Standard community hospitals will become "fixed-point medical insurance"
—— This newspaper interviewed Wen Honghai, director of the Municipal Health Bureau.
"This year, the provincial health system will adjust the urban medical service system and focus on building a secondary medical service network in the city. The first level is general hospitals and specialized hospitals, and the second level is community health service institutions.
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Yesterday, Wen Honghai, director of the Municipal Health Bureau, accepted an interview with our reporter at the site of the Municipal People's Congress, focusing on community health services that many delegates, members and citizens are very concerned about.
"Six Unifications" in Community Hospitals
Director Wen Honghai said: "Last year, the municipal health system implemented the" six unification "of health files, prescriptions, laboratory sheets, treatment sheets, clothing and signs for the city's community health service institutions, and 20 agricultural township hospitals and village clinics were transformed into community health service institutions." It is reported that Director Hong Hai introduced that according to the goal of "improving the level of general hospitals, creating the characteristics of specialized hospitals and widely covering community health service institutions", this year, the provincial health system will adjust the urban medical service system and focus on building the urban secondary medical service network. General hospitals, specialized hospitals and community health service institutions constitute a three-level first-class hospital. It is necessary to clarify their respective functional orientation and development direction, and build a medical service system with reasonable layout, clear division of labor, perfect functions, standardized services and scientific management. According to the idea of "building famous hospitals, strengthening characteristics and creating brands", municipal hospitals should make general hospitals bigger and stronger, refine specialty characteristics, make brand effects sound and bright, and improve core competitiveness. In addition, we will continue to vigorously develop community health services, and strive to transform 80% of township (town) hospitals and village hospitals in urban areas into community health service institutions during the year to provide convenient, fast, high-quality and low-cost medical and health services for community residents.
Experience of popularizing excellent community health stations
"The number of existing community medical institutions is quite large, but the setting is unreasonable. There are problems of redundant construction in some areas and need to be effectively integrated. " In this regard, Wen Honghai said that the Municipal Health Bureau will set up new community health service institutions in accordance with relevant plans. One of the important contents is to change the staff hospitals and district hospitals with poor operating conditions into community health service institutions. "Some community health service stations in Shijiazhuang have established close ties with nearby residents, which have been recognized and trusted by residents, and the two sides get along very well. This year, we will focus on promoting the experience of these service organizations. "
Community hospitals that meet the standards will be "medical insurance designated points"
Wen Honghai said that at present, there are mainly the following forms of community medical institutions in Shijiazhuang: the establishment of public hospitals, the transformation of staff hospitals and the construction of private capital investment. The Municipal Health Bureau will set up and standardize community medical service institutions in accordance with the principles of "strict access, careful examination and approval, standardized behavior and reduced low-level duplication". On this basis, the Municipal Health Bureau will actively cooperate with relevant departments to make community health service institutions that meet relevant standards become designated medical institutions for medical insurance.
Partial proposal
Xiaojianfen Wang Jie planning community sanitary clinic
Sponsor: Member Wang Shubo
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After several years of efforts, Shishi has initially formed a community health service system with basic network coverage, perfect service functions and standardized technical management. However, there is still a certain gap between the positioning of the provincial capital city as a livable city and the goal of building a medical and health system that conforms to the objective laws of the market economy, and the problem of people's difficulty in seeing a doctor has not been fundamentally solved. At present, there are more than 100 community health service institutions with insufficient resources, uneven distribution, low utilization rate, weak service capacity and low level; The government compensation mechanism is not perfect, the policy convergence is not smooth, and the operation mechanism is unreasonable, which restricts the healthy development of community health services. Developing community health services is an important responsibility of governments at all levels, and government functions should be strengthened.
Live broadcast of opinions
Further strengthen government functions
The government should incorporate community health services into the overall planning of local economic and social development and the planning of the construction of two civilizations in urban communities, improve supporting policies and measures, set up coordination leading bodies, and solve and coordinate various difficulties and problems in time. The development of urban community health services should adhere to the nature of public welfare, adhere to government leadership and encourage social participation.
