Establishing a graded diagnosis and treatment system is an important measure to rationally allocate medical resources and promote the equalization of basic medical and healthcare services, and it is an important content of deepening the reform of the medical and healthcare system and establishing a basic medical and healthcare system with Chinese characteristics, and it is of great significance in promoting the long-term healthy development of medical and healthcare, improving the people's health, and safeguarding and improving people's livelihood. Important significance. In order to implement the spirit of the Decision of the Central Committee of the People's Republic of China on a Number of Major Issues Concerning the Comprehensive Deepening of Reform and the Opinions of the Central Committee of the People's Republic of China and the State Council on Deepening the Reform of the Medical and Health Care System, and to guide the localities in promoting the construction of the hierarchical diagnosis and treatment system, with the consent of the State Council, the following opinions are hereby proposed.
One, the overall requirements
(a) Guiding ideology. Comprehensively implement the spirit of the 18th CPC National Congress and the Second, Third and Fourth Plenary Sessions of the 18th CPC Central Committee, conscientiously implement the decision-making and deployment of the CPC Central Committee and the State Council, based on the actual development of China's economic and social and medical and health care undertakings, follow the laws of medical science, in accordance with the principles of people-centeredness, public voluntarism, urban-rural integration and innovative mechanisms, with a focus on improving the capacity of primary health care services, and with the grading of diagnosis and treatment of common, frequent and chronic diseases as a breakthrough, improve the service network, operation mechanism and incentive mechanism, guide the sinking of high-quality medical resources, form a scientific and reasonable order of medical treatment, and gradually establish a system of hierarchical diagnosis and treatment in line with national conditions, so as to effectively promote the fair accessibility of basic medical and health services.
(ii) Targets and tasks.
By 2017, the policy system of hierarchical diagnosis and treatment will be gradually improved, the mechanism of division of labor and collaboration among medical and health institutions will be basically formed, high-quality medical resources will be sunk in an orderly and effective manner, the construction of primary medical and health care personnel focusing on general practitioners will be strengthened, the efficiency of the utilization of medical resources and the overall effectiveness will be further improved, the ratio of diagnosis and treatment volume to the total volume of diagnosis and treatment volume of primary medical and health care institutions will be significantly increased, and the order of medical care will be The order of medical treatment will be more reasonable and standardized.
By 2020, the service capacity of graded diagnosis and treatment will be comprehensively improved, the guarantee mechanism will be gradually improved, a medical service system with a reasonable layout, appropriate scale, optimized hierarchy, clear responsibilities, perfect functioning, and efficiency will basically be constructed, and the graded diagnosis and treatment model of first diagnosis and treatment at the grassroots level, two-way referrals, separation of acute and chronic diseases, and up-and-down linkage will be gradually formed, so that a graded diagnosis and treatment system that conforms to the conditions of the country will be basically established.
- First treatment at the grassroots level. Adhering to the voluntary, policy-guided, encourage and gradually standardize patients with common and frequent diseases to first go to primary medical and health care institutions, and for diseases beyond the functional positioning and service capacity of primary medical and health care institutions, primary medical and health care institutions will provide referral services for patients.
--Two-way referral. Adhering to the principles of scientific medical care, convenience for the public, and efficiency improvement, the two-way referral procedure is improved, a sound referral guidance directory is established, emphasis is placed on clearing the downward referral channels for patients in the chronic stage and the recovery stage, and orderly referrals are gradually realized between medical institutions of different levels and different categories.
--Separation of acute and slow treatment. Define and implement the functions of acute and chronic disease diagnosis and treatment services in all levels and types of medical institutions, improve the treatment-rehabilitation-long-term care service chain, and provide patients with scientific, appropriate and continuous diagnosis and treatment services. Patients with acute and critical illnesses can go directly to hospitals above the second level.
--Up and down linkage. Different levels and categories of medical institutions are guided to establish a division of labor and cooperation mechanism with clear goals and responsibilities, focusing on promoting the sinking of high-quality medical resources and promoting the rational allocation and vertical flow of medical resources.
