中华人民共和国福建省审计厅 Fujian Provincial Audit Office ofthePeople&5 Republic ofChina 审计报告 Audit Report ｝阂审外报〔2022〕38号 AUDIT REPORT〔2022〕NO.38 项目名称：世界银行贷款中国（福建）卫生医疗改革促进结果 导向型项目 Project Name: China(Fujian)Health Care Reform Promotion PforR Financedby thew白rld Bank 贷款号：8744一CN Loan No.:8744一CN 项目执行单位：福建省卫生与健康委员会 Project Entity:Fujian Provincial Health Commission 会计年度：2021 Accounting Year:2021 目录 ContelltS 一、审计师意见．............................................................．……，,.,.,,，二，二，,.,，…，,，二，,,1 A .Auditor&5 Opinion,,,,.,,.，二，.,,，…，，…，,,,,,.,,.,.,,,,.．…，，…，.,,.．…，……，...............．……3 二、报表及报表附注二，..........．……，……，.．…，,,.....．……，,............．……，.............．……5 B .Statemcnts and Notes二‘...............................................．……，.,,,,,,,,，…，,,,,,,,.,.,,5 （一）2021年度福建省卫生医疗改革促进专项资金使用情况汇总表．．…，5 (a)Fujian Health andMedical Reform Promotion Funds Usage Summary for theycar 0f2O21............．……，............................................．……，,.．…，,,,.,,.,.,,.,,.5 （二）贷款协定执行情况表～,，一，一，,,,.,，二，,.,,,，二，,,,，二，二，，二，二，,．…，,.．…，……，……7 (b) statement oflmplementation ofLoanAgreement...........．……，...........．……7 （三）报表附注．....................................．····································，·，，···，,,，一8 (c)NOtestothestatements,.,，二，.,.，二，,.,,，二，.,,,,.,,,,,，二，二，,.．…，,.．…，……，，……，．…，.11 三、审计发现的问题及建议…，.......．……，,.．…，..........．……，.,．…，……，..........．……14 C .Audit Findings and Recommendations.......................．……，二，…，.,,,,,,．…，,.,,,28 一、审计师意见 审计师意见 福建省卫生与健康委员会： 我们审计了世界银行贷款中国（福建）卫生医疗改革促进项目2021 年12月31日的福建省卫生医疗改革促进专项资金使用情况汇总表、贷款 协定执行情况表及报表附注（第5页至第13页）。 （一）项目执行单位及福建省财政厅对报表的责任 簖制上述报表是项目执行单位和福建省财政厅的责任，这种责任包 括： 1．按照中国的会计准则、会计制度和本项目贷款协定的要求编制报 表，并佼其实现公允反映； 2．设计、执行和维护必要的内部控制，以使项目报表不存在由于舞 弊或错误而导致的重大错报。 （二）审计责任 我们的责任是在执行审计工作的基础上对报表发表审计意见。我们按 照中国国家审计准则和国际审计准则的规定执行了审计工作，上述准则要 求我们遵守审计职业要求，计划和执行审计工作以对项目报表是否不存在 重大错报获取合理保证。 为获取有关报表金额和披露信息的有关证据，我们实施了必要的审计 程序。我们运用职业判断选择审计程序，对报表的合规性、公允性进行评 价。审计工作还包括评价所选用会计政策的恰当性和作出会计估计的合理 性，以及评价报表的总体列报。 我们相信，我们获取的审计证据是适当的、充分的，为发表审计意见 提供了基础。 1 （三）审计意见 我们认为，第一段所列报表在所有重大方面按照财政部《部门决算管 理制度》（财库〔2013〕209号）和本项目贷款协定的要求编制，公允反 映了截至2021年12月31日同年度的福建省卫生医疗改革促进专项资金 佼用情况。项目资金按计划佼用，报表中列示的项目收支和账户记录相对 应，报表中列示的支出符合规定。 我们提醒报表佼用者关注报表附注中关于编制基础的说明，福建省财 政厅簖制的福建省卫生医疗改革促进专项资金使用情况汇总表是为了遵 循贷款协定等规定。因此报表可能不适用于其他用途。本段内容不影响已 发表的审计意见。 （四）其他事项 本审计师意见之后，共同构成审计报告的还有两项内容：报表及报表 附注和审计发现的问题及建议。 中华人民共知国福建省审计厅 2 022年9月29日 地址：中国福建省福州市华林路201号 邮政簖码：350003 电话：86一591一63396功8 传真：86一591一63396260 A. Auditor's Opinion Auditor's Opinion To Fujian Provincial Health Commission (FPHC): We have audited the Fujian Health and Medical Refor-tri Promotion Funds Usage Summary for the Year ended 31 December 2021, the Statement of Implementation of Loan Agreement and Notes (from page 5 to pageJ3 to the China (Fujian) Health Care Reform Promotion Program Financed by the World Bank as at 31 December 202 1. (a) Responsibility of Project Entity and Fujian Provincial Finance Department for the Statements The preparation of the above statements is the responsibility of your entity and Fujian Provincial Finance Department (FPFD), which includes: i Preparing and -fair presenting the accompanying statements in accordance with Chinese accounting standards and system, and the requirements of the project loan agreement; li. Designing, implementing and maintaining necessary internal control to ensure that the statements are free from material misstatement, whether due to fraud or error. (b) Auditor's Responsibility Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with the Government Auditing Standards of the People's Republic of China and International Standards on Auditing. Those standards require that we comply with ethical requirements and plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement, An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor's judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity's preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the 3 circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity's internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that the audit evidence we have obtained is appropriate and sufficient to provide a basis for our audit opinion. (c) Audit Opinion In our opinion, the accompanying statements identified in the first paragraph are in accordance with requirements of MOF's Management System of the Departmental Final Accounts (Caiku [2013]No.209), and the requirements of the project loan agreement, which present fairly, in all material respects, financial position of use of Special funds for the Promotion of Health and Medical Reform in Fujian Province as at 31 December 2021, the project funds are used as planned. The items listed in the statements cotrespond to the account records, expenditures specified in the statements are in compliance with applicable provisions of state laws and regulations. We remind users of the report to pay attention to the Notes of Statements on the preparation of the instructions. Fujian Health and Medical Reform Promotion Funds Usage Summary prepared by FPFD is to comply with loan agreement and other provisions. Therefore, the statements may not be suitable for other purposes. This paragraph does not affect the opinion. (d) Other Matter(s) The audit report consists of the Auditor's Opinion and two more parts hereinafter: Statements and Notes to Statements, Audit Findings and Recommendations. Fujian Provincial Audit Office of the People's Republic of China Sept. 29 ,'2022 Address: No. 201, Hualin Road, Fuzhou, Fujian Province, P.R. China Postcode: 350003 Tel.: 86-591-63396108 Fax: 86-591-63396260 4 二、报表及报表附注 B,Statements and Notes to the Statements （一）福建省卫生医疗改革促进专项资金使用情况汇总表 (a)Fujian Health and Medical Reform Promotion funds Usage Summary 福建省卫生医疗改革促进专项资金使用情况汇总表（1) FUJIAN HEAIJH AND MEDICAL RFFORM PROMOTIAN FUNDS USAGE SUMMARY(l) 本期截至202｝年12月31日 (forthe peliod ellded 31 Dcccll飞berZOZI) 项目名称：世界银行贷款中国（福建）坦生医疗改革促进项目 Project闪dme:Chlna(Fu]ian)Health Care Reform Promotlon Program卜｝nanced by the Wor}d Bank 簖报单位；福建省财政厅货币单位：人民币元 共川下可 5 （一）福建省卫生医疗改革促进专项资金使用情况汇．悠表 (a)Fujian Health and Medical Reform Promotion funds Usage Summary 福建省卫生医疗改革促进专项资金使用情况汇总表（2) FUJIAN HEALTH AND MEDICAL REFORM PROMOTIAN FUNDS USAGE SUMMARy(2) 本期截至2 021年12月31日 丈犷。：tl:e pel，、）de, liled 3 1 Dccc:11卜crZ()21) 项目名称世界银行贷款中国（福建）卫生医疗改革促进项目 PrOJect Name:China(F川ian)He日lth Care Re杨rm Pfomotion Program「inanced by the Wor!d Bank 簖报单位福建省财政厅货币单位：人民币元 一一书 6 (b) Statement øf Implementation øf Loan Agreement 4ý x -W it K ;r 1* STATEMENT ØF IMPLEMENTATION ØF LOAN AGREEMENT 2021 ýF 12 fl 31 11 (For tlie perioel ciideel M Deceniber 2021) Project Name: China (Fujian) Health Care Reform Promotion Program Financed by the World Bank NýrZ-14-Wt : ~fflMFT : Prepared by: Fujian Provincial Department øf Finance C: urrency Unit: RMB Yuan 1t 4kI 1ý11 'Iý' ýý, ý i ý 1ý 11,ý åý11 '.,,I Luan ýýnourl CUrren1-Ytar Wffildrawals Cumulative Willidra\ýals jý, -J-L i ý si) 7L IJSD tý R m 8 7L LJSD 1ý RNI 13 40,000,ffi).00 0.00 40.000,000.00 255,028,000.00 -12 Proportion of dischai-cd persons l,ýid bý, type of discase in countv-level pablie hospitals and public Chincsc 68,150.000.00 43,ý00,000.00 2,7734,2950 (ýO 68.1 434,',O,,955.0ý) medical hospitals t, total numher of patients dischar- d Proportion ofdisch,ul-,,d personý foi siandardized implementation ofc1inical pathway managenient ln counly-lcýcl 60.01)0,00.G0 -,,5.000,000.00 2233,141).500.000 60,090,CO0.00 421,3-ý0,0 I 3.Gý) public general to total numl ýi- of pauents discharged 4, C. -2z 9 - -P i I Éý,j I" 40.00,000.00 -55.028,000ý00 255,01-18,0CP.W) Propordiai of, wpideni. ýisits tc total oulpaticnt ser\ ices in primary medical jnd licalili institutions P. - - ýt IA IR flP ýYI- i i 1- 25% ý Éý.ý 'xý Number of preftelures with pattents ofi,Te 2 diabeteý inanaged by integialed chl-orlic iliness serNice pekage reaching 44,971500.00ý C 11)l_171,0W.Iffi 44,972,ý00AX) ý86,73 1, l 65.2 5 the tirt,et value (25'. iLý Number ol' tokvnship health centi"ýconimunitv licalth 6, T " [;ý7ý E4: L 9",ý ý0,000,000 (A) 11() ý2ý,WI-190.ý0 ý10,000.000.00 318,785,000ý00 ser,, Illa( ha,ý compkted [Ile cunstrucliýNri ofthc grass-roots health intonnaflonsyslem 7 ý 1ý,ý ri 7'L, jt ý? Fi ont-clid F- 7ý7500.001 u.(K). (X) 781,500A0 5,(»Ø,8ý)3.7ý Total 311 0,000,000AK)ý 168,1-00,000.00 1,072,',ý)1740.ý)0 31 0 '000,000.00 1,976,461,000.(W 7 （三）报表附注 报表附注 1．项目概况 世界银行贷款中国（福建）卫生医疗改革促进项目经世界银行执董 会批准，我国政府于2017年6月30日正式与世界银行签订该项目《贷 款协定》和《项目协议》，获得世界银行贷款3.10亿美元，贷款号为 8744一CN。项目目标是通过公立医院综合改革，建立新型的以人为本的卫 生医疗服务体系，改进福建卫生医疗服务质量和要求，提升综合服务能 力，优化服务条件，增强粤众就医“获得感”。项目设置6项支付指标， 对应世界银行贷款3.10亿粎元。项目关账日为2021年12月31日。 2，报表编制范围 本报表的簖制范围包括2021年度全省各县（市、区）卫生医疗改革 促进专项资金佼用情况汇总表。 3，主要会计政策 3,1本项目报表按照财政部《部门决算管理制度》（财库〔20 13〕209 号）的要求编制。 3,2会计核算年度采用公历年制，即公历每年1月l日至12月31日。 3.3本项目会计核算以“收付实现制”作为记账原则，以人民币为记 账本位币。 3.4按照中国人民银行2021年12月31日公布的汇率，即l美元 =6,3757人民币元。 4.2021年度福建省卫生医疗改革促进专项资金预算投入、本年支出 和结转结余情况 8 截至2021年12月31日，福建省县域卫生医疗改革促进专项资金的 年初结转结余l,938,047,014,97人民币元，本年预算投入3,611,337,1 83.60 人民币元，本年支出3,882,595,55 1.34人民币元，年末结转结余 1,666,788,647.23人民币元。