New communities should plan community health service stations.
Optimize the structure of urban health resources, improve the service network, improve service functions, rationally set up institutions, and standardize supervision and management. Relevant departments should fully consider the planning and construction of community health service stations in the urban planning of new residential areas, reconstruction and expansion of residential areas, effectively solve the problems of community health service rooms, and improve the supporting health service facilities in residential areas.
Increase government investment
Increase the investment of governments at all levels in community health services, establish a stable investment mechanism for community health services, rationalize the compensation mechanism for community health service institutions, set up special subsidies for the establishment and development of community health services, incorporate them into the regular budget of finance and health services, and allocate them in full according to the population quota of the jurisdiction. Encourage social forces to participate in the development of urban community health services, and the government should have positive encouragement policies.
Incorporate into the designated scope of medical insurance
Improve the operation mechanism of community health service, establish and improve service institutions, improve supporting policies, implement the first consultation restraint measures of community health service, liberalize the restrictions of medical insurance on community health service institutions, bring qualified community health service institutions into the scope of designated medical institutions of urban medical insurance, and actively explore the establishment of urban medical assistance system based on community health service.
Strengthen the construction of community health service team
Strengthen the training of community service personnel, promote the on-the-job training of general practitioners and nurses, set up special funds to train community general practitioners, community preventive doctors and community nurses. Encourage medical staff in large hospitals to serve in the community. Improve service level, improve service quality, strengthen drug quality supervision, and ensure the safety of residents' medical treatment and medication.
Scientific evaluation
Incorporate community health services into the public health system, expand the scope of preventive health care, strengthen supervision and evaluation, and establish scientific performance evaluation standards for community health service institutions. In order to avoid the development of community health institutions to hospital model, we should establish a community health service system supported by hospitals and preventive health care institutions, so that community health service can become a solid foundation in the network of public health system.
Reporter's record
Large hospitals are overcrowded and community hospitals are too deserted.
Phenomenon-even minor illnesses go to big hospitals.
In the interview, the reporter found that it is a common phenomenon that people go to big hospitals for minor illnesses. On the morning of February 22, the reporter saw in the First Hospital of Shijiazhuang that the outpatients of respiratory medicine and digestive medicine were in an endless stream, and the doctors were busy. The reporter waited in these two departments for a while before trying to interview the doctor on duty. According to Wang Yuling, director of respiratory medicine, there are many patients with common diseases and frequently-occurring diseases who come to see a doctor. Many people with colds go directly to the first hospital of the city instead of the community health service station. Some of them have simple conditions and can be treated in community health service stations or through daily care and adjustment. Wang Yuling believes that some patients with simple illness should go to the community health service station first, and then go to the big hospital for treatment. Experts in big hospitals spend a lot of time diagnosing simple diseases every day, which is a waste of medical resources. Director Han of the Department of Gastroenterology introduced that community medical care is very convenient for patients, and some simple treatments and health care should be solved in community hospitals. Among the patients he treated, many people have seen in community health service institutions, and they were not cured before coming to the First Hospital of the City. Mr. Chen, a patient who came to the Department of Gastroenterology, said that he had eaten too much fried food and drank too many drinks a few days ago and always felt sick. He went directly to the first hospital of the city for examination. Mr. Chen said that he felt that the health service station was poorly equipped and the doctor's level was not high, so he was not at ease. According to the reporter, Mr. Chen's views are representative among the citizens.
Phenomenon-Few people come to community health stations.
Compared with big hospitals, some community health service stations have fewer patients. In a small community health service station, the reporter saw that there were no doors here. The doctor of the health station told the reporter that injections, infusions and other treatments can be carried out here, and residents in nearby communities can come to the door to serve. The reporter saw that the station established health records for some residents in nearby communities. According to the doctor, the community health service station can't use the medical insurance card at present, "but we are fighting for it." In a community next to the health service station, the reporter found that the station was not well-known among the residents. "What disease can be cured there? What are the benefits of establishing a health record? " Residents have raised many questions about this community health service station.
