China's medical reform, there are Chinese-style methods (new journey of health ③)
The report of the 20th National Congress of the Communist Party of China proposed to deepen the reform of the medical and health system and promote the coordinated development and governance of medical insurance, medical care and medicine.
Promote the expansion of high-quality medical resources and the balanced distribution of regions, adhere to the principle of prevention, strengthen the health management of major chronic diseases, and improve the ability of grassroots disease prevention, treatment and health management.
We will deepen the reform of public hospitals oriented towards public welfare, and standardize the development of private hospitals.
It is the goal of China's medical reform to strive to solve the problem of medical treatment for the masses and to find a path for the reform and development of health care with Chinese characteristics.
Zhu Hongbiao, a first-level inspector of the System Reform Department of the National Health and Medical Commission, said that based on the national conditions, we will give full play to the advantages of the system, and continue to explore the use of Chinese-style methods to solve the global problem of medical reform.
Reform payment methods
Spend your health insurance fund on the edge
Registration, inspection, taking medicine... In this medical treatment process, if you are a medical insurance participant, after the threshold is exceeded, a part of each expense will be borne by the medical insurance fund.
How to make good use of the people's "medical money" and "life-saving money"?
"The payment mechanism is the key mechanism to improve the efficiency of the use of medical insurance funds." Huang Huabo, director of the Medical Service Management Department of the National Medical Insurance Administration, said that promoting the reform of medical insurance payment methods is not only the need for the high-quality development of medical insurance, but also for the masses to obtain higher-quality medical insurance and medical services. needs.
Long Xuewen, head of the Medical Insurance Business Management Center of the National Medical Insurance Administration, said that the reform of payment methods is to improve the use efficiency of medical insurance funds, use limited medical insurance funds to purchase higher-quality medical services for insured persons, and at the same time encourage medical institutions and doctors to actively regulate Medical service behavior, enhance the endogenous motivation to control costs, and promote hierarchical diagnosis and treatment.
Since 2019, the National Medical Insurance Administration has successively launched a national pilot program of DRG (Disease Diagnosis-Related Group) payment in 30 cities and a DIP (Disease Type Score) payment national pilot in 71 cities.
By the end of 2021, all 101 cities have entered the actual payment stage, basically achieving the expected results, and promoting the profound transformation of the medical insurance management mechanism, including the transformation of medical insurance payment from project-based payment to value-based payment, from final payment to active action, and from simple The transition from manual auditing to big data application, from extensive supply-side management to refined supply-side management, etc.
This year, the National Medical Insurance Administration launched a three-year action plan for the reform of DRG/DIP payment methods. medical institutions that provide inpatient services.
"One is to pay close attention to the overall coverage of regions, medical institutions, disease groups and medical insurance funds; the second is to improve the management and adjustment mechanism of core elements, improve the performance management and operation monitoring mechanism, form a multi-party evaluation and dispute resolution mechanism, establish The coordinated promotion mechanism of relevant reforms; the third is to firmly grasp the construction of professional capabilities, information systems, standards and norms and demonstration sites, and to consolidate the foundation to ensure the stable and long-term progress of the reform of payment methods; the fourth is to guide and coordinate medical institutions to focus on promoting coding management, Coordination of information transmission, medical record quality control and internal operation mechanism construction.” Li Shuchun, deputy director of the Pharmaceutical Management Department of the National Medical Insurance Administration, introduced that at present, more than 200 regions across the country are promoting the reform of DRG/DIP payment methods for hospitalization expenses, and the next step will continue to be Promote the reform of medical insurance payment methods, monitor the effectiveness of the reform of payment methods, truly give full play to the role of the "bull nose" of medical insurance payment, and promote the high-quality development of medical insurance.
Building a new pattern of diagnosis and treatment
Basically realize "serious illness not in the county"
In the past 10 years, the reform of China's medical and health system has continued to deepen, and the people's problem of "difficult and expensive medical treatment" has been accelerated.
Xu Shuqiang, director of the System Reform Department of the National Health and Medical Commission, introduced that in the future, a combination of punches will be launched from four aspects to promote the construction of a new pattern of orderly medical treatment and diagnosis and treatment.
Continue to promote the expansion, sinking and balanced distribution of high-quality medical resources.
At the national level, promote the establishment and construction of national medical centers and national regional medical centers, and reduce cross-regional medical treatment.
As of July this year, 20 provinces and the Xinjiang Production and Construction Corps have joined the construction scope of national regional medical centers, and three batches of 50 national regional medical center projects have been implemented.
"Strive to build national regional medical centers to cover all provinces in the country by the end of this year." Xu Shuqiang said.
Continue to strengthen the standardized construction of primary medical and health institutions.