其中：本年支出中工资福利支出 l,068,036,916.60人民币元、商品和服务支出2,102,952,094.01人民币元、 对个人和家庭补助支出144,852,037.82人民币元、资本性支出（基本建 设支出）50,817,593,62人民币元、资本性支出509,472,414,29人民币元、 对企业补助支出5,067,400.00人民币元、债务利息及费用支出914,095.00 人民币元、其他支出483,000.00人民币元。 2021年度中央和省级预算投入“三项资金”金额共计2,167,781,400.00 人民币元，其中：中央公立医院综合改革补助273,300,000.00人民币元、 基本公共卫生服务补助1,654,407,300,00人民币元、基层实施基本药物制 度辛l·助240,074,1 00.00人民币元。 5．贷款协定执行情况 截至2021年12月31日项目累计提取世行贷款310,00认000.00美元。 分别是：(l）在省级层面实现管理上的“三保合一”提款40，。00,000.00美 元；(2）县级公立医院和县级公立中医院按病种付费的出院人数占出院总 人数的比例的提款68,150,000.00美元；(3）县级公立综合医院规范实施临 床路径管理的出院人数占总出院人数的比例的提款66,09仪000.00美元； (4）基层医疗卫生机构门诊量占门诊总量的比例的提款40,000,000,00美元； (5）佼用一体化慢病服务包管理的11型糖尿病患者占比达到目标值（25%) 的设区市数的提款44,972,500.00美元；(6）完成基层卫生信息系统建设 的乡镇卫生院／社区卫生服务中心的数量的提款50,000,000.00美元；(7) 支付项目先征费 787,500,00美元。 6．审计情况说明。（1)2018一2022年五年时间，审计对象范围达到 全覆盖。该项目的世界银行贷款总额3.10亿美元，扣除先征费78.75万 元粎元外的资金按照《世界银行贷款中国医疗卫生改革促进项目福建省 实施方案》（｝阂医改办〔2018〕15号）以及省、币、县三级签订转贷协议 的约定，分配给省本级、三明市本级、平潭综合实验区以及全省除厦门 9 市外的8个设区市所属78个县（市、区）。五年内，对78个受益县（市、 区）和平潭综合实验区都审计了一次；分别是：2018年审计8个，2019 年审计15个，2020年审计18个，2021年审计20个及平潭综合实验区， 2022年审计17个。（2）审计对象是该项目所涉及的部门和单位，包括省、 市、县三级卫健、财政部门和县域公立的综合性医院、中医医院，乡镇 卫生院、社区卫生服务中心（站）及村级医疗卫生服务机构等。（3）审 计资金涵盖4项国内预算内拨款的项目资金和1项世行贷款资金等5项 资金的管理佼用情况，重点对中央和省级预算投入的基本公共卫生服务 补助、公立医院综合改革补助、基层实施基本药物制度补助和县级医院 服务能力提升资金等4项专项资金的审计。因为“县级医院服务能力提 升资金”的实施年限截至2020年，2022年度未审计“县级医院服务能力 提升资金”。 1O (c) Notes to the Statements Notes to the Statements 1. Project overview China (FUJIan) Health Care Reform Promotion Program Financed by the World Bank (WB) was approved by the board of directors World Bank. The LA and PA of this project were both signed by China and World Bank on Jun. 30, 2017. The loan amount totals USD310 million and the Loan No. is 8744-CN. The objective is to establish a new people-oniented health and medical service system through comprehensive reform of public hospitals, improve the quality and requirements of health and medical services in Fujian, improve the comprehensive service capacity, optimize service conditions and enhances the "sense of benefit" of the masses to medical treatment. The project has 6 disbursement indicators, corresponding with the USD3 10 million WB loan. The closing date is Dec.31, 2021. 2. Consolidation Scope of the Statements Consolidation scope of the financial statements covers the summary of the use of special funds for the promotion of health care reforrn of counties (cities, districts) in Fujian Province in 2021. 3. Accounting Policies 3.1 The Statements were prepared according to the requirements of MOF's Managetnent System qf the Departniental Final Accounts (Caiku [2013] No.209). 3.2 The accounting year is the calendar year, which is from January I to December 31 every year. 3.3 The accounting of the project follows the accounting principle of accounting on the cash basis, with RMB as functional currency, 3.4 The exchange rate adopted in the financial statements was the exchange rate on December 31, 2021 of the People's Bank of China, which is USDI= PMB6.3757 yuan. 4. The Investment of Special Fund Budget for Promoting Health and Medical Reform in Fujian Province in 2021, Expenditure and Carry-over Balance of Current Year As of December 31, 2021, the balance of special fund for promoting county health and medical care reform in Fujian Province was RMB 1,938,047,014.97 yuan at the beginning of the year, the budget investment was RMB 3,611,337,183.60 yuan, the expenditures were RMB 3,882,595,551.34 yuan of current year, the carry-over balance was RMB 1,666,788,647.23 yuan at the end of the year. Among which, in the current year, wage and welfare expenditures of RMB1,068,036,916.60 yuan, goods and services expenditures of RMB2,102,952,094.01 yuan, subsidy to individuals and families of RMB144,852,037.82 yuan, infrastructure expenditures of RMB50,817,593.62 yuan, other capital expenditures of RMB509,472,414.29 yuan, subsidies to enterprises and institutions of RMB5,067,400.00 yuan, debt interest expense of RMB914,095.00 yuan and other expenses of RMB 483,000.00 yuan. In 2021, the central and provincial budgets invested RMB 2,167,781,400.00 yuan in 3 items of funds, among which, RMB 273,300,000.00 yuan for subsidizing central public hospital reform, RMB 1,654,407,300.00 yuan for subsidizing basic public health services and RMB 240,074,100.00 yuan for subsidizing implementation of the basic drug system. 5. Implementation of Loan Agreements As of Dec. 31, 2021, the cumulative withdrawal of World Bank loan proceeds has totaled USD310 million, including, (1) Withdrawal of USD40 million for realizing "three insurances in one" in the management at the provincial level; (2) cumulative withdrawal of USD68,150,000.00 based on the proportion of discharge persons paid by disease in county-level public hospitals and county-level public Chinese medicine hospitals; (3) cumulative withdrawal of USD66,090,000.00 based on Proportion of discharged persons for standardized implementation of clinical pathway management in county-level public general hospitals to total number of patients discharged; (4) cumulative withdrawal of USD40 million based on Proportion of outpatient visits to total outpatient services in primary medical and health institutions; (5) cumulative withdrawal of USD44,972,500.00 based on Number of prefectures with patients of type 2 diabetes managed by integrated chronic illness service package reaching the target value (25%); (6) cumulative withdrawal of 12 USD50 million based on number of township health centers/community health service centers that have established primary health information systems); (7) front-end fee of USD787,500.00. 6. Audit status statement: (1) during the five years from 2018 to 2022, all audited targets have been covered. The world bank loan proceeds totals USD310 million, deducting the front-end fee of USD787,500.00, in accordance with the Implementation Plan of China (Fujian) Health Care Reform Promotion Program Financed by the World Bank (Fujian Medical Reform Office [2018] No.15) and on-lending agreements reached at province, city and county level, is allocated to the provincial-level, Sanming city-level, Pingtan comprehensive experimental area and 78 counties (cities, districts) of 8 cities in Fujian except Xiamen City. During the five years, 78 beneficiary counties (cities, districts) and Pingtan comprehensive experimental area were audited once; that is, 8 audited counties in 2018, 15 audited counties in 2019, 18 audited counties in 2020, 20 audited counties and Pingtan Comprehensive experimental Area in 2021, 17 audited counties in 2022. (2) The audited targets are the departments and units involved in the project, including health care, financial departments at provincial, city and county level, county public general hospitals, traditional Chinese medicine hospitals, township health centers, community health service centers (stations) and village-level medical and health service institutions. (3) Audited fund covers project fund allocated within the domestic budget (four items) and WB loan proceeds (one item). It focuses on the audit of four items of special funds, including basic public health service subsidies invested by the central and provincial budgets, comprehensive reform subsidies for public hospitals, subsidies for the implementation of essential drug systems, and funds for improving the service capacity of county hospitals. Because the implementation period of the "fund for improving the service capacity of county hospitals" is up to 2020, the fund is not audited in 2022. 13 三、审计发现的问题及建议 审计发现的问题及建议 除了对报表进行审计并发表审计意见外，我们还关注了项目执行过 程中有关单位遵守国家法规和项目贷款协定情况、内部控制和项目管理 及上年度审计建议的落实情况。我们发现如下问题： （一）项目资金管理及使用情况方面 第一、基本公共卫生服务补助资金情况 1．镼乐区、拓荣县仅转发上级文件，未根据本地实际情况制订细化《基 本公共卫生服务补助资金管理办法》，不符合福建省财政厅、福建省卫 生和计划生育委员会关于印发的《福建省基本公共卫生服务补助资金管 理暂行办法》（｝闰财社〔20 17〕16号）第十八条“币（县、区）财政部 门和同级卫生计生部门应根据本办法制定实施办法”的规定。省卫健委 应商省财政厅共同督促有关市（县、区）财政部门和卫健部门根据有关 规定制订细化本级资金管理办法。 2．财政部门未及时拨付专项资金 福州市未将省级下达的2021年度基本公共卫生服务补助的转移支付 资金及时分配；其中：25,363万元历时38日、4,1 50.73万元历时108日 才分解下达。不符合《福州市基本公共卫生服务补助资金管理暂行办法》 （榕财社〔2017〕104号）第十五条“.，二，．执行中收到中央和省级转移支 付补助资金时，市财政局、市卫计委确保在接到上级资金后的30日内分 解下达……”规定和《福建省省级财政专项资金管理办法》（2013年福 建省人民政府令第131号）第二十二条“县级以上人民政府财政和其他 有关部门、乡（镇）人民政府应当及时、足额拨付专项资金，不得截留、 挪用专项资金，不得无故拖延专项资金的拨付”规定。省卫健委应商省 财政厅责成福州市卫健委、福州币财政局今后在收到中央和省级转移支 l4 付补助资金后应及时分解下达至县（市、区）。 3．基本公共卫生服务补助资金累计结转结余较多 (l）截至2022年6月底，惠安县全县12个乡镇卫生院基本公共卫 生服务补助资金累计结转结余仍有652.51万元。 (2）截至2022年6月底，东山县7家乡镇卫生院的基本公共卫生 服务补助资金结转结余874.62万元。 对于上述问题，不符合（{j昌建省省级财政专项资金管理办法》（20 13 年福建省人民政府令第131号）第二十二条“县级以上人民政府财政和 其他有关部门、乡（镇）人民政府应当及时、足额拨付专项资金，不得 截留、挪用专项资金，不得无故拖延专项资金的拨付”规定。省卫健委 应责成有关市（县、区）卫健局等部门，及时拨付专项资金，提高资金 佼用效率。 4．财务管理方面不够规范 (l）拓荣县乡镇卫生院未经批准使用基本公共卫生服务补助结余资 金2021年拓荣县双城镇等9所乡镇卫生院未经县财政及卫健部门批准， 将结余资金用于日常运营，涉及资金259.29万元。不符合宁德市财政局、 宁德市卫生健康委员会《关于进一步加强全市基本公共卫生服务补助资 金管理的通知》（宁财社〔2019〕58号）第三条“（二）经卫健部门考 核，基本公共卫生服务任务数已完成的上年结余资金，由项目实施单位 申请，经各县（市、区）财政、卫健行政部门批准后，将基本公共卫生 服务补助资金上年结余转为日常运营经费”的规定。 (2）拓荣县村卫生所委托服务团队完成基本公共卫生服务，未按规 定签订委托协议。拓荣县共有71家村级卫生所，其中：空白村所36家， 上述71家村级卫生所的基本公共卫生服务任务均由服务团队完成，但都 未签订委托协议，不符合宁德市财政局、宁德市卫生计生委《关于完善 基本公共卫生服务经费管理的通知》（宁财社〔20 17〕33号）三、3.