the idea of multiple top-level design, gap in compensation mechanism, increasing pressure on local government finances, uncoordinated hospital management mechanism, urgent establishment of encouragement mechanism for medical members, the hysteretic reflection of health care value in pricing system, lack of qualified personnel, unobvious effect on the medical expense control, security of health insurance fund, etc. The county public hospital reform needs to be under the guidance of multiple top-level design, make sure of the position of county public hospital, pay attention to both public nature and operating efficiency, and create the modern hospital management system of county-level public hospitals. County public hospital reform should seek a breakthrough point in innovating of human resource management mechanism, improving the compensation mechanism, supporting measures and regulatory system, strengthening the guidance of health insurance fund in medical needs of the residents, and accelerating the hospital information construction and so on.