Random search
Residents have "three worries" about community health stations.
On February 22nd and 23rd, the reporter interviewed more than 50 citizens randomly on the street on the issue of "community health service". More than half of the people said that they seldom or rarely went to the community health service station to see a doctor. The reporter's investigation found that there is a "gap" between residents and community health service stations for the following reasons: First, residents do not understand the level of diagnosis and treatment of doctors in the station and are worried about their irregular behavior in treatment; Second, residents are not at ease with the medical equipment and instruments in the service station; Third, some health service stations cannot use medical insurance cards. Due to the above-mentioned "insecurity", many citizens often go thousands of miles to queue up in big hospitals even if they suffer from minor illnesses. At present, there is still a long way to go for community health institutions to fully gain the trust of residents. Empirical interview
"demonstration health station"
Explain the advantages of community medical care.
On the morning of February 23, the reporter saw in Chang 'an District Community Health Service Center and Jianhua Community Health Service Station that the medical situation here was very standardized. Chang 'an Community Health Service Center has a "general outpatient service", and its related departments, Liu Jingcong, said that their positions are different from those of specialists in large hospitals. Doctors are trained as "general practitioners", and now there are more and more patients with common diseases and frequently-occurring diseases. Jianhua community health service station is built in the community, and its service scope is under the jurisdiction of Jianhua four community neighborhood committees. There are 2,758 households with more than 9,000 people in the jurisdiction, and residents can walk to the health service station within 15 minutes. The station not only provides good medical services for residents, but also can measure blood pressure for residents and take care of elderly patients for free. On the morning of February 23rd, 70-year-old Xiao Lao had a scab on his neck. He personally went to Jianhua community health service station to see a doctor and praised the community health service station for facilitating journalists. According to Shen Jinghui, director of the office of Chang 'an District Community Health Service Center, Chang 'an District Community Health Service Station has been gradually recognized by residents and is playing an increasingly important role. Community health service is the development direction of residents' medical care in China, which has been affirmed by the Ministry of Health and the State Council. On February 8th, the State Council issued "Guiding Opinions on Developing Urban Community Health Services", demanding to vigorously develop urban community health services. He said that for individuals, community health service stations can reduce medical expenses. Community health service stations can provide convenient, fast, thoughtful and cheap services. For example, the community health service station in Chang 'an District does not charge consultation fees and registration fees, and measures blood pressure for free. The charging standard is lower than that of district and county hospitals, and ordinary people can save a lot of money. In addition, the community health service station in Chang 'an District signed a "two-way referral" agreement with the Third Municipal Hospital, and some seriously ill patients transferred to the Third Municipal Hospital can be exempted from registration fees and even enjoy some preferential treatment. The health service station has established the health records of community residents, recording their medical history, allergy history and medication history. But it is still too early to say that community health service stations can eradicate the phenomenon of "expensive medical treatment", but it will be an important idea and an effective way. He believes that community health service stations can avoid the waste of medical resources. Some common and frequently-occurring diseases can be cured in the community without going to a big hospital. Large hospitals can provide better services for serious and difficult diseases, and can rationally adjust and effectively use the resources of large hospitals and health service stations. He believes that community health service stations can ease the relationship between doctors and patients. An important reason for the long-standing contradiction between doctors and patients is the lack of communication between doctors and patients. Doctors in big hospitals are generally busy and rarely have time to communicate with patients, while doctors in health service stations will gradually get familiar with many residents in the community, so it is more likely to communicate and spend more time, and they can also answer health consultations put forward by patients and residents in detail. In addition, according to the reporter's understanding, community health service stations also undertake health education, community rehabilitation, family planning technical services, prevention and treatment of chronic non-communicable diseases and infectious diseases, endemic diseases and parasitic diseases. Health service stations can provide prenatal, postpartum and menopausal health care guidance for women, and provide health care guidance for newborns, infants and preschool children for young parents.