“对 于空白村或确实无法完成40％左右工作量基本公共卫生服务任务的乡村 医生，其基本公共卫生服务任务可委托乡镇卫生院（社区卫生服务中心） 服务团队或邻近乡医兼职完成，但需签订委托协议，委托部分的补助经 15 费列入扼担相应任务的乡镇卫生院或村卫生所管理”的规定。 (3）福安市赛岐镇卫生院未按标准发放村医补助。2021年度福安市 赛岐卫生院对村医完成发放不少于12种印刷资料的补助为200元／年和村 医配合乡镇卫生院及社区卫生服务中心开展健康咨询活动的补助为50元 ／期，分别低于福安市卫健局制定的800元／年和100元／期的补助标准。不 符合福安市制定的《关于做好2021年国家基本公共卫生服务项目实施效 果评价（监测）工作的通知》（安卫毅2021〕367号）附件3福安市基本 公共卫生服务项目经费补助参考标准（2019版）的规定。 对于以上问题，省卫健委应责成相关县（市、区）卫健局督促相关 单位加强管理，规范佼用结余资金、按规定签订委托协议和按规定的标 准核相关支出。 5．基本公共卫生服务项目向村级医疗卫生室（所）的工作推进不到 位 门）萝城区的基层卫生院拨付给公办村卫生所的基本公共卫生服务 经费的比例偏低，经抽查，萝城区天宝镇、过塘、浦南镇、北斗、浦林 和石亭镇卫生院等6家基层卫生院拨付给公办村卫生所经费比例分别为 22.91％、26.80％、23.40％、15.33％、33,72％、16.64%，均末达到40％的 要求。经调查了解，各公办村卫生所的公卫服务运行经费已由区卫健局 从其他资金科目列支，以及公办村卫生所的公卫服务质量未达考核要求， 影响经费拨付数额造成拨付比例偏低。 (2）新籗区拨付给全区村卫生所的基本公共卫生服务补助资金比例 较低。2021年全区基本公共卫生服务补助资金共计5,89!,9万元，其中： 15个乡镇卫生院实际拨付村卫生所的基本公共卫生服务补助资金合计 1,213万元，占比为21%，未达到40％的要求。 (3）连江县敖江镇和江南镇卫生院的2021年基本公共卫生服务资 金拨付给村级的比例均偏低，未达到40％规定的要求。2021年，敖江镇 卫生院收到县卫健局拨付的基本公共卫生服务补助资金283,71万元，其 中：拨付村医补助92.21万元，拨付率为32.5%，未达到40％规定的要求； 江南镇卫生院收到县卫健局拨付的基本公共卫生服务补助资金179.44万 元，其中：拨付村医补助48,61万元，拨付率为27.09％。 16 (4）惠安县12个乡镇卫生院（含社区卫生服务中心）2021年收到 基本公共卫生服务补助资金合计547 1 .3万元，其中，拨付村卫生所补助 资金1,422 .69万元，占比26%，未达到40％的要求。 对于上述问题，不符合《国务院办公厅关于巩固完善基本药物制度 和基层运行新机制的意见》（国办发〔2013〕14号）七、（二十四）“全 面落实乡村医生补偼政策。明确村卫生室和乡镇卫生院的基本公共卫生 服务任务分工和资金分配比例，原则上将40％左右的基本公共卫生服务 任务交由村卫生室扼担，考核后将相应的基本公共卫生服务经费拨付给 村卫生室”的规定。 省卫健委应责成有关市（县、区）卫健局加强管理和培训，逐步提 高村卫生所扼担基本公共卫生服务任务的比重，提高村卫生所承接服务 的能力，促进惠民政策更好地服务于民。 6．基本公共卫生服务的宣传力度不够 拓荣县双城镇社区卫生服务中心、城郊卫生院等9所乡镇卫生院 2021年基本公共服务经费开支中宣传费用开支均未达到10%，对基层基 本公共卫生服务宣传力度不足，普及率低。不符合宁德市财政局、宁德 市卫生健康委员会《关于进一步加强全市基本公共卫生服务补助资金管 理的通知》（宁财社〔20 19〕58号）第二条“各地要继续加大基本公共 卫生服务宣传力度，确保基本公共卫生服务宣传经费（含健康教育宣传） 不得少于当年基本公共卫生服务率】·助资金的l0o/o&，的规定。省卫健委应 责成拓荣县卫健局加强资金监管，将基本公共卫生服务宣传经费支出纳 入年度考核，将宣传工作做到位。 7．基本公共卫生服务部份任务未完成 (l）新籗区东肖和曹溪社区卫生服务中心2021年度部分基本公共 卫生服务未完成。一是新籗区东肖社区卫生服务中心辖区内的居民电子 健康档案2021年建档率65%，未完成90％以上的任务；糖尿病患者2021 年目标健康管理人数为1157人，实际管理1011人，糖尿病患者健康管 理人数小于目标管理人数。二是曹溪社区卫生服务中心辖区内的居民电 子健康档案2021年建档率65%，未完成90％以上的任务；高血压患者 17 2021年目标健康管理人数为4006人，实际管理3590人，高血压患者健 康管理人数小于目标人数；糖尿病患者2021年目标健康管理人数为1 809 人，实际管理1527人，糖尿病患者健康管理人数小于目标管理人数。 (2）连江县部分乡镇卫生院的基本公共卫生服务任务未完成。连江 县敖江镇卫生院2021年“早孕建册率”目标完成90％以上，实际完成 87.50/0;“肺结核患者管理转诊率”目标值90%，实际完成43.85%；江 南镇卫生院2021年“早孕建册率”目标完成90％以上，实际完成84.27％。 (3）福安市2021年部分基本公共卫生服务任务未完成 ①居民电子健康档案任务数未完成。福安市居民电子健康档案的建 档率为81.53%，未达到目标值90％的要求。②新生儿访视任务数未完成。 2021年新生儿访视完成率87.02伙），未达到任务完成率为90％要求凸不符 合福安市卫健局《关于做好2021年国家基本公共卫生服务项目实施效果 评价（监测）工作的通知》（安卫〔2021〕367号）的规定。市卫健局今 后做好任务分解工作，并督促相关单位及时完成任务。 对于上述问题，不符合福建省卫健委、福建省财政厅《关于做好2019 年基本公共卫生服务项目工作的通知》（｛闰卫基层〔2019〕87号）“一、 （一）原基本公共卫生服务内容。……以提高项目工作质量为重点，切 实把各项任务做实做好，确保完成绩效目标”等规定和《关于做好2020 年基本公共卫生服务项目工作的通知》（｝阂卫基层函〔2020〕475号）“二、 明确资金要求和主要工作任务：由基层医疗机构提供服务的原12类基本 公共卫生服务项目由各地依据《国家基本公共卫生服务规范》（第三版） 推进工作”等要求以及各地出台的目标标准。省卫健委应责成有关市（县、 区）卫健局加强基层医疗卫生机构的监督和管理，科学制订任务，督促 按时完成任务；规范操作，提高项目服务质量，从而推进提高项目服务 的覆盖率和满意度。 8．居民电子健康档案不完整、不规范 门）东山县部分居民健康档案录入不规范、重复建档。①部分乡镇 卫生院的居民健康档案录入不规范。东山县共有12556位居民身份证录 入不规范，身份证为空或非规范18位数；东山县铜陵、西埔、杏陈等4 个乡镇卫生院有10位居民的姓名录入不规范。②部分居民健康档案重复 18 建档。东山县的杏陈镇等4个乡镇卫生院中有6位高血压患者和4位糖 尿病患者的居民健康档案在同一卫生院或不同卫生院重复建档的情况； 东山县7家乡镇卫生院的居民健康档案中有2853位居民在同一卫生院或 不同卫生院重复建档的情况。 (2）连江县敖江镇、江南镇卫生院的部份居民电子健康档案不完整。 截至审计日，连江县敖江镇卫生院建档立卡共33471份，其中有6257份 档案不完整，不完整率18,69%；连江县江南镇卫生院建档立卡共23708 份，其中有2357份不完整，不完整率9.9％。 (3）建宁县部分居民健康档案存在项目不完整。如：部分居民健康 档案号为空、联系电话不规范、详细地址填写不完整、医保卡号不规范、 村和居委会为空等现象。 (4）萝城区13家基层医疗卫生机构的居民健康档案存在126个错 项，个别随访信息、未及时更新和随访录入出错的情况。 (5）福安市部分居民健康档案管理存在：①部分卫生院系统信息无 法提取。如，2021年甘棠、溪柄和晓阳等3个乡镇卫生院的信息除死亡 人数名单外，其余信息无法从卫生健康信息系统导出。②部分居民档案 的建档与签约医生的数据不匹配。如：凤洋村居民陈某的签约医生在康 屠镇卫生院，建档却在湾坞镇卫生院；南洋村居民高某的建档在康屠镇 卫生院，但签约医生却在湾坞镇卫生院。 以上问题，不符合《福建省卫生计生委关于进一步规范居民健康档 案管理工作的通知》（｝阂卫基层函〔2018〕333号）第一条：“…，二本地 区健康档案进行认真全面的清理规范，督促辖区内所有基层医疗卫生机 构对现有健康档案进行全面清理、排查，.．…；对清查出的重复等健康档 案进行清理．，…，。”的规定。福建省卫健委应责成有关市（县、区）卫 健部门加强居民健康档案的管理，及时清理、排查和更新。 9．部分绩效目标自评数据不准确。如，2021年福安市卫健局填报的 《基本公共卫生服务补助资金绩效目标自评表》中老年人中医药健康管 理率为67%，经审计组核实却为58.2％。不符合福建省财政厅、福建省 卫健委关于印发的《福建省基本公共卫生服务补助资金管理暂行办法》 (｝间财社〔2017〕16号）第八条关于市（县、区）财政部门、卫生计生 19 部门负责组织本地区的资金申报、审核、资金拨付、监督及绩效评价工 作的规定，省卫健委责成相关地方卫健部门今后要认真组织实施绩效评 价工作，发挥好绩效评价激励导向作用。 第二、实施基本药物零差率制度补助资金情况 1．部分县（市、区）财政、卫健部门未根据本地实际情况制订细化 资金管理实施办法。连江县、清流县和台江区未制度细化《基层医疗卫 生机构实施基本药物制度补助资金管理办法》；长乐区、拓荣县仅转发 上级文件，未细化。这种情况不符合福建省财政厅，福建省卫生健康委 员会关于印发《福建省基层医疗卫生机构实施基本药物制度补助资金管 理办法》（｝闰财社〔20 19〕23号）第十九条“本办法由省财政厅会同省 卫生健康委负责解释。各市、县（区）财政、卫生健康部门可结合当地 实际，根据本办法制定具体实施办法”的规定。省卫健委应商省财政厅 共同督促有关市（县、区）财政部门和卫健部门根据有关规定制订细化 本级资金管理办法。 2．拓荣县卫健局2021年未根据实际的药品零差价核算财政补偿资 金，造成多补偼3.27万元 2021年拓荣县卫健局下达了基本药品零差价补助款90.25万元，其 中：县精神病防治院3.5万元、县妇幼保健所3．巧万元，但根据实际药 品零差价测算财政补助，县精神病防治院应字1·助2.76万元、县妇幼保健 所应补助0.62万元，县卫健局分别多补助0.74万元和2,53万元，合计 3.27万元。不符合《宁德市县级公立医院药品零差率销售改革实施方案》 （宁医改办〔2014〕2号）第四条“（一）全市县级公立医院全面取消药 品加成，全部实行药品零差率销售改革，医院由此减少的合理收入，通 过医疗服务价格调整补偼82％、财政补偿15％、医院分担3％的办法解决” 的规定。省卫健委应责成拓荣县卫健局收回多补助款项3,27万元。 3．拓荣县总医院2021年对乡镇卫生院的基本药物制度考评结果与实 际不符，造成多支付补助款1.32万元 2O 2022年1月，拓荣县总医院对下属9个乡镇卫生院（社区卫生服务 中心）进行2021年度实施基本药物制度绩效考核，并根据考核结果出具 了《考核结果通报》：考评得分均在85分以上，考核结果均为“优秀”, 但通报结果的部份情况与实际不相符，因为该通报中富溪、乍洋、英山 三个卫生院的最终考核成绩汇总表的扣分内容与实际检查中发现问题的 扣分内容不一致；实际结果应为‘浪好”，造成县总医院多拨付给富溪、 乍洋、英山卫生院的基本药物制度补助资金分别是0.42万元、0.45万元、 O,45万元，合计多拨付补助1.32万元。 不符合《拓荣县总医院基层医疗卫生机构基本药物制度考核办法》 （拓总医〔2021〕42号）第四条：&85分以上〔含85分）为优秀，70 一85分为良好二，二，”、第六条（二）:“与补助资金挂钩。绩效考核组 对考核结果为优秀予以全额支付基本药物制度补助资金；考核为良好以 85分为基数按比例支付基本药物制度补助资金……”的规定。省卫健委 应责成荣拓县卫健局督查县总医院收回多补助款项1,32万元。 4．推进村级卫生所的基本药物零差率工作不力 (l）连江县未全面推进村卫生所实施药品零差率政策的落实。截至 审计日，实施基本药物零差率制度的补助资金223 .03万元未拨付村卫生 所，其中：2020年日1 .03万元，2021年112万元。原因是：由于县卫健 局和乡镇卫生院无法对村卫生所运行情况全面监管到位，导致连江县实 施药品零差率政策无法全县铺开，专项资金沉淀。 (2）新籗区村卫生所均未实施药品零差率制度改革 截至2021年12月，新籗区卫健局下拨15个乡镇村级基本药物补助 92.29万元，各村卫生所实际支出。元，结余92之9万元，各卫生所均未 开展基本药物零差率工作。 (3）惠安县村级卫生所实施基本药物制度效果不理想。2021年惠安 县共207个村卫生所从各卫生院购药，但购药总金额少，获得基本药物 零差率补助26.77万元，仅占当年资金安排123.81万元的21.62％。 对于上述问题，不符合《福建省人民政府办公厅转发福建省卫生厅 等部门关于福建省村卫生所实施国家基本药物制度工作方案的通知》（｝闰 政办〔2012〕132号）第一条第（一）点：“全省行政村卫生所全面配备、 21 佼用基本药物（含省增补品种），并实行药品零差率销售改革”等规定。 福建省卫健委应责成相关设区市、县（市、区）卫健局，认真分析存在 问题的原因，采取有效措施，切实推进基本药物制度的改革和基本药物 零差率政策有效落实，确保群众从医改中真正得到实惠。 5．东山县7家卫生院的基本药物补助资金结转结余195.03万元未及 时拨付使用 截至2022年6月，东山县7家卫生院2021年末基本药物补助结转 结余195.03万元未及时拨付佼用。不符合《福建省省级财政专项资金管 理办法》（2013年福建省人民政府令第1引号）第二十二条“县级以上 人民政府财政和其他有关部门、乡（镇）人民政府应当及时、足额拨付 专项资金，不得截留、挪用专项资金，不得无故拖延专项资金的拨付” 规定。省卫健委应责成东山县卫健局督促相关乡镇卫生院及时拨付专项 资金，提高资金使用效率。 6．分配基本药物补助资金时的绩效考评工作不到位 (l）镼乐区卫健局在对2021年度省级补助资金243 .78万元分配时， 未将绩效因素作为分配依据，仅根据上一年度药品收入及门诊住院人数 占比作为分配依据。 (2）丰泽区财政局、卫健局在分配基本药物补助资金时绩效考评不 到位。2021年丰泽区财政局、卫健局只是根据区财力及各社区卫生服务 中心的财务状况以社区卫生服务中心的药品销售收入的7.5％和耗材的 8％进行测算分配，未能统筹考虑各社区卫生服务中心实施基本药物制度 成效以及绩效评价结果。 以上问题不符合《福建省基层医疗卫生机构实施基本药物制度辛1·助 资金管理办法》第九条“专项补助资金采取因素法分配。分配因素主要 包括补助标准、服务人口数量和地方财力状况等。同时，统筹考虑各地 基层医疗卫生机构实施国家基本药物制度、综合改革进展及实施成效、 绩效评价结果等情况进行结算（绩效因素权重原则上不低于5%)”的规 定。省卫健委应责成相关市（县、区）卫健局切实推动实施实施基本药 物制度，进一步加强项目管理和资金绩效管理，提高资金分配的公平性 22 和有效性。 第三、公立医院改革补助资金情况 1．公立医院改革补助资金未及时佼用，截至审计日余额670.23万元， 影响资金的使用效率 (l）清流县总医院余额390万元。2021年县财政局收到上级拨款后 已授权县总医院“公立医院改革补助资金”零余额支付额度390.00万元， 至2022年6月22日，仍末提取使用。 (2）拓荣县医院和妇幼保健所截至审计日余额169.75万元，其中二 拓荣县医院玉29.75万元，拓荣县妇幼保健所40万元。 (3）光泽县医院2021年的290万元，截至2022年6月20日仍未 支出，绩效目标未完成。截至2022年8月末，光泽县医院已支付1 79.52 万元，剩余1 10.48万元将按设备尾款到期支付。 对于上述问题，不符合财政部《中央对地方专项转移支付管理办法》 （财预〔2015〕230号）第四十条“预算单位应当加快项目实施”的规定 和《福建省省级财政专项资金管理办法》（2013年省政府令第131号） 第二十四条“专项资金项目实施单位应当及时按照批准的专项资金使用 项目的计划和内容实施项目，不得挪用专项资金，不得无故拖延项目实 施进度”的规定。省卫健委应责成相关市（县、区）卫健部门今后要加 强项目建设和管理，加快建设进度和资金拨付，提高财政资金的使用效 率。 2．绩效评价工作不够重视 (l）拓荣县卫健局未开展公立医院改革补助资金绩效评价工作。 2021年度县卫健局未按要求对公立医院改革补助资金进行跟踪监督和绩 效评价。 (2）丰泽区卫健局2021年收到中央公立医院综合改革补助款80万 元，未按规定执行预算绩效评价管理。 以上问题不符合福建省财政厅《公立医院综合改革省级专项补助资 金管理暂行办法》（｝闰财社〔2018〕24号）第十一条“专项资金执行期 23 间，各级卫生计生部门应按照绩效目标对专项资金进行跟踪监督和绩效 评价”的规定。省卫健委应责成相关县（市、区）卫健局加强对专项资 金的跟踪监督和绩效评价工作，提高财政资金的绩效。 （二）特定财务报表方面 1．拓荣县2021年度专项资金决算报表编制不够准确。拓荣县医院、 妇幼保健所等2家医院的2021年度公立医院改革省级专项资金支出以及 双城镇卫生服务中心等9家乡镇卫生院的2021年度基本公共卫生服务支 出和基本药物制度支出的决算报表数据与财务数据不符。 2．萝城区13家医院及基层医疗卫生机构编制2021年度决算报表存 在报表数据与财务数据不相符。 以上问题不符合财政部《部门决算管理制度》（财库〔2013〕209 号）第十七条第三款“应当根据登记完整、核对无误的账簿记录和其他 有关会计核算资料簖制决算，做到数据真实正确、内容完整，账证相符、 账实相符、账表相符、表表相符”的规定。省卫健委应责成相关相关县 （市区）财政局、卫健局督促相关单位今后要做好会计核算和核对工作， 做到决算报表与财务数据相符。 （三）世行贷款资金管理使用方面 1．世行贷款资金结转结余金额较大 本年度审计的省卫健委及17个县〔市、区）财政、卫健及相关用款 单位，截至审计日，各部门、单位的世行贷款资金累计结转结余16,530.34 万元。审计报告征求意见期间，石狮币结转在项目单位金额调减222.44 万元，福安市财政局拨付市卫健744名5万元，目前结转结余金额为 16,307.9万元，其中：省卫健委本级结转结余1,798,07万元，17个县（市、 区）累计结转结余为14,509.83万元。 (l）按结存的部门和单位分类：分别是：县级财政部门8,176石7万 元（台江区555.48万元，连江县740.36万元，萝城区740.36万元，东山 24 县2,004.39万元，丰泽区504.81万元，清流县2,273.95万元，沙县362,2 万元，拓荣县995.12万元）；②卫健部门6,343.93万元（省本级l,798.07 万元，连江县104.72万元，萝城区16 .1万元，丰泽区72.74万元，惠安 县154耳3万元，石狮币626.23万元，秀屿区434.63万元，邵武市661.11 万元，光泽县884.58万元，新籗区69.57万元，福安市744.85万元，拓 荣县776.9万元）；③相关总医院1,537.07万元（长乐区934.77万元， 石狮市379.07万元，建宁县223.23万元）；④石狮市其他医共体单位 2 50.23万元。 (2）结存的原因分析及例子 一是医改促进信息化项目（一期）项目未验收或部分尾款未付而结 转结余。如，石狮市卫健局世行贷款资金结转结余626.24万元（2019 年收到世行贷款专项资金630万元，计划用于医改促进信息化【一期】 项目，2020年列支初验进度款98.90万元，截止2022年6月底结转531,10 万元；2021年收到95,14万元还未用），石狮市正计划用于信息、化项目 建设。 二是医改促进信息化（二期）项目暂缓实施，资金结转待用。如， 省卫健委本级世行贷款资金截至2022年7月18日的结转结余为1,798.07 万元，资金原计划将用于信息化项目平台二期建设，但因目前我省促进 信息化建设方向有所调整，福建省要建设全省“三医一张网”,2022年 3月福建省卫健委、医保局等6个部门联合印发《福建省“三医一张网” 建设工作方案》，由福建省数字办指导省大数据公司负责具体实施，因 此，医改信息化（二期项目）暂簓实施，世行贷款资金现结转结余待用。 三是县医院新大楼项目未完成，无法购置医疗专用设备和信息化建 设等因素而结转结余。一是清流县财政局的世行贷款资金余额2,273 .95 万元，主要原因是县总医院医疗综合大楼尚末完成项目，医疗专用设备 购籮、信息化的建设进程受到影响，暂时不需大额资金。二是拓荣县卫 健局的世行贷款资金余额776.9万元，主要原因是县医院异地新建将于 2023年3月完成，县卫健局计划将资金用于新医院购置设备，因此，该 专项资金尚未下达。 