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1、中国医院管理体制和医疗对外开放政策Management of Chinese Hospitals and the Opening up policy of Medical Care in China,医政司 张宗久副司长 Vice director of Department of Medical Administration Mr. Zhang Zongjiu,提 要 Outline,一、医院管理体制 Management of hospitals 医院管理 Hospital management 医护人员管理 Medical staff management 医疗技术临床应用管理 Mana
2、gement of Clinical application of medical techniques 建立和完善国家医疗质量保障和持续改进体系 Establish and develop national medical quality and continuous improvement system 二、医疗对外开放政策 Opening up policy of medical care 中外合资、合作医疗机构管理 Management of Sino-foreign equity joint and cooperative joint medical institutions 外籍医
3、师在华行医管理 Management of foreign doctors working in China,一、中国医院管理体制 Management of Chinese Hospitals,（一）医院管理 Hospital management,医院管理法规和制度 Rules and regulations of hospital management 医院准入 Hospital certification 医院类别 Hospital classification 医院基本标准 Hospital basic standards 医院功能和任务 Hospital functions and
4、 tasks 医院执业规则 Hospital Professional Rules for doctors 目前中国医院数量、分布和构成概况 Number, distribution and structure of Chinas hospitals.,（一）医院管理 Hospital management,1、 医院管理法规和制度 Rules and regulations of hospital management 医疗机构管理条例及其实施细则 Regulation on management of medical institutions and Detailed rules for
5、implementation 中外合资合作医疗机构管理暂行办法 Interim measures for management of Sino-foreign equity joint and cooperative joint medical institutions 医院工作制度 Rules and regulations for hospitals 医院工作人员职责 Responsibilities for medical staff in hospital 实验室管理办法 laboratory management 放射诊疗管理规定 Management of Radiotherapy
6、,（一）医院管理 Hospital management,2、 医院准入制度-规划设置审批制度 Hospital Certification-Examination and approval system 县级以上地方人民政府卫生行政部门根据本行政区域内的人口、医疗资源、医疗需求和现有医疗机构的分布状况，制定本行政区域医疗机构设置规划 Health administration department above county levels shall make the plans for establishing medical institutions according to the po
7、pulation, medical resources, needs and the distribution of existing medical institutions in the region 设置医院应当符合医疗机构设置规划和医疗机构基本标准，经县级以上地方人民政府卫生行政部门审查批准，并取得设置医疗机构批准书 The establishment of hospitals shall meet the criteria of medical institution standards, shall be approved by the Health administration
8、department above county levels and shall obtain the Approval Certificate for the Establishment of Medical institutions,（一）医院管理 Hospital management,2、医院准入制度-执业登记制度 Hospital Certification-Practice registration 医院执业，应申请执业登记，领取医疗机构执业许可证 Practice registration is required and the practice shall be obtaine
9、d. 申请执业登记，必须具备相应条件 For practice registration, the following is necessary 设置批准书 Approval certificate 符合医院的基本标准 Meeting the basic standards of hospitals 名称、组织机构、场所 Name, organizer and location 经费、设施、设备、人员 Fund, facilities, equipment and staff 规章制度 Rules and regulations 独立承担民事责任 Ability to independentl
10、y bear civil liability 医院改变名称、场所、负责人、诊疗科目、床位的，办理变更登记手续 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）医院管理 Hospital management,3、医院类别-根据医院功能和任务、服务范围等医院分为 Hospital classification-according to functio
11、ns, tasks and scopes of services 综合医院 Comprehensive hospitals 专科医院 Specialized Hospitals 口腔医院、肿瘤医院、 儿童医院、精神病医院、传染病医院、皮肤病医院、整形外科 医院、美容医院、康复医院等 Dental Hospital, Tumor hospital , Childrens hospital, mental hospital, Infectious diseases hospital, dermatosis hospital, plastic surgery hospital, Cosmetic s
12、urgery hospital, Rehabilitation hospital 中医医院、民族医院医院等 Hospitals of Chinese Medicine, Minority Hospital,（一）医院管理 Hospital management,4、医院基本标准-不同级别、类别的医院有不同基本标准，包括事项 Hospital standards-different standards for hospital of different levels, including 床位 bed 科室设置（临床、医技） departments（clinical ,technical） 人员
