在今年1月召开的全国卫生工作会议上,卫生部党组书记高强在总结讲话中谈到深化公立医院改革时,将医疗机构实行全行业属地化管理列在亟待破解的问题之首。所谓全行业属地化管理,就是除军队医院、中央和省级政府保留少数医院以及县医院以外,其他所有城市医院不分隶属关系,都要由所在市级政府实行全行业属地化管理。其实医疗机构全行业属地化管理很早就已经提出,目的是要解决当时卫生行政管理体制条块分割的状况,以及由此造成的管理缺位或越位的矛盾。然而,时至今日,业内的基本共识却是目前尚无真正的“医疗机构全行业属地化管理”。就像有人质疑的那样,全行业属地化管理的范围和内容是什么;管理是否还要延续原有的方式,其必要手段有哪些;落实医疗机构管理奖惩机制,管得好怎么办,管得不好怎么办?包括政府部门和医疗机构各自承担的职能如何划分等。这些问题没有答案,全行业属地化管理便难于落实。由此看来,解析全行业属地化管理这道重大命题,不仅需要冷静地思考,积极稳妥地实践,还需要提升到理论的高度支撑改革,包括从国家层面定义相关问题。 At the National Health Work Conference held in January this year, Gao Qiang, party secretary of the Ministry of Health, made a concluding remarks when it comes to deepening the reform of public hospitals, putting the implementation of the sector-wide management of the entire industry in medical institutions as the first issue to be solved urgently. The so-called industry-wide management of the entire industry means that except for the military hospitals, the central and provincial governments retain a few hospitals and county hospitals, all other cities and hospitals are subject to subordination without exception. As a matter of fact, the localization of the entire industry in medical institutions has long been put forward. The objective is to resolve the current situation of the fragmentation of the administrative system of public health and the resulting contradictions in the absence of management or offside. However, up to now, the basic consensus in the industry is that there is no real “management for the entire industry in medical institutions”. As some people have questioned, what is the scope and content of the industry-wide management of the whole industry? Whether the management should continue the original methods and what are the necessary means? How to manage the rewards and punishments of medical institutions? Bad how to do? Including government departments and medical institutions, how to divide their respective functions. There is no answer to these questions, and it is difficult to implement the entire industry in its territory. From this, it is not only necessary to calmly think and actively and steadily practice the resolution of the major proposition of territory-wide management of the entire industry. It is also necessary to elevate to the theoretical height to support the reform, including defining relevant issues at the national level.