对于上述问题，不符合《福建省省级财政专项资金管理办法》（2013 年省政府令第131号）第二十四条规定和福建省财政厅福建省卫生健康 25 委员会《关于印发福建省医改促进项目世行贷款资金管理暂行办法的通 知》（｝阂财外债〔2019〕2号）第五条、第六条的规定。福建省卫健委应 商省财政厅并责成有关市（县、区）财政、卫健局和县总医院进一步加 强对世行医改项目资金管理，加快把世行贷款资金投入当地医改领域项 目建设，提高资金的使用效率。 2，拓荣县卫健局未将世行医改资金纳入部门预算管理 2019一2022年拓荣县卫健局均未根据资金的使用计划，将世行医改 资金纳入到下年度的预算簖制中。不符合《福建省医改促进项目世行贷 款资金管理暂行加去》（｝间财债〔2019〕2号）第六条“设区市、县级卫 健（计）部门（项目办）负责辖区内的项目实施，将分配给同级预算单 位的世行贷款资金按规定纳入部门预决算统一管理”和第二十五条“各 级卫健部门在簖制下年度部门预算时，依据本地区、本项目外贷资金使 用计划，反映本项目下年度支出安排”的规定。应责成拓荣县卫健局今 后加强把世行贷款资金纳入部门的预算管理，促进规范运行。 3．部分地方的世行贷款资金未安排专项用于卫生人才队伍建设，未 执行不低于8％的支出要求。萝城区、建宁县和清流县在世行贷款资金的 分配佼用中，都没有安排资金给卫生人才队伍建设方面。这种情况不符 合福建省财政厅、福建省卫生健康委员会关于印发《福建省医改促进项 目世行贷款资金管理暂行办法》的通知（｝间财债〔2019〕2号）第十五条 “世行贷款资金专项用于当地医改领域投入，重点用于全省（不含厦门） 医疗服务能力提升、信息化建设以及人才队伍建设等；其中，各地区用 于卫生人才队伍建设资金占比达到8％。”的规定。省卫健委应责成相关 县（区）卫健部门要合理安排部分资金用于卫生人才队伍建设，提高卫 生医疗服务能力。 4．新籗区龙岩人民医院的2个信．息化建设项目未按时进行验收。龙 岩人民医院区域检验中心和合理用药系统等两个项目中标价的分别是 56.2万元和50万元，项目现都完工，分别于2021年11月和2020年底 正式上线运行，但都尚未验收，款项暂未支付。以上不符合《世界银行 26 贷款医改促进项目福建省县域医疗卫生信息、化整体实施方案》（｝间卫规 划〔2018〕41号）第八点实施计划“项目建设周期为2018一2019年，2020 年项目收尾（竣工验收、效果评估、工作总结）．…，.”的要求。省卫健 委应责成新籗区卫健局督促龙岩人民医院及时对已完成建设的项目进行 验收并支付款项。 （四）以前年度审计发现问题整改方面 2021年度审计报告反映的25个问题（限改4个，备案改21个）。 截止2021年12月27日，4个限期整改问题都已整改；21个备案整改问 题整改8个，整改中13个。2022年继续抓整改落实工作，截至2022年 7月29日，备案整改的13个问题已全邵整改到位。总体上，省卫健委 高度重视整改工作，督促有关单位逐一对账，按时反馈整改情况；并能 够加强管理，加快资金的拨付和使用进度，提高资金使用效益。 27 C. Audit Findings and Recommendations Audit Findings and Recommendations In addition to performing the audit and expressing an opinion on the statements, we also make observations with respect to compliance with applicable provisions of the state laws and regulations and the loan agreement of performance, internal control and project management, and the implementation of the previous year's audit recommendations. We found the following issues: 1. Project fund management and use a. Subsidies for basic public health services (1) Changle District and Zherong County only forwarded the superior documents, and didn't formulate the detailed Management Measures of Subsidy for Basic Public Health Services according to the local actual situation, which does not con-tply with the Article 18 of Management Interim Measures of Provincial Special Subsidy for Comprehensive Public Hospital Reform (FPFD Society [2017] No. 16) issued by FPHC and FPFD, that 's, "the cities (counties, districts) financial and health departments at the same level shall formulate their own implementation regulation accordingly". It is recommended that your unit negotiate with FPFD to jointly urge the relevant cities (counties, districts) financial and health departments to formulate detailed management measures at the corresponding level accordingly. (2) The financial departments failed to allocate special funds in time. Fuzhou City did not allocate the transfer payment subsidy funds of 2021 basic public health service subsidy issued by the provincial level in time; arnong them, it took 38 days to allocate 253.63 million yuan, took 108 days to allocate 41.5073 million yuan, respectively, which does not conform to the Article 15 of Interim Measures for the Administration of Subsidy Funds for Basic Public Health Services in Fuzhou City (Fuzhou Finance Society [20171 No. 104) and the Article 22 of the Administration of Fujian Provincial Special Financial Funds (Fujian Government Order [20131 No. 13 1), that is, ...... when receiving the central and provincial transfer payment subsidy funds during the implementation, the Municipal Finance Bureau and the 28 Municipal Health Commission ensure that the funds allocated within 30 days after receiving the superior funds......" and "The financial and other related departments at or above the county level, the township government shall allocate special funds in full and on time, and shall not withhold or misappropriate special funds, delay the disbursement of special funds without reason." It is recommended that your unit instruct the Fuzhou Health Commission and Fuzhou Finance Bureau to timely allocate to counties (cities, districts) after receiving the central and provincial transfer payment subsidy funds. (3)There was large cumulative accumulative carryover balance of subsidies for basic public health services. (i) By the end of Jun. 2022, the cumulative carryover balance of basic public health service subsidy funds in 12 township hospitals in Hui'an County was still 6.525 1 million yuan. (ii) By the end of Jun. 2022, the cumulative carryover balance of basic public health service subsidy funds in 7 township hospitals in Dongshan County was still 8.7462 million yuan. The above doesn't comply with the Article 22 of the Administration of Fujian Provincial Special Financial Funds (Fujian Government Order [2013] No.131), that is, "The financial and other related departments at or above the county level, the township government shall allocate special funds in full and on time, and shall not withhold or misappropriate special funds, delay the disbursement of special funds without reason." It is recommended that your unit instruct the health bureaus of relevant cities (counties, districts) to timely allocate special funds in full and improve the efficiency of financial funds. (4) Financial management is not standardized. (i) Unauthorized use of the balance of basic public health services subsidies in township health centers in Zherong County. In 2021, nine township health centers, including Shuangeheng Town, Zherong County, used the balance for daily operation, involving 2.5929 million yuan, without the approval of the county finance and health department, which doesn't comply with the Article 3.2 of Notice on Further Strengthening Management of City Basic Public Health Service Subsidies (Ningde Finance Society [2019] No. 58) issued by 29 Ningde Finance Bureau and Ningde Health Commission, that is, "after the assessment of the health department, the completed balance of the basic public health services of the previous year will be applied by the project implementation unit (PIU), after being approved by the county (city, district) finance and health departments, the balance of the basic public health service subsidy funds will be transferred into the daily operating funds". (ii) The village health centers of Zherong County entrusted service team to complete the basic public health services, and failed to sign the entrustment agreement according to the regulations. There are 71 village-level health centers in Zherong County, including 36 health centers for blank villages. The basic public health services task of the above 71 centers are all completed by the service team, but none of them have signed an entrustment agreement, which doesn't comply with the Article 3.3 of Notice on Improving the Management of Funds for Basic Public Health Services (Ningde Finance Society [2017] No. 33) issued by Ningde Finance Bureau and Ningde Health Commission, that is, "for blank village or really unable to complete about 40% of the basic public health service task of rural doctors, it can entrust township health center (community health service center) service team or rural doctors in adjacent townships for part-time completion, but the entrustment agreement need to be signed, the subsidy funds for entrustment shall be managed by village and township health centers undertaking corresponding task." (iii) Saiqi Town Health Center in Fu'an City did not issue village doctor subsidies according to the standard. In 2021, the subsidy allocated by Fu'an Saiqi Health Center for no less than 12 kinds of printed materials is 200 yuan/year, and the allocated subsidy for village doctors to carry out health consultation activities with township health centers and community health service centers is 50 yuan/period, which is lower than the subsidy standard of 800 yuan/year and 100 yuan/period set by Fu'an Health Bureau respectively. It doesn't comply with the provisions of the Annex 3 Subsidy Reference Standard of Fu'an Basic Public Health Service Projects (2019 edition) under the Notice on the Evaluation (Monitoring) of the Implementation Effect of the National Basic Public Health Service Projects in 2021 (Fu'an Health [2021] No. 367). For the above problems, it is recommended that your unit instruct the health bureaus of relevant cities (counties, districts) to urge the relevant units to strengthen management, standardize the balance use, sign entrustment agreements according to the regulations, check and approve the relevant expenditures according to the prescribed standards. 