13、 staff 房屋 building 设备 equipments 规章制度、岗位责任、医疗护理技术操作规程 rules and regulations, position responsibilities, procedures for medical care techniques 注册资金 registered capital,（一）医院管理 Hospital management,5、医院功能和任务 Hospital functions and tasks 开展诊疗服务活动，完成一定的预防、保健康复服务 Offer diagnoses and treatments and other h
14、ealth related services 接受转诊，开展疑难危重症诊疗服务；接受基层医疗人员进修，指导、培训基层医务人员，完成卫生支农任务；遇特殊灾害、重大事故、疫情等，派出专家医疗队进行紧急救援；承担临床教学、实习任务，开展临床医学研究，追踪国际先进的临床医学领域 Accept transferred patients, research of difficult diseases, training of medical staff, fulfilling medical care tasks in the country side, sending medical team to a
15、ccident sites, internship, research of clinical techniques, learning international advanced techniques,（一）医院管理 Hospital management,6、医院执业规则 Hospital practice rules 医院必须按照核准登记的诊疗科目开展诊疗活动 Offer treatment according to the registered treatment scope 加强医疗质量管理，确保医疗质量和医疗安全 Strengthen medical quality manage
16、ment for the assurance of medical safety 定期检查、考核各类人员岗位责任制执行和落实情况 Examine, evaluate medical staff regularly 对医务人员进行“三基”、“三严”的培训与考核 Train and evaluate medical staff according to Three fundamentals and three musts 严格执行无菌消毒、隔离制度，预防和减少医院感染 Exercise sterilization and isolation rules, Prevention and contro
17、l of nosocomial infection,（一）医院管理 Hospital management,6、医院执业规则 Hospital practice rules 加强病历书写与管理 Strengthen the management of medical records 加强医务人员职业道德建设 Promote professional ethics 对患者实行保护性医疗措施 Protective measures for patients 尊重患者的权利 Respect the rights of patients 被吊销或注销执业许可证后不得继续开展诊疗活动 Stop offe
18、ring treatment after the license is suspended 医院不得使用非卫生技术人员从事医疗卫生技术工作 Non medical staff are not allowed to be hired in medical care work,（一）医院管理 Hospital management,7、实行医院工作评价制度-医院管理评价指南（试行） Hospital evaluation system- Hospital Management Evaluation Guide （for trial implementation） 2005年3月卫生部发布医院管理评
19、价指南（试行） Hospital Management Evaluation Guide issued by the Ministry of Health in March, 2005 目标：为人民群众提供优质、安全、经济的医疗服务 Goal：provide good, safe and economical medical service 核心内容：持续改进医疗质量和保障医疗安全 Core content：improve medical quality and safety 重点突出 目标明确 Clear goals and key points 突出“质量、安全、服务、费用、绩效”等内容
20、Emphasize quality, safety, service, fee and performance 注重内涵建设 Emphasize implementation,（一）医院管理 Hospital management,7、实行医院工作评价制度-主要内容 Hospital evaluation system-Contents 评价指标 考核内容 Evaluation index evaluation item 医院管理 8 48 Hospital management 医疗质量管理与持续改进 24 127 quality management 医疗安全 3 14 safety 医院
21、服务 4 27 Hospital service 医院绩效 3 15 Hospital performance 共计评价指标42 考核内容231 evaluation index42 evaluation item231 部分统计指标（45项） Part of statistics（45） 三级综合医院指标参考值 Level one comprehension hospital as the reference,（一）医院管理 Hospital management,7、实行医院工作评价制度-评价方式 Hospital evaluation system -method 自我评价 Self e
22、valuation 同行评价（行业自律、自主监控） Colleague evaluation（self discipline and self control） 社会评价：科学地利用社会调查方法评估医疗服务，力求客观、公正、真实地 反映社会和群众的意见，促进为患者提供更加优质的医疗服务 Social evaluation：use social survey, take into consideration the opinions of people to promote the development of medical service 患者的评价（院内、院外） Patients eval
23、uation（in hospital、outside hospital） 各省可以制订细则，也可根据执行情况适时进行修订、完善 The provincial medical departments can make detailed rules or adapt this one,（一）医院管理 Hospital management,8、医院校验制度 Hospital examination regulation 医院应遵守国家医疗机构检验制度 Hospitals shall abide by the national examination regulation 根据医院规模和服务范围，医
24、院校验分为1年和3年校验 Hospital examination period is 1 year or 3 year according to the scale of hospitals 医院应当于检验期满前三个月向登记机关申请办理校验手续 Hospitals shall apply for the examination certificate three months before the end of the examination period,（一）医院管理 Hospital management 2005年中国各省（市）医院分布情况 Hospital Distribution
