The special demand medical services meet the diversified and personalized medical demands of the masses,and are the feedbacks of basic medical service.On the basis of searching and reviewing the policy documents on the price management of special demand medical service in public hospitals at the national level,it sorts out the key points and shortcomings of the current policy texts,and uses the thematic framework method and comparative analysis method to cover the application conditions for carrying out special demand,the scale control of special demand services the charging standard of special demand service,and the dimensions of the price supervision of special demands services.The specific provisions vary from provinces.Strengthening the management of the price of special medical services in public hospitals,in terms of system design,promoting the beneficial experience of typical provinces,and improving the project management program of the price of special medical services;in terms of implementation,the provision of special services in accordance with the published price items and the control of the size of the service,and the independent pricing and filing of the record.

With the reform of the medical and health system entering a critical period,public hospitals have also exposed new risks and challenges in economic operation.As an important means of hospital standardized management,internal control can better prevent and resolve the risk of hospital economic operation and ensure the sustainable operation of the hospital.By interpreting the requirements of current national policies on hospital internal control,it analyzes the functional positioning of financial and accounting supervision in hospital internal control,shares the internal control implementation path of sample hospitals from the perspective of financial and accounting supervision,and puts forward suggestions on strengthening internal control construction of public hospitals in the new era,in order to lay a good foundation for the high-quality development of hospitals.

It reviewed the policies related to the standardized management of medical service price items,analyzed the current difficulties in the implementation of medical service price regulations:the technical specifications of national medical service price item are heavy and cannot be dynamically adjusted with technological innovation;provincial level item access control is not strict,and the elements of the same price item are not completely unified,affecting the horizontal comparison.The policy suggestions to speed up the improvement of the medical service price item specifications include:medical services that are allowed to be applied and have clear technical specifications are accepted as the scope of new price item declaration;promote the separation of technology and consumption,except for consumables and reagents,which are priced separately according to service items+special consum-ables;priority should be given to responding to the legitimate demand for medical technology improvement innovations through cur-rent price item compatibility;contrast technical specifications and item guidelines,integrating current price items,improving item standardization and compatibility;complete the innovation and economic evaluation of the newly declared item price,check the quality,and reasonably determine the increment.

Scientific and appropriate medical service pricing mechanism is one of the important factors affecting the wide application of new medical technology.On the basis of reviewing the policies related to the management of new medical service price items at the national level and combining with local practices,it sorts out the factors affecting the independent pricing of new medical service price items in public hospitals:according to the mechanism of action,it is divided into promoting factors(estimated cost,technical difficulty,risk degree)and restricting factors(price of items with similar technical difficulty and risk degree,material consumption,equipment depreciation ratio,price of new medical service items approved by foreign provinces,hospital grade,doctor grade,financial subsidy,local economic development level,patient affordability).The policy suggestions to give play to the role of the anchor point of the price of new medical service items and promote the reasonable formation of prices include:issuing guidance opinions on the management of new medical service price items,and unifying the sample table of cost calculation and the aperture of taking numbers;evaluate the value of new medical service price items,and review major innovative technologies according to the green channel and allow premium;monitor and report the service volume and operating cost of the new medical service price items during the pilot period,and promote the pricing of the new medical service items.

Pharmaceutical care plays an important role in promoting rational drug use,improving medical quality and ensuring drug safety for patients.On the basis of defining the scope of pharmaceutical medical services provided by clinical pharmacists and sorting out the status quo of the establishment of pharmaceutical medical service price items at the national level,it reviewed the transformation process of typical areas from the pilot establishment of"pharmaceutical service fee"items or the revision of existing items to the stage of adding fees in a compatible way according to the existing price items.Taking pharmacy outpatient examination fee,inpatient examination fee(clinical pharmacy plus charge)and intravenous drug dispensing fee as examples,the factors and charging levels of pharmaceutical price items in sample provinces were compared.The typical regional practice has the following implications for other provinces and cities to standardize the pharmaceutical price project management:rationally adding new pharmacy price items based on clinical value and independent service output;clarifying the criteria for charging additional fees in different application scenarios;and rationally revising compatible pharmacy price items.

