原(yuan)標題：甘肅(su)省全面推進緊密型(xing)縣域醫共體建設

　　近日，甘肅省衛生健康(kang)委等(deng)10部(bu)門出臺《全面推進(jin)緊(jin)(jin)密(mi)型縣域(yu)醫(yi)療衛生共同體建設(she)實施(shi)意(yi)見(jian)》，標志著我省緊(jin)(jin)密(mi)型縣域(yu)醫(yi)共體建設(she)由試點(dian)階(jie)(jie)段進(jin)入全面推進(jin)階(jie)(jie)段。

　　意見提出(chu)，2024年9月底前，全(quan)(quan)省(sheng)所有縣(xian)（縣(xian)級市及有條件(jian)的(de)(de)市轄區參(can)照(zhao)開展(zhan)）全(quan)(quan)面(mian)開展(zhan)縣(xian)域(yu)(yu)醫共(gong)(gong)體(ti)(ti)建(jian)設。到(dao)2025年底，縣(xian)域(yu)(yu)醫共(gong)(gong)體(ti)(ti)建(jian)設取(qu)得(de)明顯(xian)進(jin)展(zhan)，力爭90%以(yi)上(shang)的(de)(de)縣(xian)基(ji)本建(jian)成布局(ju)合理、人(ren)財物統一(yi)(yi)(yi)管(guan)理、權責清(qing)晰、運行高效、分(fen)工(gong)協作、服(fu)務(wu)連續(xu)、信息共(gong)(gong)享(xiang)的(de)(de)縣(xian)域(yu)(yu)醫共(gong)(gong)體(ti)(ti)。到(dao)2026年底，縣(xian)域(yu)(yu)醫共(gong)(gong)體(ti)(ti)建(jian)設取(qu)得(de)階段性成效，縣(xian)域(yu)(yu)醫共(gong)(gong)體(ti)(ti)內資源共(gong)(gong)建(jian)共(gong)(gong)享(xiang)、管(guan)理同標同質基(ji)本實現，全(quan)(quan)方位、一(yi)(yi)(yi)體(ti)(ti)化的(de)(de)基(ji)本醫療和健康(kang)管(guan)理服(fu)務(wu)機(ji)制(zhi)趨(qu)于完善(shan)。到(dao)2027年底，縣(xian)域(yu)(yu)醫共(gong)(gong)體(ti)(ti)基(ji)本實現全(quan)(quan)覆蓋(gai)，管(guan)理體(ti)(ti)制(zhi)運行機(ji)制(zhi)進(jin)一(yi)(yi)(yi)步(bu)(bu)鞏固，縣(xian)域(yu)(yu)防病(bing)治病(bing)和健康(kang)管(guan)理能力明顯(xian)提升，縣(xian)鄉(xiang)(xiang)村三級協同支(zhi)持關系進(jin)一(yi)(yi)(yi)步(bu)(bu)夯(hang)實，鄉(xiang)(xiang)村兩級服(fu)務(wu)水平明顯(xian)加強，群眾獲(huo)得(de)感進(jin)一(yi)(yi)(yi)步(bu)(bu)增強。

　　意(yi)見提出(chu)以下(xia)主(zhu)要任務(wu)(wu)：一(yi)是構(gou)(gou)(gou)建(jian)(jian)(jian)(jian)科(ke)(ke)學合理(li)(li)(li)的(de)(de)(de)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)。建(jian)(jian)(jian)(jian)立(li)(li)由縣(xian)級(ji)(ji)黨委(wei)(wei)領導(dao)、政(zheng)(zheng)(zheng)府主(zhu)導(dao)，相關部門及鄉(xiang)鎮(zhen)、街道和(he)(he)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)成員(yuan)單(dan)(dan)位(wei)代表參與的(de)(de)(de)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)管(guan)(guan)理(li)(li)(li)委(wei)(wei)員(yuan)會(hui)。原則上每個縣(xian)（市(shi)、區）組(zu)建(jian)(jian)(jian)(jian)1至2個由縣(xian)級(ji)(ji)公立(li)(li)綜合醫(yi)(yi)(yi)(yi)院或中(zhong)(zhong)(zhong)醫(yi)(yi)(yi)(yi)醫(yi)(yi)(yi)(yi)院牽頭的(de)(de)(de)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)。