25、 in 2005,（一）医院管理 Hospital management 2005年 各 类 医 院 构 成 Kinds of hospital in 2005,目前，中国共有医院18703所，其中综合医院12982所，中医医院2620所，中西 医结合医院194所，民族医院195所，专科医院2682所 Now, there are 18703 hospitals in China, including 12982 comprehensive hospitals, 2620 hospitals of Chinese medicine, 194 hospitals specialized in b
26、oth Chinese medicine and western medicine, 195 minority hospitals and 2682 specialized hospitals,（二）医护人员管理 Management of medical staff,1、医院医师管理 Management of doctors 执业医师和执业助理 医师 doctors and assistant doctors 医师管理制度 management of doctors 医院医师概况 Overview of doctors in hospital 2、医院护士管理 Management of
27、nurses 护士管理制度 Management of nurses 医院护士数量和构成 Number and structure of hospital nurses,（二）医护人员管理 Management of medical staff,1、医师管理 Management of doctors 根据 中华人民共和国执业医师法 According to Law on Licensed Doctors of the Peoples Republic of China 医师考试合后，获得医师资格证书，经注册领取医师执业证书后方可在注册的执业地点、执业类别、执业范围内执业 Doctors qu
28、alification certificates are issued to those who have passed the examination. After registration and getting the doctors license, they can work in the location registered. 医师分为执业医师和执业助理医师 licensed doctors and doctor assistants 分为临床类别、口腔类别、中医类别、公共卫生类别 classification: clinical, Stomatology, Chinese me
29、dicine, public health 临床类别医师可注册为 17个专业等 there are 17 specialties available for registration for clinical doctors,（二）医护人员管理 Management of medical staff,1、 医师管理-管理制度 Management of doctorsrules and regulations 实行医师资格考试制度 Examination for qualification 实行医师执业注册制度 Registration 明确医师权利和义务 Rights and obligat
30、ions 明确医师执业规则 Working rules 医学处置规则 Medical practice 医学出证规则 Doctors license 医疗急救规则 Medical first aid 临床用药规则 Clinical medication,病情告知规则 Symptom inform 实验医学规则 Experimental medicine 职业道德规则 Professional ethic 服从调遣规则 Order abide-by 报告规则 Reporting regulation 助理医师执业规则 Assistant doctors working rules 医师定期考核和
31、培训制度 Regulation examination and training system,（二）医护人员管理 Management of medical staff 2005年执业（助理）医师分布 Distribution of doctors (doctors assistants) in 2005,（二）医护人员管理 Management of medical staff,2、医院护士管理-管理制度 Management of nurses 根据中华人民共和国护士管理办法 According to rules and regulations for the management of
32、 nurses in China 护士执业考试制度 Examination for nurses 考试合格者，发给中华人民共和国护士执业证书 Issue Practice license to candidates who passed the examination 护士执业注册制度 Registration required for nurses 护士注册的有效期为二年 Registration valid for 2 years,（二）医护人员管理 Management of medical staff 医院护士管理-注册护士数量和构成 management of nursesnumbe
33、r of registered nurses and structure,（三）医疗技术临床应用的管理 Management of medial technology and clinical application,医疗技术迅速发展：新的诊断、治疗设备和药品不断问世为了加强对特殊医疗 技术临床应用的管理，规范特殊医疗技术在临床的应用，提高医疗技术水平和 医疗质量，保障医疗安全，卫生部正在制定： Fast development of medial technology: with the emergence of new diagnosis, treatment equipment and
34、medicine, to promote the management of medical technology and improve medical e quality, the Ministry of Health is stipulating 特殊医疗技术临床应用管理办法（20个项目） Management of specialized medical technology and its clinical application (20 projects) 四项技术的整顿、规范 Standardization of 4 techniques 人类辅助生殖技术管理 Managemen
35、t of Assisted Reproductive Technology 器官（脏器）移植诊疗管理 Management of organ transplant 人工关节植入诊疗管理 Management of artificial arthroplasty 介入诊疗管理 Management of intervention treatment,（四）建立和完善国家医疗质量 保障和持续改进体系 Establish and develop national medical quality and continuous improvement system,医疗服务直接关系到人基本的生存权和健康
36、权。医疗质量是医院生存和发展的生命线和永恒主题，是衡量医院发展状态的核心内容 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 建立国家医疗质量保障和持续改进体系，是实行“以病人为中心”，保障病人安全和人民群众身体健康的需要；是卫生行政部门义不容辞的责任 Establishing su