II. Improvement of graded diagnosis and treatment service system focusing on strengthening the grassroots level
(1) Define the function and positioning of diagnosis and treatment services of medical institutions of all levels and categories. Urban tertiary hospitals mainly provide diagnosis and treatment services for acute and critical illnesses and difficult and complex diseases. Urban tertiary Chinese medicine hospitals make full use of Chinese medicine (including ethnic medicine, the same below) technical methods and modern science and technology, to provide acute and critical illnesses and difficult and complex diseases of Chinese medicine diagnostic and treatment services and Chinese medicine advantage of outpatient diagnostic and treatment services. Secondary hospitals in cities mainly receive patients referred by tertiary hospitals in the recovery period of acute diseases, patients in the recovery period after surgery and patients in the stabilization period of critical illnesses. County-level hospitals mainly provide diagnosis and treatment of common and frequent diseases within the county, as well as rescue of patients with acute and critical illnesses and upward referral services for difficult and complex diseases. Primary healthcare institutions and rehabilitation hospitals, nursing homes, etc. (hereinafter collectively referred to as chronic disease medical institutions) provide treatment, rehabilitation, and nursing care services for chronic disease patients with clear diagnosis and stable conditions, rehabilitation patients, geriatric patients, and patients with advanced tumors.
(2) Strengthening the construction of primary medical and health care personnel. Through the transfer training of physicians on duty at the grass-roots level, directed training of general practitioners, and upgrading the academic level of physicians on duty at the grass-roots level, multi-channel cultivation of general practitioners is being carried out, with a gradual transition to the standardized cultivation of general practitioners, so as to achieve the goal of having 2-3 qualified general practitioners for every 10,000 inhabitants in both urban and rural areas. The construction and management of standardized training bases for general practitioners will be strengthened, the content and methods of training will be standardized, the capacity of general practitioners in basic medical care and public health services will be improved, and the role of general practitioners as "gatekeepers" of residents' health will be brought into full play. An incentive mechanism for general practitioners has been established, with a bias toward general practitioners in the distribution of performance pay, job setting, education and training. Strengthen the training of rehabilitation therapists, nursing staff and other professionals to meet the people's multi-level and diversified health service needs.
(3) Vigorously improving the capacity of primary medical and health care services. Through government-run or purchased services and other means, the scientific layout of primary medical and health institutions, a reasonable division of service areas, and strengthen the standardization of construction, to achieve full coverage of urban and rural residents. Through the formation of medical consortia, counterpart support, and multiple practice by physicians, physicians from urban hospitals above the second level are encouraged to engage in multiple practice in primary medical and healthcare institutions, or to make regular visits or rounds, so as to improve the service capacity of primary medical and healthcare institutions. Reasonably determining the varieties and quantities of medicines to be provided and used by primary medical and healthcare institutions, and strengthening the connection between the use of medicines in hospitals above the second level and primary medical and healthcare institutions, so as to meet the needs of patients. It has strengthened the basic medical service functions of township health centers, and upgraded the medical service capacities of emergency rescue, routine surgeries up to the second level, normal childbirth, high-risk maternal screening, and pediatrics. Vigorously promoting the running of medical services by society, simplifying the admission and approval procedures for individual medical practice, and encouraging qualified physicians to set up individual clinics to serve the grass-roots population close to their homes. To enhance the capacity of primary medical and healthcare institutions to provide Chinese medicine services and medical rehabilitation services, strengthen the construction of diagnostic and treatment zones featuring Chinese medicine, promote the integrated service model of Chinese medicine, and give full play to the role of Chinese medicine in the prevention and treatment of common and frequent diseases and chronic illnesses. In ethnic areas, the special role of minority medicine in serving the ethnic groups should be given full play.
