Chinanews.com, Beijing, July 12th, title: Why does China promote the Sanming medical reform experience?
Reporter Li Chun
The General Office of the State Council of China recently issued the "Key Tasks for Deepening the Reform of the Medical and Health System in 2021", the first of which is to "further promote the medical reform experience of Sanming City and accelerate the reform of medical, medical insurance, and pharmaceutical linkages."
Why did China propose to promote the Sanming medical reform experience nationwide?
How did this small mountain town with a permanent population of about 2.5 million get to the forefront of this round of medical reform?
In early July, the reporter followed the relevant personnel of the National Health Commission of China to Sanming to investigate and investigate the medical reform situation to find out.
The Sha County General Hospital of Sanming City established a health management department.
Li Chunshe
Why is Sanming?
Sanming is a city that started with old industries. The problem of “getting old before getting rich” was once quite serious, and medical expenses increased by double-digits every year.
In 2012, when the local medical insurance fund faced the risk of "penetrating the bottom", the Sanming medical reform was officially launched, and the first goal was to target the inflated prices of medicines and consumables.
"For example, when a certain medicine was not reformed, some places sold for more than 400 yuan at the highest price. At that time, we talked about 256 yuan in Sanming." Xu Zhiluan, director of the Sanming Medical Insurance Bureau, told reporters that in the first national concentration belt After the mass purchase, the price of the drug dropped to 17.36 yuan, and the second centralized procurement dropped to 3.83 yuan.
"This shows how high the price of this medicine is."
Promote zero-markup sales of hospital medicines and consumables throughout the city, carry out centralized purchases, monitor the use of key medicines in real time, and strictly control excessive diagnosis and treatment... Fighting against falsely high medicine prices is the first battle of Sanming’s medical reform. After the reform, medical expenses quickly achieved a "cliff-like" decline.
The data shows that from 2012 to 2020, the total medical cost of Sanming City will be saved by 11.068 billion yuan, and the cost of medicine and consumables will be saved by 12.403 billion yuan.
Taking this as a breakthrough, Sanming City "vacated the cage and changed the bird" to make room for subsequent reforms.
The reform of the “three-medicine linkage” of medicine, medical insurance, and medical treatment was promoted. The general hospitals (medical community) with a high degree of centralized management of counties, villages, and people, finances and materials were established, and the “packaged payment” of medical insurance and the collection of diseases related to diagnosis (C-DRG) were promoted. Paying reform, improving the hospital's income structure and medical staff's salary...
Rao Guanyin, Dean of Wan'an Branch of Jiangle County General Hospital in Sanming City, introduced the health management platform used by the hospital.
Li Chunshe
A series of reform measures constituted a "combined boxing", straightening out the medical insurance management system, returning medicines to the function of treating diseases, and returning doctors to the role of seeing a doctor.
Patients, hospitals, and doctors have all benefited from the reform.
Wu Yongyang, president of the Sanming First Hospital, said that since the reform, the hospital’s medical income has been on the rise. The medical income in 2020 will be 552 million yuan, an increase of 135.9% from 2011.
At the same time, the proportion of drug revenue and management and operation costs have all declined.
The operating efficiency of the hospital has also been improved. The average length of stay for discharged patients was 8.39 days, which was 2.33 days shorter than in 2011, and it was shortened to 8.19 days in the first quarter of 2021.
In addition, Sanming has adopted a series of reform measures such as the total salary system of public hospitals, the target annual salary system for all employees, and the annual salary calculation work point system. The enthusiasm of medical staff has also been further mobilized in this process.
Xie Xianjin, president of Shaxian General Hospital, told reporters that from 2011 to 2020, the total salary of public hospitals above the second level in Sanming City will increase from 382 million yuan to 1.557 billion yuan, and the average annual salary of doctors will also increase from 56,500 yuan to 169,300 yuan. .
"People get benefits, hospitals get development, and doctors get motivated." This is the achievement of Sanming Medical Reform in more than 9 years.