30 (5) The basic public health service project in village-level health centers is not fully implemented. (i) In basic health centers of Xiangcheng District, the proportion of basic public health services subsidy funds allocated to the public village health clinics is low, after spot check, the proportion of subsidy allocated by six townships (Tianbao, Guotang, Punan, Beidou, Pulin and Shiting) health centers to public village health clinics is 22.91%, 26.80%, 23.40%, 15.33%, 33.72%, 16.64%, respectively, which did not meet the standard of 40%. It's understood through investigation that the operating funds of public health centers have been included from other funding accounts by the district Health bureau, and the quality of public health services of public village health centers has not met the assessment requirements, which affects the amount of subsidies, resulting in the low proportion of allocation. (ii) The proportion of basic public health services subsidy funds allocated by Xinluo District Health Bureau to the public village health clinics is low. In 2021, the district basic public health service subsidies totaled 58.919 million yuan, of which, 15 township health centers actually allocated 12.13 million yuan to the village health centers, accounting for 21%, which did not meet the standard of 40%. (iii) The proportion of basic public health services subsidy funds allocated by health centers of Ao'jiang Town and Jiangnan Town, Lianjiang County to the public village health clinics is low. In 2021, Ao'jiang Town Health Center received 2.8371 million yuan of basic public health service subsidies from the County Health Bureau, including 922,100 yuan subsidy for village doctors, or 32.5%, didn't meet the standard of 40%. Jiangnan Town Health Center received 1.7944 million yuan of basic public health service subsidies from the County Health Bureau, including 486,100 yuan subsidy allocated to village doctors, or 27.09%. (iv) In 2021, 12 township health centers (including community health service centers) in Hui'an County received a total of 54.713 million yuan in subsidies for basic public health services, of which 14.2269 million yuan was allocated to village health centers, or 26%, did not meet the standard of 40%. The above problems don't comply with the Article 7.24 of Opinions of The General Office of the State Council on Consolidating and Improving the System of Essential Drugs and the New mechanism for Grassroots Operation (State Banfa [2013] No. 14), that is, "fully implement the compensation policy for rural doctors. To clarify the division of basic public health service tasks and the proportion of fund allocation between village and township 31 health centers. In principle, about 40% of the basic public health service tasks will be assigned to village clinics, and the corresponding basic public health service funds are allocated to village clinics after assessment." It is recommended that your unit instruct the health bureaus of relevant cities (counties, districts) to strengthen management and training, gradually increase the proportion of village health centers undertaking basic public health services, improve the capacity of village health centers to undertake services, and promote the beneficial policies to better serve the people. (6) Publicity of basic public health services is insufficient. In the basic public services expenditure of 9 township health centers such as Shuangcheng Town Community Health Service Center and Chengjiao Health Center in Zherong County in 2021, the publicity expenditure did not reach 10%, and the publicity of basic public health services at the grassroots level was insufficient, which doesn't comply with the Notice on Further Strengthening the Management of City's Basic Public Health Service Subsidy Fund (Ningde Finance Society [2019] No.58) issued by Ningde Finance Bureau, Ningde Health Commission, that is, "All localities shall continue to increase publicity on basic public health services, and ensure that the funds for publicity on basic public health services (including health education and publicity) not be less than 10% of the subsidy funds for basic public health services in the current year". It is recommended that your unit instruct the Zherong County Health Bureau to strengthen the monitoring of funds, include the expenditure of publicity funds for basic public health services in the annual assessment, and strive to promote the publicity. (7) Some tasks of the basic public health services were not completed. (i) Some basic public health services in Dongxiao and Caoxi Community Health Service Centers of Xinluo District have not been completed in 2021. First, the filing rate of residents' electronic health records in the jurisdiction of Dongxiao Community Health Service Center in 2021 is 65%, didn't reach the target of more than 90%; the target number of health management for diabetic patients in 2021 was 1157, the actual number was 1011, less than the target number. Second, the filing rate of residents' electronic health records in the jurisdiction of Caoxi Community Health Service Center in 2021 is 65%, didn't reach the target of more than 90%; the target number of health management for hypertensive patients in 2021 was 4006, the actual number was 3590, less than the target number. The target number of health 32 management for diabetic patients in 2021 was 1809, the actual number was 1527, less than the target number. (ii) The basic public health service tasks of some township health centers in Lianjiang County have not been completed. The target of "early pregnancy registration rate" in Aojiang Town Health Center of Lianjiang County in 2021 was more than 90%, and the actual completion was 87.5%; the target value of "management referral rate of tuberculosis patients" was 90%, and the actual completion was 43.85%; the target of "early pregnancy registration rate" in Jiangnan Town Health Center in 2021 was more than 90%, and the actual completion was 84.27%. (iii) Some tasks of the basic public health services in Fu'an City were not completed. Othe number of electronic health records of residents was not completed. The establishment rate of electronic health records of residents in Fu 'an City was 81.53%, which did not reach the target value of 90%. ( The number of neonatal visit tasks was not completed. In 2021, the completion rate of neonatal visit was 87.02%, which did not reach the target value of 90%. It doesn't comply with the Notice on the Implementation Effect Evaluation (Monitoring) of National Basic Public Health Service Projects in 2021 (Fu'an Health [2021] No. 367) issued by Fu'an City Health Bureau. The Fu'an City Health Bureau shall improve task decomposition in the future, and urge the relevant units to complete the task in time. The above problems don't comply with the Article 1.1 of Notice of FPHC and FPFD on Implementation of Basic Public Health Service Projects of 2019 (Fujian Health Grass-roots [2019] No.87), that is, "the original content of basic public health serviess...... Focusing on improving the project quality, earnestly do all tasks well and ensure the achievement of performance targets", and Notice on Implementation of Basic Public Health Service Projects of 2020 (Fujian Health Grass-roots Letter [2020] No. 475), that is, "Clarifying financial requirements and main tasks: the original 12 types of basic public health services provided by primary medical institutions will be promoted in accordance with the National Basic Public Health Services Standards (the third edition)". It is recommended that the health bureaus of relevant cities (counties, districts) be instructed by your unit to strengthen the supervision and management of primary medical and health institutions, formulate scientific tasks, supervise the completion of tasks on time; standardize the operation, improve the quality of project services, so as to improve the coverage and satisfaction of project services. 33 (8) Some residents' electronic health records were incomplete and not standardized. (i) The health records of some residents in Dongshan County are not typed in standard and duplicated. (The residents' health records in some township health centers are not typed in standard. There are 12,556 residents in Dongshan County whose ID card entry is not standardized, and the ID number is empty or not in standardized 18 digits; the names of 10 residents in health centers of fours towns (e.g. Tongling, Xipu, Xingchen) in Dongshan County were not typed in standard. OSome residents' health records were duplicated. The health records of 6 patients with hypertension and 4 patients with diabetes were repeatedly recorded in the same health center or different four health centers (e.g. Xingchen Town in Dongshan County). Among the health records of residents from 7 township health centers in Dongshan County, 2,853 residents had repeated records in the same health center or different health centers. (ii) The electronic health records of some residents in Aojiang Town and Jiangnan Town of Lianjiang County are incomplete. By the audit date, Aojiang Town Health Center had 33,471 records, of which 6,257 were incomplete, or 18.69%. Jiangnan Town Health Center had 23,708 records, of which 2,357 were incomplete, or 9.9%. (iii) The health records of some residents in Jianning County are incomplete. For example, some residents' health file number is empty, the contact phone number is not standard, the detailed address is not complete, the medical insurance card number is not standard, the village and the neighborhood committee is empty and so on. (iv) There are 126 wrong items in the resident health records of 13 primary medical and health institutions in Xiangcheng District, some follow-up information is not updated in time and there are errors in the entry of follow-up information. (v) The health records management of some residents in Fu'an City exists: TThe system information of some health centers can't be extracted. For example, except for the death toll list, the information of health centers of three towns, Gantang, Xibian and Xiaoyang in 2021 can't be extracted from the health information system. (©The data of some residents' files don't match the data of contracted doctors. For example, the contracted doctor of Chen, resident of Fengyang village, is in Kangcuo Town health center, while the file is in Wanwu Town health center; the file of Gao, resident of Nanyang village, is in Kangcuo Town health center, while the contracted doctor is in Wanwu Town health center. 