鼓(gu)勵有條件的(de)(de)(de)縣(xian)級(ji)(ji)中(zhong)(zhong)(zhong)醫(yi)(yi)(yi)(yi)醫(yi)(yi)(yi)(yi)院牽頭組(zu)建(jian)(jian)(jian)(jian)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)，服(fu)務(wu)(wu)能(neng)力達到(dao)二(er)級(ji)(ji)以上的(de)(de)(de)基(ji)(ji)(ji)(ji)層醫(yi)(yi)(yi)(yi)療(liao)衛(wei)(wei)生(sheng)(sheng)(sheng)(sheng)機(ji)構(gou)(gou)(gou)也(ye)可作為牽頭單(dan)(dan)位(wei)。縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)建(jian)(jian)(jian)(jian)立(li)(li)議事決(jue)策制(zhi)(zhi)(zhi)度，逐步(bu)實現(xian)行(xing)政(zheng)(zheng)(zheng)、人事、財(cai)務(wu)(wu)、業(ye)務(wu)(wu)、藥品、信息系統、后勤服(fu)務(wu)(wu)等(deng)統一(yi)管(guan)(guan)理(li)(li)(li)。聚焦“人員(yuan)、技術、服(fu)務(wu)(wu)、管(guan)(guan)理(li)(li)(li)”下(xia)沉(chen)(chen)，加強(qiang)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)績效考(kao)核。二(er)是提升縣(xian)域(yu)(yu)(yu)防病治病和(he)(he)健康(kang)(kang)(kang)管(guan)(guan)理(li)(li)(li)能(neng)力。推動縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)療(liao)資(zi)源(yuan)服(fu)務(wu)(wu)共(gong)(gong)享下(xia)沉(chen)(chen)，建(jian)(jian)(jian)(jian)立(li)(li)完(wan)善(shan)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)學檢(jian)驗、影像、心電、病理(li)(li)(li)、消毒供(gong)應(ying)等(deng)醫(yi)(yi)(yi)(yi)學中(zhong)(zhong)(zhong)心和(he)(he)縣(xian)域(yu)(yu)(yu)腫瘤(liu)防治、慢病管(guan)(guan)理(li)(li)(li)、微創介入(ru)、麻(ma)醉(zui)疼痛診(zhen)療(liao)、重(zhong)癥(zheng)監護等(deng)臨床服(fu)務(wu)(wu)中(zhong)(zhong)(zhong)心。加強(qiang)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)基(ji)(ji)(ji)(ji)層成員(yuan)單(dan)(dan)位(wei)內科(ke)(ke)、兒科(ke)(ke)、婦科(ke)(ke)、口(kou)腔科(ke)(ke)、中(zhong)(zhong)(zhong)醫(yi)(yi)(yi)(yi)科(ke)(ke)、康(kang)(kang)(kang)復(fu)(fu)科(ke)(ke)、眼科(ke)(ke)、急診(zhen)急救等(deng)科(ke)(ke)室建(jian)(jian)(jian)(jian)設。建(jian)(jian)(jian)(jian)立(li)(li)健全縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)傳染病監測預警和(he)(he)應(ying)急處理(li)(li)(li)聯動機(ji)制(zhi)(zhi)(zhi)，提升重(zhong)大疫情應(ying)對和(he)(he)醫(yi)(yi)(yi)(yi)療(liao)應(ying)急處置能(neng)力。構(gou)(gou)(gou)建(jian)(jian)(jian)(jian)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)疾病預防、篩查、診(zhen)治、護理(li)(li)(li)、康(kang)(kang)(kang)復(fu)(fu)、健康(kang)(kang)(kang)管(guan)(guan)理(li)(li)(li)為一(yi)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)的(de)(de)(de)醫(yi)(yi)(yi)(yi)防融(rong)合服(fu)務(wu)(wu)鏈條。