The latest medical reform in 2022 is to accelerate the construction of an orderly new pattern of medical diagnosis and treatment.
1. Give play to the leading role of the National Medical Center and the National Regional Medical Center: relying on the existing resources, speed up the establishment and construction of the National Medical Center, carry out the construction project of the National Regional Medical Center, deepen the reform of the operation mechanism, and basically complete the planning and layout of the construction project of the National Regional Medical Center within this year.
2. Give full play to the radiation leading role of provincial high-level hospitals: relying on existing resources, guide local governments to build a number of provincial regional medical centers, improve the system and mechanism, introduce 1 into the central city of provincial capital cities and areas with weak supporting resources for hospitals in megacities, and promote the extension of high-quality medical resources to cities and counties.
3. Improve the service capacity of hospitals in cities and counties: each province will carry out pilot projects of compact urban medical groups in 2-3 districts and cities, improve the system and mechanism, and implement grid layout and standardized management.
The reform of medical insurance payment system is reverse;
1, the hospital income is facing the ceiling bottleneck: the limited funds and the public's concern about the high cost of medical treatment all determine that the room for extensive growth of hospitals is limited, and the hospital income must be adapted to the people's affordability. Under the current situation of insufficient government financial input, hospital income is facing the ceiling bottleneck.
2. Negotiation and negotiation mechanism The hospital is at a disadvantage: the medical insurance department or the new rural cooperative medical system has an advantage in the negotiation, and more is to divide the cake according to the total amount of funds. The hospital has limited negotiation space and is in an obvious advantage position, and the negotiation rights and responsibilities will not be equal. The medical insurance fund management department is more of an administrative imperative negotiation and announces the rules of the game.
3. Risk differentiation forces hospitals to pay attention to the quality and benefit of domestic wine: the limitation of medical insurance fund greatly increases the financing ratio, but it is restricted by economy. Through the reform of the payment system, the medical insurance management department transferred the risk of insufficient funds caused by the policy number to the hospital, and strictly regulated the use of the fine deduction medical insurance fund. Facing the low cost of medical expenses, the use of essential drugs, the control of the proportion of drugs, the control of the proportion of medical technical examination, the control of the average cost, the control of hospitalization rate, the control of hospitalization days and the control of the burden rate of medical insurance patients.
The main contents of the new medical reform
The new medical reform will start with the problem of "difficult and expensive medical treatment" strongly reflected by the people, and focus on solving the following five problems in 2009-20 1 1:
First, speed up the construction of the basic medical security system. The participation rate of urban workers' basic medical insurance, urban residents' basic medical insurance and new rural cooperative medical care has reached more than 90%, the urban and rural medical assistance system has been improved, and the burden of personal medical expenses of urban and rural residents has been significantly reduced.
In 20 10, the basic medical insurance for urban residents and the new rural cooperative medical subsidy standard were raised to per person per year 120 yuan. In the year of 20 10, there were farmers 1468 12 in our district, and the participation rate reached 95. 18%. The reimbursement rate of hospitalization expenses within the scope of the new rural cooperative medical policy in the overall planning area is 63.05%, and the maximum payment limit of the new rural cooperative medical fund reaches 20,000 yuan.
The second is to initially establish a national essential drug system, and establish a relatively complete system for the selection, production, supply, use and reimbursement of essential drug vector treatment insurance. In 2009, the state announced 307 kinds of essential drugs; The primary medical and health institutions organized by our district government are all equipped with and use basic drugs, and sell them at different prices.
The third is to improve the primary medical and health service system, speed up the construction of rural tertiary medical and health service network and urban community health service institutions, give play to the leading role of county-level hospitals, and build a relatively complete primary medical and health service system in three years.
The fourth is to promote the gradual equalization of basic public health services. Since 2009, urban and rural residents have been provided with basic public health services such as disease prevention and control, maternal and child health care and health education.
Improve the urban and rural public health service system and the public health service funding guarantee mechanism. By 20 10, the per capita funding standard for basic public health services in our district will reach 2 1.5 yuan.
The fifth is to promote the pilot reform of public hospitals, promote the reform of compensation mechanism of public hospitals, increase government investment, improve the economic compensation policy of public hospitals, and gradually solve the problem of "supplementing medicine with medicine".
In 2009, China published the National Essential Drugs List, and established a management mechanism for the selection and adjustment of the National Essential Drugs List, which was adjusted and updated regularly.
According to this "Implementation Plan", China will establish a system of priority selection and rational use of essential drugs, and all retail pharmacies and medical institutions should equip and sell national essential drugs to meet the needs of patients. Since 2009, all grass-roots medical and health institutions organized by the government are equipped with and use essential drugs, and other medical institutions must also use essential drugs according to regulations.
According to the "Implementation Plan", patients are allowed to buy drugs in retail pharmacies with prescriptions. All essential drugs are included in the reimbursement list of basic medical insurance drugs, and the reimbursement ratio is significantly higher than that of non-essential drugs.
The establishment of the national essential drug system is of great significance for ensuring the fairness, accessibility, safety and effectiveness of people's drug use and reducing the burden of people's drug use.
According to the definition of the World Health Organization (WHO), essential drugs refer to drugs that meet the health care needs of most people, have sufficient quantities and suitable dosage forms at any time, and their prices are affordable for individuals and communities.
To this end, the newly published "Implementation Plan" clearly stated that the state should set retail guidance prices for essential drugs. According to the provincial people's government
China's medical reform has seven specific contents.
First, comprehensively deepen the reform of public hospitals.
20 16 it is necessary to further consolidate and improve the comprehensive reform of county-level public hospitals, strengthen classified guidance and demonstration guidance, and choose to carry out demonstration work of county-level public hospitals. There are 100 new urban public hospitals, and the number of pilot cities in China has reached 200. Promote the inclusion of 10 hospitals supervised by the National Health and Family Planning Commission in the comprehensive reform of local public hospitals, and establish a performance appraisal mechanism.
Second, promote the construction of graded diagnosis and treatment system.
20 16. Continue to take comprehensive medical reform as a pilot in accordance with the requirements of "first consultation at the grass-roots level, two-way referral, rapid and slow division and treatment, and linkage from top to bottom".
Focusing on the pilot cities of provincial and public hospital reform, we will accelerate the graded diagnosis and treatment and carry out pilot projects in about 70% cities.
Third, further consolidate and improve the universal medical insurance system.
Promote the integration of the basic medical insurance system for urban and rural residents. Promote the implementation of the "six unification" policy in the coverage, financing policy, security treatment, medical insurance catalogue, fixed-point management and fund management of urban and rural residents' medical insurance.
Fourth, improve the drug supply guarantee mechanism.
Grasp the key links such as drug production, procurement, circulation, distribution and use, and further improve the drug supply guarantee mechanism.
Fifth, further strengthen the supervision system.
Improve the legal system of medical and health supervision. Severely crack down on all forms of illegal medical practice.
Sixth, strengthen the construction of talent team.
First, continue to strengthen the training of grassroots health personnel with general practitioners as the focus. The second is to comprehensively organize and implement standardized training for residents.
Seven, to further stabilize the equalization system of basic public health services.
Raise the per capita financial subsidy standard of basic public health service funds to 45 yuan, optimize existing service items and expand service coverage.
Eight, to further promote the construction of health information.
Make overall plans to promote the construction of national, provincial, municipal and county population health information platforms, and accelerate the construction of business application information systems such as public health, family planning, medical services, medical security, drug management and comprehensive management to achieve interconnection.
Nine, accelerate the development of health service industry.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 24
The state establishes and improves the new rural cooperative medical system. Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25
The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.