New concept of community health service
Chang 'an District of Shijiazhuang takes the lead in developing community health service institutions in the whole province and even the whole country. At present, there are 36 community health service stations and 4 community health service centers, and many of their practices have been promoted throughout the country.
One of the new concepts: two-way referral
According to Shen Jinghui, director of the office of Chang 'an District Community Health Service Center, a few years ago, Chang 'an District Community Health Service Station (Center) signed a "two-way referral" agreement with the Third Hospital of the City. When community doctors find some diseases that are difficult to treat, they will directly recommend the patients to the relevant experts in the Third Hospital of the City according to the diagnosis, and the patients are exempt from paying the registration fee when they go to the Third Hospital of the City. After diagnosis, treatment and examination, experts from the Third Hospital of the City think that patients can go back to the community health service station for further treatment, and recommend them to go back to the community health service station. The city's third hospital can even give certain discounts to referral patients. On February 1 1 this year, Xinhua News Agency announced that the Ministry of Health would promote the two-way referral system throughout the country. Community health service institutions have signed agreements with regional large and medium-sized general hospitals and specialized hospitals. Common diseases and frequently-occurring diseases can be treated in community health service institutions, serious diseases can be transferred to large hospitals above the second level, and chronic disease treatment and postoperative rehabilitation after diagnosis in large hospitals can be transferred to community health service institutions. In this way, we can achieve "minor illness does not leave the community, and serious illness is referred in time". According to the relevant personage of the Ministry of Health, there are two main tasks to increase people's trust in community health service institutions. First, increase the training of community doctors; The second is to let the public know the content and mode of community health service.
The second new concept: general practitioner
Liu Jingcong is the director of Chang 'an Community Health Service Center. Her department is called "general clinic" and is called general practitioner by many people. According to Liu Jingcong, as a doctor in a community health service center, she is obviously different from a specialist in a big hospital. The patients she treated were all kinds of diseases, and the specialists were incompetent. Liu Jing is trained as a general practitioner and has rich clinical experience. Many old patients came back to see Liu Jing after leaving this community. It is understood that some medical colleges have set up the specialty of "general practitioner", and the health department of our province has also carried out a number of general practitioner trainings to meet the needs of society.
The third new concept: residents' health records
Unlike many hospitals and private clinics, Chang 'an District Health Service Station has residents' health records. In Chang 'an District Community Health Service Center, the reporter saw a file bag neatly placed in a cupboard. The cover of each file bag is marked with the home address and name, which contains the residents' "personal health records". There are residents' names, ages, blood types, allergic history, catalogues of major problems, catalogues of temporary problems and other information. , and indicate the names of the submitting doctors and nurses and the date of submission. It is understood that this file can let community doctors know the overall situation of the community, quickly find out the cause when residents are sick, and guide residents to prevent diseases in a targeted manner. In addition, community doctors also provide free physical examinations for the elderly who are lonely and widowed, and provide on-site services when necessary to conduct physical examinations for residents in the jurisdiction.
The fourth new concept: designated medical insurance into the community
Although community health service stations are convenient, fast and cheap, many service stations can't use medical insurance cards, so many residents often go far and near even if they are slightly ill, and queue up in big hospitals to see a doctor. The reporter learned that this is indeed a bottleneck restricting the development of community health service stations. At present, only a few community health service stations in Shijiazhuang are listed as designated medical insurance units. Jianhua Community Health Service Station in Chang 'an District is one of the designated medical insurance institutions in Shijiazhuang. In the future, with the gradual standardization of community health service stations and the reform of related systems, more health service stations can be included in designated medical insurance units. On February 8th, the State Council issued "Guiding Opinions on Developing Urban Community Health Services", which clearly pointed out that giving full play to the role of community health services in medical security requires that community health service institutions should be included in the designated medical institutions of urban medical insurance and guide insured workers to visit the community. The relevant person of the Ministry of Health once said, "Some qualified community health service institutions will be included in the designated medical insurance institutions as soon as possible to enhance the people's recognition of community health services and let residents get more and better services."