Effective internal control plays an important role in ensuring the orderly development of public hospitals'economic activities and related business activities.The internal control of public hospitals has experienced the development stages of trial exploration,comprehensive promotion to strengthening and deepening,and dynamically adjusted with the change of environment and risk.Looking forward to the future,the internal control of public hospitals shows the following development trends:pay attention to evaluation and reporting,strengthen the responsibility of hospital management,promote the establishment and effective implementation of internal control system;accelerate the transformation of data intelligence,automatically prevent the risk of key nodes according to the pre-rules,and improve the control efficiency and effect;expand the scope of control,achieve full coverage of internal control of economic and business activities of public hospitals in the integration of business and finance;focus on key businesses and key positions to prevent and resolve major risks in the economic operation and business activities of public hospitals;multi-department coordination,multi-mechanism linkage,all-round joint efforts to urge the establishment and implementation of public hospital internal control.

Scientific and appropriate medical service pricing mechanism is one of the important factors affecting the wide application of new medical technology.On the basis of reviewing the policies related to the management of new medical service price items at the national level and combining with local practices,it sorts out the factors affecting the independent pricing of new medical service price items in public hospitals:according to the mechanism of action,it is divided into promoting factors(estimated cost,technical difficulty,risk degree)and restricting factors(price of items with similar technical difficulty and risk degree,material consumption,equipment depreciation ratio,price of new medical service items approved by foreign provinces,hospital grade,doctor grade,financial subsidy,local economic development level,patient affordability).The policy suggestions to give play to the role of the anchor point of the price of new medical service items and promote the reasonable formation of prices include:issuing guidance opinions on the management of new medical service price items,and unifying the sample table of cost calculation and the aperture of taking numbers;evaluate the value of new medical service price items,and review major innovative technologies according to the green channel and allow premium;monitor and report the service volume and operating cost of the new medical service price items during the pilot period,and promote the pricing of the new medical service items.

Pharmaceutical care plays an important role in promoting rational drug use,improving medical quality and ensuring drug safety for patients.On the basis of defining the scope of pharmaceutical medical services provided by clinical pharmacists and sorting out the status quo of the establishment of pharmaceutical medical service price items at the national level,it reviewed the transformation process of typical areas from the pilot establishment of"pharmaceutical service fee"items or the revision of existing items to the stage of adding fees in a compatible way according to the existing price items.Taking pharmacy outpatient examination fee,inpatient examination fee(clinical pharmacy plus charge)and intravenous drug dispensing fee as examples,the factors and charging levels of pharmaceutical price items in sample provinces were compared.The typical regional practice has the following implications for other provinces and cities to standardize the pharmaceutical price project management:rationally adding new pharmacy price items based on clinical value and independent service output;clarifying the criteria for charging additional fees in different application scenarios;and rationally revising compatible pharmacy price items.

Effective internal control plays an important role in ensuring the orderly development of public hospitals'economic activities and related business activities.The internal control of public hospitals has experienced the development stages of trial exploration,comprehensive promotion to strengthening and deepening,and dynamically adjusted with the change of environment and risk.Looking forward to the future,the internal control of public hospitals shows the following development trends:pay attention to evaluation and reporting,strengthen the responsibility of hospital management,promote the establishment and effective implementation of internal control system;accelerate the transformation of data intelligence,automatically prevent the risk of key nodes according to the pre-rules,and improve the control efficiency and effect;expand the scope of control,achieve full coverage of internal control of economic and business activities of public hospitals in the integration of business and finance;focus on key businesses and key positions to prevent and resolve major risks in the economic operation and business activities of public hospitals;multi-department coordination,multi-mechanism linkage,all-round joint efforts to urge the establishment and implementation of public hospital internal control.

Scientific and appropriate medical service pricing mechanism is one of the important factors affecting the wide application of new medical technology.On the basis of reviewing the policies related to the management of new medical service price items at the national level and combining with local practices,it sorts out the factors affecting the independent pricing of new medical service price items in public hospitals:according to the mechanism of action,it is divided into promoting factors(estimated cost,technical difficulty,risk degree)and restricting factors(price of items with similar technical difficulty and risk degree,material consumption,equipment depreciation ratio,price of new medical service items approved by foreign provinces,hospital grade,doctor grade,financial subsidy,local economic development level,patient affordability).The policy suggestions to give play to the role of the anchor point of the price of new medical service items and promote the reasonable formation of prices include:issuing guidance opinions on the management of new medical service price items,and unifying the sample table of cost calculation and the aperture of taking numbers;evaluate the value of new medical service price items,and review major innovative technologies according to the green channel and allow premium;monitor and report the service volume and operating cost of the new medical service price items during the pilot period,and promote the pricing of the new medical service items.