37、ch a system is to meet the need of Patient orientedprinciple and the safety of patients and people. It is the responsibility of medical departments,准入体系,控制体系,评价体系,监督体系,信息监测预警,医疗风险保险制度,（四）、建立和完善国家医疗质量保障和持续改进体系 Establish and develop national medical quality and continuous improvement system,（四）建立和完善国家
38、医疗质量 保障和持续改进体系 Establish and develop national medical quality and continuous improvement system,中国医疗服务体系庞大，医疗质量保障与持续改进体系的各个部分发展不平衡，有的已相对完善，有的在逐步探索之中。提高医疗质量、保障医疗安全是今后完善医疗服务体系的重要内容。 China has a large medical care network and the development of the different parts of the network is not balanced. Some a
39、re more advanced while 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、医疗对外开放相关政策 Opening up policy of medical care,医疗对外开放相关政策 Opening up policy of medical care,中国将本着符合国家基本国情，有利于提高医疗服务质量和水平 ，有利于满足群众医疗服
40、务 需求，促进国民健康素质提高的原则，按照入世承诺逐步开放牙医和医疗服务市场 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 可以通过现代通讯手段等向其他国家购买医疗咨询、诊断、治疗和医学教育等服 务，或到境外购买医疗服务和医学教育。在市场准入和国民待遇方面对此没有限 制 buy services such
41、 as medical consultation, 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 允许外资与中方合作伙伴合作设立中外合资合作医院。在准入和数量方面有一定要 求和限制 Allow the establishment of foreign Chinese joint hospital
42、s. There are certain requirements for the number of such hospitals 允许具有本国办法的专业证书的境外医师，在获得我国省级以上卫生行政部门的许 可后，在中国提供短期的医疗服务 Allow foreign doctors provide medical services for short period of time after being approved by the medical department above provincial levels,医疗对外开放相关政策 Opening up policy of medic
43、al care,（一）中外合资合作医疗机构管理 Management of Sino-foreign equity joint and cooperative joint medical institutions 设置要求 Requirements 设置审批和登记程序 Approval and registration procedurs 执业规则 Practice rules 目前概况 Status quo （二）外籍医师在华短期行医 Foreign doctors practice in China on a short term basis,医疗对外开放政策 Opening up pol
44、icy of medical care,（一）中外合资、合作医疗机构管理-设置要求 Sino-foreign equity joint and cooperative joint medical institutions establishment requirement 根据中外合资、合作医疗机构管理暂行办法 according to Interim Measures for the Administration of Sino-foreign Equity Joint and Cooperative Joint Medical Institutions 符合当地区域卫生规划和医疗机构设置规
45、划，并取得国家卫生行政部门设置批准 Conform to the local medical planning and has been approved by related medical administrative department 总额不得低于2000万人民币。合资、合作中方股权比例或权益不得低于30% At least 20 million RMB. The Chinese partner must have at least 30% of the shares 合作各方应是能够独立承担民事责任的法人；具有直接或间接从事医疗卫生投资与管理的经验 The partners mus
46、t have the ability to independently bear civil liability and experienced in medical care services directly or indirectly 合作各方能够提供国际先进的医疗机构管理经验、管理模式和服务模式；或提供具有国际领先水 平的医学技术和设备；或可以补充或改善当地在医疗服务能力、技术、资金和医疗设施方面的不 足 Able to provide advanced medical service, advanced management, or advanced technology and e
47、quipment to compensate for the lack of resources in the region. 合作期限不超过20年 Maximum cooperation period is 20 years,医疗对外开放政策 Opening up policy of medical care 中外合资、合作医疗机构的管理-设置审批与登记程序 approval and registration procedure of Sino-foreign equity joint and cooperative joint medical institutions,向所在地设区的市级卫
48、生行政部门提出申请,报所在地省级卫生行政部门审核,报 卫 生 部 审 批,向外经贸部提出申请,到国家工商行政管理部门办理注册登记手续,向所在地省级卫生行政部门规定的卫生行政部门申请执业登记,中外合资、合作医疗机构不得设置分支机构 Sino-foreign equity and cooperative medical institutions shall not establish subsidiary,申请在中国境内设立外商独资医疗机构的，不予以批准 Applying to establish solely foreign-owned medical institution in China shall not be approved,医疗对外开放政策 Opening up policy of medical care,（一）中外合资、合作医疗机构管理-执业规则 Management of Sino-foreign equity joint and cooperative joint medical institutions-rules and regulations for practice 必须遵守国家有关法律、法规 Abide by national laws and regulatio