(4) Comprehensively improving the comprehensive capacity of county-level public hospitals. According to the service population, disease spectrum, diagnosis and treatment demand and other factors, the number and size of county-level public hospitals are reasonably determined. In accordance with the principle of "filling in the gaps", the construction of clinical specialties in county-level public hospitals will be strengthened, focusing on strengthening the specialties related to common and frequent diseases in the county, as well as the construction of clinical specialties such as infectious diseases, psychiatry, emergency and first-aid, critical care medicine, nephrology (hemodialysis), obstetrics and gynecology, pediatrics, traditional Chinese medicine, and rehabilitation, so as to enhance the comprehensive service capacity of county-level public hospitals. service capacity. On the premise of having the capacity and guaranteeing safety, the restrictions on the clinical application of medical technology in county-level public hospitals will be appropriately liberalized. At the same time, county-level Chinese medicine hospitals focus on strengthening the construction of Chinese medicine specialties and clinically weak specialties and medical technology departments, such as internal medicine, surgery, gynecology, pediatrics, acupuncture, massage, orthopedic injury and oncology, so as to improve the diagnostic and treatment capacity of Chinese medicine advantageous types of illnesses and the comprehensive service capacity. Through the above measures, the rate of consultation within the county will be increased to about 90%, basically realizing that major diseases do not leave the county.
(E) Integration and promotion of regional medical resources **** enjoy. Integrate the existing examination and testing of hospitals above the second level, disinfection and supply centers and other resources, open to primary health care institutions and chronic disease medical institutions. Explore the establishment of independent regional medical testing institutions, pathology diagnostic institutions, medical imaging institutions, sterilization supply institutions and blood purification institutions to achieve regional resource **** enjoyment. Strengthening medical quality control and promoting mutual recognition of inspection and test results among medical institutions at the same level, as well as between medical institutions and independent inspection and test institutions.
(VI) Accelerating the construction of medical and healthcare informatization. Accelerating the construction of information technology projects for the protection of the health of the entire population, establishing regional medical and health information platforms, realizing the continuous recording of electronic health records and electronic medical records, as well as the enjoyment of information*** between medical institutions of different levels and categories, and ensuring the smooth flow of referral information. Upgrading the capacity of telemedicine services, utilizing information technology to promote the vertical flow of medical resources, improving the accessibility of high-quality medical resources and the overall efficiency of medical services, encouraging second- and third-tier hospitals to provide primary healthcare institutions with services such as teleconsultation, telepathology diagnosis, teleimaging diagnosis, telecardiography diagnosis, and tele-training, and encouraging localities in a position to do so to explore the concept of "primary examination and higher diagnosis". Encourage places with the conditions to explore the effective mode of "primary-level examination and higher-level diagnosis". Promoting cross-regional and cross-organizational consultation information***sharing. The development of Internet-based medical and health services, give full play to the Internet, big data and other information technology means in the hierarchical diagnosis and treatment.
Three, establish and improve the protection mechanism of graded diagnosis and treatment
(1) Improve the mechanism of rational allocation of medical resources. Strengthen the regional health planning and medical institutions set up planning in the allocation of medical resources to guide and constrain the role. It formulates standards for the service capacity of different levels and categories of medical institutions, and guides medical institutions of all levels and types to implement their functional positioning through incentives and constraints such as administrative management, financial input, performance evaluation, and medical insurance payment. It focuses on controlling the number and scale of tertiary general hospitals, establishing a mechanism for regulating public hospital beds centered on the structure of disease types, the scope of service radiation, the fulfillment of functional tasks, the cultivation of talents, and work efficiency, and strictly controlling the unreasonable expansion of the scale of hospital beds. Tertiary hospitals focus on playing a leading role in medical science, technological innovation and talent cultivation, gradually reducing the number of follow-up consultations for common and frequent diseases and general outpatient consultations for chronic diseases with clear and stable diagnoses, diverting patients with chronic diseases, shortening the average hospitalization days and improving operational efficiency. Chinese medicine hospitals in areas with insufficient capacity for grassroots Chinese medicine services and in weak areas should be treated differently. Supporting the development of chronic disease medical institutions, and encouraging some secondary hospitals in areas rich in medical resources to transform into chronic disease medical institutions.