34 The above problems don't comply with the Article 1 of the Notice of FPHC on Further Standardizing the Management of Residents' Health Records (Fujian Health Jichenghan [2018] No. 333), that is, "...... The health records in the region shall be carefully and comprehensively cleaned up and standardized, and urge all grass-roots medical and health institutions within their jurisdiction to comprehensively clean up and investigate the existing health records, to clean up the duplicate health records......". It is recommended that the health bureaus of relevant cities (counties, districts) be instructed by your unit to strengthen the management of the residents' health records, and timely clean up, investigate and update the residents' health records. (9) Some performance target self-assessment data are not accurate. For example, in 2021, the health management rate of traditional Chinese medicine for middle-aged and elderly people in the "performance target self-assessment form of basic public health service subsidy funds" reported by Fu'an City Health Bureau was 67%, which was verified by the audit group to be 58.2%. It doesn't compiy with the Article 8 of Management Interim Measures of Provincial Special Subsidy for Comprehensive Public Hospital Reform (FPFD Society [2017] No.16) issued by FPHC and FPFD, that is, the provisions on the cities (counties, districts) financial and health departments responsible for organizing the fund declaration, examination, fund allocation, supervision and performance evaluation in their respective regions. It is recommended that relevant health bureaus be instructed by your unit to conscientiously organize and implement performance evaluation in the future, and give full play to the incentive and guiding role of performance evaluation. b. Implementation of basic drugs zero price difference rate system (1) The financial and health departments of some counties (cities, districts) have not formulated detailed fund management implementation measures according to the local actual situation. Lianjiang County, Qingliu County and Taijiang District didn't refine the Management Measures of Subsidy Funds for Implementing the Basic Drug System in Grassroots Medical and Health Institutions; Changle District and Zherong County only forwarded the superior document while not refined. It doesn't comply with the Article 19 of Management Measures of Subsidy Funds for Implementing the Basic Drug System in Grassroots Medical and Health Institutions (FPFD Society [2019] No. 23) issued by FPHC and FPFD, that is, "FPFD and FPHC shall be 35 responsible for the interpretation of these Measures. The cities (counties, districts) financial departments and the health departments at the same level shall formulate their own implementation regulation accordingly". It is recommended that your unit negotiate with FPFD to jointly urge the relevant cities (counties, districts) financial and health departments to formulate implementation regulation of its own accordingly. (2) In 2021 ,Zherong County Health Bureau did not calculate the financial compensation funds according to the actual drug zero price difference, resulting in an additional compensation of 32,700 yuan. In 2021 Zherong County Health Bureau allocated basic drugs zero price difference subsidies of 902,500 yuan, including, 35,000 yuan to county psychiatric hospital, 31,500 yuan to county maternal and child health center, however, based on the calculation of the actual zero price difference of drugs, the county psychiatric hospital shall be subsidized 27,600 yuan, the county maternal and child health center shall be subsidized 6,200 yuan, the additional allocated subsidy was 7,400 yuan and 25,300 yuan respectively, a total of 32,700 yuan. It doesn't comply with the Article 4.1 of Implementation plan of drugs zero price difference rate sales reform in county-level public hospitals of Ningde City (Ningde Medical Reform Office [2014] No. 2), that is "all county-level public hospitals in the city cancelled drug markup and implemented the drugs zero price difference rate sales reform. The resulting reduction in reasonable income of hospitals was resolved through compensation from adjustment of medical service price (82%), financial compensation (15%), and hospital share (3%). It is recommended that your unit instruct Zherong County Health Bureau recover the additional subsidy of 32,700 yuan. (3) In 2021,the evaluation results of the essential drugs system of township health centers in Zhorong County General Hospital were inconsistent with the reality, resulting in an additional subsidy of 13,200 yuan. In Jan. 2022, Zherong County General Hospital carried out the performance assessment of the essential drugs system in 9 township health centers (community health service centers) in 2021, and issued a "assessment result notification" according to the assessment results, the assessment scores were all above 85 points, and the assessment results were all "excellent", but some of the notification results were inconsistent with the reality. Because the points deducted in the final assessment summary table of Fuxi, Zhayang and Yingshan health centers in the notification are not consistent with the points deducted in the actual inspection. The actual result shall be "good", resulting in an additional subsidy for essential drugs system of 4,200 yuan, 4,500 yuan 36 and 4,500 yuan allocated to Fuxi, Zhayang and Yingshan health center respectively, a total of 13,200 yuan. The above doesn't comply with the Article 4 and Article 6.2 of Assessment Method of Essential Drugs system in Primary Medical and Health Institutions of Zherong County General Hospital (Zherong General Hospital [2021] No. 42), that is, "above 85 (including 85) is excellent, 70-85 is good......" and "Tied to subsidy funds. The performance assessment team will fully pay the essential drugs system subsidy funds for the excellent results; the essential drugs system subsidy funds will be paid in proportion to the base of 85 points for good results......" It is recommended that your unit instruct Zherong County Health Bureau recover the additional subsidy of 13,200 yuan. (4) Poor efforts to promote zero price difference rate for essential drugs in village health centers. (i) Lianjiang County has not fully promoted the system of zero price difference rate for essential drugs implemented by village health centers. As of the audit date, 2.2303 million yuan of subsidy funds for implementing the system of zero price difference rate for essential drugs had not been allocated to village health centers, including 1.1103 million yuan in 2020 and 1.12 million yuan in 2021. It is because the county health bureau and township health centers can't fully supervise the operation of village health centers, the policy in Lianjiang County can't be implemented throughout the county, resulting in special funds precipitation. (ii) The village health centers of Xinluo District have not implemented the system reform of zero price difference rate for essential drugs. As of Dec. 2021, Xinluo District Health Bureau has allocated 922,900 yuan for village-level essential drugs subsidies to 15 towns, and the actual expenditure of village health centers was zero and the balance was 922,900 yuan. All health centers have not carried out the zero price difference rate for essential drugs. (iii) The effect of implementing essential drugs system in village health centers of Hui'an County is not as expected. In 2021, a total of 207 village health centers in Hui'an County purchased drugs from various health centers, while the total amount of drugs purchased was small, and the subsidy of zero price difference rate for essential drugs was 267,700 yuan, which only accounted for 21.62% of the