三是強(qiang)化(hua)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)發(fa)(fa)展(zhan)支持保(bao)障(zhang)。落(luo)實政(zheng)(zheng)(zheng)府投入(ru)保(bao)障(zhang)責(ze)任，中(zhong)(zhong)(zhong)央和(he)(he)省級(ji)(ji)預算內投資(zi)對縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)內符合條件的(de)(de)(de)項目加大支持力度。市(shi)縣(xian)政(zheng)(zheng)(zheng)府新增財(cai)政(zheng)(zheng)(zheng)衛(wei)(wei)生(sheng)(sheng)(sheng)(sheng)健康(kang)(kang)(kang)支出(chu)向(xiang)縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)內基(ji)(ji)(ji)(ji)層醫(yi)(yi)(yi)(yi)療(liao)衛(wei)(wei)生(sheng)(sheng)(sheng)(sheng)機(ji)構(gou)(gou)(gou)適當傾斜。優(you)化(hua)人事編(bian)制(zhi)(zhi)(zhi)管(guan)(guan)理(li)(li)(li)，縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)內基(ji)(ji)(ji)(ji)層成員(yuan)單(dan)(dan)位(wei)專(zhuan)(zhuan)業(ye)人員(yuan)所占編(bian)制(zhi)(zhi)(zhi)不低于編(bian)制(zhi)(zhi)(zhi)總(zong)額的(de)(de)(de)90%。將基(ji)(ji)(ji)(ji)層醫(yi)(yi)(yi)(yi)療(liao)衛(wei)(wei)生(sheng)(sheng)(sheng)(sheng)機(ji)構(gou)(gou)(gou)專(zhuan)(zhuan)業(ye)技術中(zhong)(zhong)(zhong)級(ji)(ji)崗(gang)位(wei)結構(gou)(gou)(gou)比例提高到(dao)40%。鄉(xiang)鎮(zhen)衛(wei)(wei)生(sheng)(sheng)(sheng)(sheng)院“定向(xiang)評(ping)價、定向(xiang)使(shi)用”的(de)(de)(de)崗(gang)位(wei)實行(xing)總(zong)量控(kong)制(zhi)(zhi)(zhi)、專(zhuan)(zhuan)崗(gang)專(zhuan)(zhuan)用，按同級(ji)(ji)崗(gang)位(wei)總(zong)量的(de)(de)(de)15%控(kong)制(zhi)(zhi)(zhi)。建(jian)(jian)(jian)(jian)立(li)(li)符合縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)發(fa)(fa)展(zhan)、有利于人才資(zi)源(yuan)下(xia)沉(chen)(chen)的(de)(de)(de)薪酬(chou)制(zhi)(zhi)(zhi)度。縣(xian)域(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)共(gong)(gong)體(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)(ti)全面落(luo)實醫(yi)(yi)(yi)(yi)保(bao)基(ji)(ji)(ji)(ji)金(jin)總(zong)額付(fu)費，建(jian)(jian)(jian)(jian)立(li)(li)完(wan)善(shan)“結余留用、合理(li)(li)(li)超支分擔(dan)”的(de)(de)(de)責(ze)任共(gong)(gong)擔(dan)機(ji)制(zhi)(zhi)(zhi)。在實施(shi)動態調整醫(yi)(yi)(yi)(yi)療(liao)服(fu)務(wu)(wu)價格時，對鄉(xiang)村醫(yi)(yi)(yi)(yi)療(liao)衛(wei)(wei)生(sheng)(sheng)(sheng)(sheng)機(ji)構(gou)(gou)(gou)發(fa)(fa)展(zhan)進行(xing)適當傾斜。

　　蘭(lan)州日報社全媒(mei)體記者 劉曉芳