By the end of 2021, nearly 980,000 primary medical and health institutions of various types have been established nationwide, with over 4.4 million health personnel.
According to the sixth statistical survey of health services, 90% of households can reach the nearest medical point within 15 minutes.
At present, the proportion of primary diagnosis and treatment has remained above 50% for a long time.
The next step is to increase the training and training of general practitioners at the grassroots level, improve the contract service of family doctors, and enhance the service capacity of township health centers.
Further play the active role of information technology in hierarchical diagnosis and treatment.
Build a telemedicine collaboration network to narrow the gap in service capabilities between regions.
Promote information exchange and data sharing within the medical alliance, build a hierarchical diagnosis and treatment information platform, and provide technical support for family doctors to sign services, two-way referrals, and appointments for diagnosis and treatment.
Improve the system and mechanism for promoting hierarchical diagnosis and treatment.
Strengthen the main responsibility of local governments, do a good job in regional medical and health planning and medical institution setup planning; build a multi-modal medical insurance payment method to give full play to the guiding role of medical insurance on both supply and demand sides; increase investment in the construction of grassroots talent teams, so that grassroots retention Residential talents; increase the weight of graded diagnosis and treatment in the performance appraisal of medical and health institutions at all levels.
"Taking Zhoukou City as an example, the municipal level established 'three groups and one center', established Internet hospitals, established national-level clinical research cooperation centers, provincial-level regional medical centers, and carried out the construction of key specialties; the county-level established a close county-level medical community management Committee, set up a medical and health service group, and implement the unified management of county and township people, property and property, and the integration of responsibilities and rights." Zhang Jianhui, secretary of the Zhoukou Municipal Party Committee of Henan Province, said that through the "three sinks" of municipal hospital experts, disciplines, and management, the four levels of cities, counties, and villages are vertically connected. Medical resources, realize the coordinated development of medical resources in the city area, and basically realize that the masses will not stay in the county for serious illness, in the village for recovery, and in the village for minor illness.
Empowering public hospitals
Play the role of the mainstay
Public hospitals are the main body of China's medical service system and the main place for the masses to see a doctor.
In meeting the daily medical service needs of the masses and responding to major public health emergencies, public hospitals have played the role of the mainstay.
Jiao Yahui, director of the Medical Administration and Medical Administration Bureau of the National Health and Health Commission, pointed out that the National Health and Health Commission put forward the development requirements of "three changes and three improvements" for public hospitals.
"Three changes" means that the development mode should be changed from scale expansion to quality and efficiency improvement, the operation mode should be changed from extensive management to refined management, and the resource allocation should be changed from focusing on material factors to focusing on talents and technology.
"Three improvements" are to improve the quality of medical services, improve the efficiency of medical services and improve the enthusiasm of medical staff.
"Take the province as a unit, take the lead in promoting the high-quality development of public hospitals in 11 pilot provinces of comprehensive medical reform. For public hospitals at all levels and categories in the province, clarify specific goals, key tasks and supporting measures. The path for high-quality development of public hospitals. Taking prefectures and cities as units, implement demonstration projects for public hospital reform and high-quality development.” Xu Shuqiang introduced.
"The establishment of a modern hospital management system, from disease treatment to health as the center, is based on maintaining public welfare. The premise of maintaining public welfare is to adhere to the government's leadership and the main body of public hospitals." Deputy Mayor of Suzhou City, Jiangsu Province Ji Jing introduced that in recent years, Suzhou has launched a series of measures of "transfer, push, fix, and reform".
The transformation is to speed up the transformation of government functions, clarify the responsibilities of the health department for medical management, the independent legal person status of public hospitals, and clarify rights, responsibilities and obligations.
The push is to promote the "three medical linkages" of medical insurance, medical treatment and medicine, and the proportion of the city's residents' personal health expenditure in the total health expenditure has continued to decrease.
The decision is to determine the responsibility system of the president under the leadership of the party committee, formulate the charter of the public hospital, establish a management system that conforms to the actual situation and development focus of the hospital, and improve the efficiency and efficiency of the hospital's performance management.
The first is to reform the system. At present, all public medical institutions in the city are included in the medical alliance, and 11 urban medical groups, 15 county medical associations, 98 specialist alliances, and 29 remote collaboration networks have been established. %; the second is to improve the model, and vigorously promote multi-disciplinary consultation, day surgery, responsibility-based overall care and TCM comprehensive diagnosis and treatment models; the third is to improve services and deepen the level of smart health construction, citizens only need a mobile phone for medical treatment.
"Through the above measures, the health benefits of the people will be implemented to the 'last mile', and the people's sense of obtaining medical treatment will be enhanced. The modern hospital management system will truly be based on public welfare, and realize the purpose of people's health as the center." Ji Jing said.
Wang Meihua