(2) Establishing a grassroots contracting service system. Through policy guidance, promote residents or families to voluntarily sign service agreements with contracted physician teams. The contracted doctor team consists of physicians from hospitals above the second level and medical staff from primary healthcare organizations, and individual clinics are explored to carry out contracted services. The contracted services focus on the elderly, patients with chronic diseases and severe mental disorders, pregnant women, children, and persons with disabilities, and gradually expand to the general population. The content and conditions of contracted services are clearly defined, and the responsibilities, rights and obligations of both parties and other relevant matters are determined. According to the service radius and service population, the areas of responsibility of the contracted doctor teams are reasonably divided, and grid-based management is implemented. The contracted physician team is responsible for providing the agreed basic medical, public **** hygiene and health management services. The fees for contracted services are standardized, and the incentive and constraint mechanism for contracted services is improved. The fees for contracted services are mainly settled by the medical insurance fund, contracted residents' payment and basic public **** health service funding. Contracted doctors or contracted doctor teams provide contracted residents with agreed-upon basic medical and healthcare services, and shall not charge other fees in addition to the contracted service fees in accordance with the regulations. Various forms of contracted services, such as providing differentiated services, categorized contracting and paid contracting, are explored to meet residents' multi-level service needs. Patients with chronic diseases can be prescribed long-term medicines for chronic diseases by contracted doctors, exploring various forms to meet patients' medication needs.
(3) Promote the reform of health insurance payment system. In accordance with the requirements of hierarchical diagnosis and treatment work, timely adjustment and improvement of medical insurance policy. The role of various types of medical insurance in guiding the supply and demand of medical services and controlling medical costs is being brought into full play. It has pushed forward the reform of the payment method of medical insurance, strengthened the budget for the income and expenditure of the medical insurance fund, established a composite payment method based on the payment for each type of disease, such as capitation payment and payment for each service unit, and explored the capitation payment for patients with chronic illnesses in primary medical and healthcare organizations. Continue to improve outpatient coordination and other related policies for residents' health insurance. It will improve the differentiated payment policies for different levels of medical institutions, appropriately increase the proportion of payment for primary medical and healthcare institutions, and allow continuous calculation of the starting line for patients referred for hospitalization in accordance with the regulations, so as to promote the orderly flow of patients. Qualified primary health care institutions and chronic disease medical institutions will be included in the designated scope of basic medical insurance in accordance with the regulations.
(4) Improving the price formation mechanism for medical services. Reasonably set and adjust the price of medical services, the implementation of the functional positioning of medical institutions, patients reasonable choice of medical institutions to form an effective incentive to guide. According to the overall level of price regulation, in accordance with the total amount of control, structural adjustment, rise and fall, gradually in place the principle of reducing the cost of medicines and medical consumables, large-scale medical equipment inspection and treatment prices on the basis of raising the value of the project reflecting the value of the technical services of medical personnel. Streamline the relationship between the price of medical services, and establish a dynamic adjustment mechanism for the price of medical services.
(v) Establishing and improving the benefit distribution mechanism. Through the reform of health insurance payment methods, strengthen cost control and other means, to guide the second level of hospitals downward referral of patients with chronic diseases with clear diagnosis and stable conditions, and take the initiative to undertake the diagnosis and treatment of patients with difficult and complex diseases. Improve the performance pay allocation mechanism for primary health care organizations, tilting the balance in favor of medical personnel who sign up for services.