funding arrangement of 1,238,100 yuan in that year. The above problems don't comply with the Article 1.1 of the Notice of 37 Implementation Plan of the National Basic Drug System in Village Health Centers of Fujian Province (Fujjian Government Office [2012] No. 132), that is, "The provincial administrative village health centers are fully equipped with and use basic drugs (including provincial supplementary varieties) and implement the reform of zero-difference sales of drugs." It is recommended that relevant health bureaus be instructed by your unit to take timely measures to advance the reform of the basic drug system, and put the policies of subsidizing the basic drug system in place, ensure that the people truly receive tangible benefits from medical refonm. (5) The carryover balance of the subsidy funds for essential drugs in seven health centers in Dongshan County of 1.9503 million yuan and was not allocated for use in time. As of Jun. 2022, 7 health centers in Dongshan County had a carryover balance of 1.9503 million of essential drug subsidy at the end of 2021, which hadn't been allocated for use in time. It doesn't comply with the Article 22 of the Administration of Fujian Provincial Special Financial Funds (Fujian Government Order [2013] No.131), that is, "The financial and other related departments at or above the county level, the township government shall allocate special funds in full and on time, and shall not withhold or misappropriate special funds, delay the disbursement of special funds without reason." It is recommended that the Dongshan County Health Bureau be instructed by your unit to urge relevant township health centers to timely allocate special funds and improve the efficiency of financial funds. (6) The performance assessment in allocating subsidy funds for essential drugs is not fully implemented. (i) The Changle District Health Bureau did not take performance factors as the basis when allocating the provincial subsidy funds of 2,437,800 yuan in 2021, but only took the drug income and the proportion of outpatient inpatients in the previous year as the basis. (ii) The performance assessment of the Finance Bureau and Health Bureau in Fengze District is not fully implemented when allocating the subsidy funds for essential drugs. In 2021, the Finance Bureau and Health Bureau of Fengze District only calculated and allocated the subsidy funds for essential drugs based on district financial resources and the financial situation of community health service centers, as well as the 7.5% of the drug sales income and 8% of consumables of community health service centers, which failed to comprehensively consider the effectiveness of the implementation of essential .38 drugs system and the performance assessment results of community health service centers. The above problems don't comply with Article 9 of the Management Measures for Implementation of Basic Drug System Subsidy in Grassroots Medical and Health Institutions in Fujian Province, that is, "special subsidy funds will be allocated based on the factor method. The allocation factors mainly include the subsidy standard, the number of serving population and the local financial situation. Besides, the settlement shall be made by considering the implementation of the national essential drugs system, comprehensive reform progress and implementation results, and performance assessment results of local primary medical and health institutions (the weight of performance factors shall not be less than 5% in principle)." It is recommended that the health bureaus of relevant cities (counties, districts) be instructed by your unit to effectively promote the implementation of the essential drugs system, further strengthen project management and fund performance management, and improve the fairness and effectiveness of fund allocation. c. Subsidies for public hospital reform (1) The reform subsidy funds of public hospitals have not been used in time, with the balance of 6.7023 million yuan as of the audit date, which affects the use efficiency of funds. (i) The balance of the public hospital reform subsidy funds of Qingliu County General Hospital is 3.9 million yuan. In 2021, the Qingliu County Finance Bureau has authorized the County General Hospital the zero balance payment limit for "public hospital reform subsidy fund" of 3.9 million yuan after receiving the funding from the superior, which has not been withdrawn and used until Jun. 22, 2022. (ii) Zherong County Hospital and Maternal and Child Health Center received public hospital reform subsidy funds, which have not been used, resulting in idle funds and a balance of 1,697,500 yuan by the audit date, including: Zherong County Hospital public hospital reform funds of 1,297,500 yuan, Zherong County Maternal and Child Health Center of 400,000 yuan. (iii) Guangze County Hospital received 2.9 million yuan of subsidies for public hospital reform in 2021, which had not been used as of Jun. 20, 2022, and the performance target had not been achieved.By the end of Aug.2022,Guangze County Hospital had paid 1,795,200 yuan,and remained 1,104,800 yuan will be paid according to the due date of the final payment of 39 the equipment. The above problems don't comply with the Article 40 of Measures for the Administration of Special Transfer Payments from the Central Government to local governments (MOF Budget [2015] No. 230) and Article 24 of the Administration Measures of Special Financial Funds at the Provincial Level of Fujian Province (Fujian Government Order [2013] No. 131), that is, "Budget units shall speed up the implementation of projects" and "the implementing unit receiving special funds shall implement the project in a timely manner in accordance with the plan and contents of the approved project for special fund use, shall not misappropriate the special funds, and shall not delay the implementation progress without reason". It is recommended that your unit instruct relevant cities (counties, districts) health bureaus to strengthen project construction and management, speed up construction progress, and promote the quality and efficiency of project finds. (2) Insufficient attention is paid to performance assessment. (i) The Zhorong County Health Bureau has not carried out the performance assessment of public hospital reform subsidy funds. In 2021, the Zherong County Health Bureau did not follow up, supervise and evaluate the performance of public hospital reform subsidy funds as required. (ii) Fengze District Health Bureau received 800,000 yuan of comprehensive reform subsidy from central public hospitals in 2021, but did not implement budget performance assessment management according to regulations. The above problems don't comply with the Article 11 of Management Interim Measures of Provincial Special Subsidy for Comprehensive Public Hospital Reform issued by FPHC and FPFD (FPFD Society [2018] No.24), that is, "during the implementation of the special funds, health departments at all levels shall follow up, supervise and evaluate the performance of the special funds according to the performance targets." It is recommended that your unit instruct relevant cities (counties, districts) health bureaus to strengthen the tracking, supervision and performance assessment of special funds to improve the performance of financial funds. 2. Special financial statements (1) The final statement of 2021 special funds in Zherong County is not accurate enough. The 2021 final statement data and financial data of provincial special fund expenditure for public hospital reform in Zherong County Hospital and County Maternal and Child Health Center, as well as that in expenditure on basic public health services and the essential drugs system 40 in health centers of nine towns (e.g. Shuangcheng Town) in 2021, are inconsistent. (2) In the prepared 2021 annual final account statements for 13 hospitals and primary medical and health institutions in Xiangcheng district, the statement data are inconsistent with financial data. The above problems don't comply with the Article 17.3 of MOF's Notice on Issuing the Final Accounts Management System (Caiku [2013] No.209), that is, "Final accounts shall be prepared according to the complete, correct account records and other relevant accounting materials, so as to ensure that the data are true and complete, as well as the conformity of accounts, facts, statements." It's recommended that your unit instruct relevant cities (counties, districts) finance bureaus and health bureaus to improve accounting and checking in the future, and ensure that the data of the statements are true and accurate. 