Nowadays, Sanming's medical reform has gone through the two stages of "treatment of chaos and waste prevention" and "establishment of regulations and establishment of systems". It has entered the 3.0 stage of medical reform of "preventing diseases and improving health", and has also gained important medical reform experience.
Health management platform for residents in Jiangle County, Sanming City.
Li Chunshe
How to learn from Sanming's experience?
In March 2017, the meeting of the Central Leading Group for Comprehensively Deepening Reform pointed out that the direction of Sanming's medical reform is correct and the results are obvious, and attention should be paid to promotion.
With the continuous deepening of reform and exploration, the achievements of Sanming's medical reform have also been affirmed by all parties.
According to media reports, from 2013 to 2019, a total of more than 1,300 batches and nearly 20,000 people from all over the country went to Sanming to learn and exchange experience in medical reform.
Li Bin, deputy director of the National Health Commission, also pointed out that Sanming took the comprehensive reform of public hospitals as an entry point to coordinate the promotion of the "three-medical linkage" reform of medical care, medical insurance, and medicine, setting a model for the deepening of medical reform across the country.
In the past few years, this small mountain town in central Fujian has become a pioneer in China's medical reform.
Today, this pioneering role needs to be further brought into play.
Xu Shuqiang, director of the System Reform Department of the National Health Commission, pointed out at a press conference in early July that the current deepening of medical improvement has entered the deep water area, and reform is facing new situations and tasks.
On the one hand, on the basis of systematically summarizing the reform work of the previous period, we should put the strengthening of reform system integration and the promotion of reform implementation in a more prominent position, adhere to the system concept, strengthen reform policy coordination, progress coordination, and effect coordination, and give full play to the reforms. The overall effect.
On the other hand, China has entered a stage of high-quality development, adapted to the main contradictions and changes in Chinese society, met the people's growing needs for a better life, and put forward new requirements and expectations for deepening the medical reform.
At the same time, during the "14th Five-Year Plan" period, China will enter a moderately aging stage, bringing new challenges to medical services, medical insurance, and rehabilitation care.
"Based on the new development stage, implementing the new development concept, and building a new development pattern, we must use greater strength and more practical measures to break through the problems in the medical reform and lead the reform to advance in depth," Xu Shuqiang said, "Sanming medical reform has given us Our very important experience and inspiration."
After answering the question of "Why Sanming", the next step is to focus on how to learn from its successful medical reform experience.
China has a vast territory, and different places have different levels of population and economic development. "Adapting measures to local conditions" is undoubtedly a key to learning from the experience of Sanming's medical reform.
Zhu Hongbiao, the first-level inspector of the Department of System Reform of the National Health Commission, said that it is necessary to comprehensively learn and promote the universally applicable experience that has been proven in the Sanming medical reform.
For example, the leaders of Sanming's party and government personally grasped the medical reform, implemented the government's investment responsibility in public hospitals, and deepened the reform of the salary system. All of these good practices are worth learning from, copying and promoting.
However, he pointed out that all localities should seek truth from facts in light of actual conditions, instead of simply copying them.
For example, in the price adjustment of medical services, one can learn from Sanming's practice of "walking in small steps without stopping" to establish a dynamic price adjustment mechanism.
However, the specific items to be adjusted, the scope and priority of adjustment, etc., must be determined by each locality in light of its own actual conditions.
Zhu Hongbiao also expressed that it is necessary to base on the conditions of the province, the city, and the county, and creatively learn from the experience of Sanming.
It is necessary to highlight the problem orientation, grasp the main contradictions, explore and innovate, overcome difficulties, boldly try, boldly change, and break out of a new world.
It is certain that Sanming's medical reform, which is a national model, will continue to deepen. It will continue to exert efforts in the integrated management of chronic diseases, the establishment of a medical and prevention integration mechanism, and the improvement of residents' health management capabilities throughout the life cycle, and will move toward the goal of reforming people’s health as the center. Step forward. It is also foreseeable that Sanming's beneficial experience will also bring enlightenment and assistance to the medical reform work in more parts of the country, and promote the improvement of Chinese people's sense of gain, security, and happiness. (Finish)