(6) Building a mechanism for division of labor and coordination among medical and healthcare institutions. Oriented on enhancing the capacity of primary healthcare services, and with business, technology, management, and assets as the link, it explores the establishment of various modes of division of labor and collaboration, including medical consortiums and counterpart support, and improves the management and operation mechanism. Higher-level hospitals provide priority consultation, examination and hospitalization services to patients referred to them. Higher-level hospitals are encouraged to issue drug treatment plans and implement the treatment in lower-level hospitals or primary healthcare institutions. For patients with acute and critical illnesses and surgical procedures requiring hospitalization, smooth referrals between medical institutions at all levels are achieved through the formulation and implementation of admission and discharge criteria and the principle of two-way referral. Primary medical and health care institutions can work in concert with hospitals above the second level and chronic disease medical institutions to provide geriatric care, home care, community care, mutual aid care, home hospital beds, medical rehabilitation and other services for patients with chronic diseases and geriatric diseases. Give full play to the role of medical institutions of different organizing bodies in the mechanism of division of labor and collaboration.
Four, organization and implementation
(A) strengthen organizational leadership. Graduated diagnosis and treatment work involves a wide range of strong policy, with long-term and complexity, local governments at all levels and the relevant departments should be based on the principle of unremitting, persistent, and effectively strengthen the organizational leadership, as a core task into the deepening of the overall arrangements for the reform of the medical and health system, the establishment of the relevant coordinating mechanism, a clear division of tasks, combined with the local actuality, study and formulate a practicable plan for the implementation of the program.
(ii) clear departmental responsibilities. Health and family planning administrative departments (including Chinese medicine management) to strengthen the planning, set up, approval and supervision of medical service behavior, clear two-way referral system, optimize the referral process, take the lead in the development of common diseases, admission, discharge and two-way referral standards, improve the new rural cooperative medical system payment policy, guidance related to the development of the relevant academic (Association) to improve the diagnosis and treatment of the relevant diseases guidelines and clinical pathway. Development and reform (price) departments should improve pharmaceutical pricing policies and implement tiered pricing measures. Human resources and social security departments should strengthen supervision, improve health insurance payment policies, promote reform of health insurance payment methods, and improve the performance pay allocation mechanism. The financial sector should implement financial subsidy policies. Other relevant departments should, in accordance with the division of responsibilities, timely introduction of supporting policies, and the implementation of the implementation.
(C) steadily promote the pilot. Local governments at all levels should adhere to the actual starting point, according to local conditions, in various forms to promote the pilot work of graded diagnosis and treatment. 2015, all public hospitals to reform pilot cities and comprehensive health care reform pilot provinces to carry out graded diagnosis and treatment pilot, and to encourage conditional provinces (autonomous regions and municipalities) to increase the graded diagnosis and treatment of the pilot area. Take hypertension, diabetes, tumors, cardiovascular and cerebrovascular diseases and other chronic diseases as breakthroughs to carry out graded diagnosis and treatment pilot work, and focus on hypertension and diabetes graded diagnosis and treatment pilot work in 2015. Explore the graded diagnosis and treatment of tuberculosis and other chronic infectious diseases and the integrated management of patient service model. The National Health and Family Planning Commission, in conjunction with relevant departments, will guide the pilot work of graded diagnosis and treatment, summarize the experience and inform the progress in a timely manner.
(4) Strengthening publicity and guidance. Carry out policy training for administrators and medical staff to establish a graded diagnosis and treatment system as a necessary requirement for fulfilling social responsibility and promoting career development, to further unify thinking, gather **** knowledge, enhance initiative and improve motivation. Give full play to the role of public **** media, widely publicize knowledge of disease prevention and treatment, and promote patients to establish the concept of scientific medical care, improve scientific medical care ability, and reasonably choose to visit medical institutions. Strengthening the publicity on the enhancement of the service capacity of primary medical and health care institutions and the work of graded diagnosis and treatment, guiding the public to improve their awareness and recognition of primary medical and health care institutions and graded diagnosis and treatment, changing their concepts and habits of medical treatment, and choosing primary medical and health care institutions nearby and giving priority to them for medical treatment.
Attachment: Assessment and Evaluation Criteria for the Pilot Work of Graded Diagnosis and Treatment
General Office of the State Council
September 8, 2015