3. Management and use of World Bank loan proceeds (1) Larger balance of carryover of World Bank loan proceeds As of the audit date, for FPHC and finance, health departments and relevant units in 17 counties (cities and districts) audited in this year, the total cany-over balance of the World Bank loan proceeds has reached 165,303,400 yuan. During the period of soliciting opinions on the audit report, the project unit amount carried forward by Shishi City was reduced by 2,224,400 yuan, the Fu'an City Finance Bureau allocated 7,448,500 yuan to City Health Bureau, the current carryover balance is 163,079,000 yuan, among which, the carryover balance of the FPHC reached 17,980,700 yuan, and the cumulative carryover balance of the 17 counties (cities and districts) reached 145,098,300 yuan. (i) Classified by department and unit of balance: including, 1f81.7667 million yuan in county finance bureaus (5,554,800 yuan in Taijiang District, 7,403,600 yuan in Lianjiang County, 7,403,600 yuan in Xiangcheng District, 20,043,900 yuan in Dongshan County, 5,048,100 yuan in Fengze District, 22,739,500 yuan in Qingliu County, 3.622 million yuan in Sha County, 9,951,200 yuan in Zherong County); 0 63,439,300 yuan in health departments (17,980,700 yuan at province-level, 1,047,200 yuan in Lianjiang County, 161,000 yuan in Xiangcheng, 727,400 yuan in Fengze District, 1,544,300 yuan in Hui'an County, 6,262,300 yuan in Shishi City, 4,346,300 yuan in Xiuyu District, 6,611,100 yuan in Shaowu City, 8,845,800 yuan in 41 Guangze County, 695,700 yuan in Xinluo District, 7,448,500 yuan in Fu'an City, 7,769,000 yuan in Zherong County); @15,370,700 yuan in relevant general hospital (9,347,700 yuan in Changle District, 3,790,700 yuan in Shishi City, 2,232,300 yuan in Jianning County); j2,502,300 yuan in other medical units in Shishi City. (ii) Reason analysis and examples of balance First, the project of promoting informatization of medical reform (phase-1) has not been accepted or part of the final payment has not been paid and the balance is carried over. For example, Shishi City Health Bureau carried forward the balance of World Bank loan proceeds of 6,262,400 Yuan (the special fund received in 2019 of 6.3 million yuan from the World Bank, which was planned to be used for the project of promoting informatization of medical reform (phase-1). The payment of 989,000 yuan for preliminary acceptance was included in 2020, and 5,311,000 yuan was carried forward by the end of June 2022; 951,400 yuan received in 2021 but not yet used), Shishi City is planning to use it for the construction of information project. Second, the project of promoting informatization of medical reform (phase-2) was suspended to implement, and funds were carried forward to be used. For example, the carryover balance of the World Bank loan proceeds at the FPHC level as of Jul. 18, 2022 was 17.9807 million yuan. The funds were originally planned to be used for the second phase construction of the informatization platform project, but due to the current promotion direction in Fujian changed, Fujian plans to build "A network of medical treatment, medical insurance and medicine", in Mar. 2022, the FPHC, Fujian Provincial Medical Insurance Bureau and other four departments jointly issued the Work Plan for the Construction of A network of medical treatment, medical insurance and medicine, implemented by Fujian Big Data Company and guided by Fujian Digital Office, therefore, the project of promoting informatization of medical reform (phase-2) was suspended to implement, and the World Bank's loan proceeds are now carried over and remained for use. Third, the new building project of the county hospital is not completed, it's impossible to purchase special medical equipment and information construction, the WB loan proceeds are accordingly carried over and remained. TThe balance of the World Bank loan proceeds of Qingliu County Finance Bureau is 22,739,500 yuan. The main reason is that the medical complex building of the county General Hospital has not been completed, the purchase of special medical equipment and the construction process of information technology are affected, and large funds are not needed for the time being. 0 The balance of the World Bank loan proceeds of Zherong County Health 42 Bureau is 7.769 million yuan, the main reason is that the county hospital will be built in Mar. 2023, the county health bureau plans to use funds for the purchase of new hospital equipment, the special funds have not been allocated accordingly. The above problems don't comply with Article 24 of the Administration Measures of Special Financial Funds at the Provincial Level of Fujian Province (Fujian Government Order [2013] No. 131) and Article 5, 6 of the Notice of Issuing the Interim Measures of VB Financing Management of Fujian Medical Reform Promotion Program issued by FPFD and FPHC (Fujian Foreign Debt [2019] No.2). It is recommended that your unit negotiate with FPFD to instruct finance, health departments and general hospital of relevant cities (counties, districts) to further strengthen project fund management, speed up the allocation of WB loan proceeds, and improve the efficiency of the use of funds. (2) The Zherong County Health Bureau did not include the World Bank's medical reform funds in the departmental budget management. From 2019 to 2022, the Zherong County Health Bureau did not include the World Bank's medical reform funds in the budget for the next year according to the use plan of the funds, which doesn't comply with the Article 6 of the Notice of Issuing the Interim Measures of WB Financing Management of Fujian Medical Reform Promotion Program issued by FPFD and FPHC (Fujian Foreign Debt [2019] No.2), that is, "The health (planning) bureaus (PMOs) of districts and counties shall be responsible for the project implementation within their jurisdiction... and comprehensively promote the completion of various project targets and payment related targets on time." It is recommended that your unit instruct Zherong County Health Bureau to include the World Bank's loan proceeds in the departmental budget management and promote the standardized operation. (3) The World Bank loan proceeds in some localities have not been used for the construction of health talents, and the expenditure requirement of no less than 8% has not been implemented. Xiangcheng District, Jianning County and Qingliu County have not arranged the funds for the construction of health talents in the allocation and use of the loan funds from the World Bank. It doesn't comply with the Article 15 of the Notice of Issuing the Interim Measures of WB Financing Management of Fujian Medical Reform Promotion Program issued by FPFD and FPHC (Fujian Foreign Debt [2019] No.2), that is, "The World Bank loan proceeds will be used for local medical 43 reform, focusing on the improvement of medical service capacity, informatization construction and talent team construction of the whole province (excluding Xiamen City). Among them, the funds for the construction of health talents in various regions accounted for 8%." It is recommended that your unit instruct health departments of relevant cities (counties, districts) to properly allocate part of the funds for the construction of health talents and improve the capacity of health and medical services. (4) Two informatization construction projects of Longyan People's Hospital in Xinluo District have not been accepted on time. The awarded price of Regional Inspection Center and rational Drug Use system of Longyan People's Hospital is 562,000 yuan and 500,000 yuan respectively Both projects have been completed and officially put into operation in November 2021 and the end of 2020 respectively, but they have not been accepted and paid, which doesn't comply with the Article 8 of Overall Implementation Plan of Medical and Health Informatization at County Level in Fujian Province under the World Bank Financed Medical Reform Promotion Project (FPHC Planning [2018] No. 41), that is, "the construction period of the project is from 2018 to 2019, and ends in 2020 (completion acceptance, effect evaluation and work summary)......" It is recommended that your unit instruct Xinluo District Health Bureau to urge Longyan People's Hospital to accept the completed projects and make payment in time. d. Issues identified during the audit of previous year 25 problems reflected in the 2021 annual audit report (4 problems for rectification within the deadline, 21 problems for record rectification). By December 27, 2021, the four problems for rectification within the deadline have been corrected; eight of the 21 problems for record rectification have been rectified, of which 13 problems are under rectification. In 2022, continue to focus on rectification and implementation. As of July 29, 2022, all the 13 problems for record rectification have been rectified. In general, the FPHC attaches great importance to the rectification, urges the relevant units to check accounts one by one and feedback the rectification situation on time; also can strengthen the management, speed up the fund disbursement and use progress, improve the fund use efficiency. 44