Medical reform to where to go, about hundreds of millions of people's health, thousands of happiness, the Party Central Committee and the State Council attaches great importance to. After a long period of brewing, extensive consultation with all walks of life, April 6, Xinhua News Agency was authorized to release the "China *** Central State Council on deepening the reform of the medical and health system of the opinion", involving the fundamental interests of the majority of the people of the new health care reform points out the way forward. The Opinions are an inevitable requirement for the implementation of the scientific concept of development and the promotion of comprehensive, coordinated and sustainable economic and social development, and are another concrete practice of the Chinese ****anufacturing Party's adherence to the people-oriented philosophy of governance.
According to the "Opinions", the new health care reform to solve the people's worries of the core initiatives one is to reduce the burden on the masses, highlighting the nature of public welfare. Since the founding of New China, China's health care program has made remarkable achievements. China's per capita life expectancy has increased from 35 years in 1949 to 72.5 years in 2007, and the health of the entire population has improved significantly. However, with the rapid development of the economy and society, the original medical and health care system has become less and less adapted to the people's growing demand for medical and health care services, and "difficult and expensive access to medical care" has become a lingering shadow in the minds of many ordinary people. In order to solve the people's worries, the new health care reform in the government, society, the individual's tripartite adjustment of interests, highlighting the leading role of the government and the public welfare attributes of basic medical and health services. Clearly put forward through increased investment, strengthen supervision, improve services and other initiatives, and effectively play the role of the government in the system, planning, financing, services, supervision and other aspects of the responsibilities of the government, to maintain the public *** health care of the public interest, to promote fairness and justice, and effectively alleviate the problem of medicine costs rising too fast, the individual burden is too heavy.
The second is to expand the scope of protection, promote urban and rural parity. In the past, the problem of irrational allocation of medical and health resources was more prominent, and there was a large gap between urban and rural areas, between regions, and between different social groups in terms of enjoyment of medical protection. Therefore, the new health care reform has made it a priority to address the irrational allocation of resources and to promote the equalization of health care services, and has explicitly proposed that the basic health care system be made available to the entire population as a public **** product, and that the rural health care system be vigorously developed, with the aim of establishing a basic health care insurance system and a basic drug system that comprehensively cover both urban and rural residents by the year 2011, so as to universalize the provision of basic public **** health services, and of establishing a basic medical insurance system that covers both urban and rural residents by 2020, to establish a basic medical and health care system covering urban and rural residents, and to realize the goal of basic medical and health care services for all.
Thirdly, the quality of services should be improved and the medical system perfected. In addition to insufficient government investment and an imbalance in resource allocation, an unsound and irrational institutional mechanism is another major cause of "difficult and expensive access to medical care". The new medical reform emphasizes the guiding ideology of separation of government affairs, management and operation, medicine, profit and non-profit, and clearly puts forward the improvement of the four major systems of medicine and health, encourages and guides all kinds of social forces to actively participate in the development of medical and health care, and strengthens the construction of medical and health personnel to ensure the effective and standardized operation of the medical and health system, and builds a systematic framework for the realization of the goal of basic medical and health care services for all.
The people are the foundation of the state, the foundation of the state peace. The new health care reform is a solution to the people's worries, but also in the solid foundation of the country.
Under the guidance of the Opinions, the new healthcare reform will further improve the social security system with the socialist system with Chinese characteristics, and effectively solve the problems of the people's most concerned, most direct and most realistic interests. This will not only be conducive to improving people's health and ****enjoying the fruits of social progress, but will also be of positive significance in reducing social conflicts and promoting social harmony.
"Health care reform" is a global problem, whether to meet the people's growing health care needs and sustainable economic and social development to find a balance between the test of wisdom of the ruling party, but also directly affect the process of building a moderately prosperous society in all aspects. In the process of formulating the new health care reform program, the Party and the government actively drew on advanced foreign experience, widely accepted the wisdom of the people, and drew on the lessons of history, and by highlighting the public welfare and fairness, it put into practice the ruling concept of development for the people, development depends on the people, and the fruits of development are enjoyed by the people ****.
The 17th Party Congress put forward the goal of establishing a medical and health system with Chinese characteristics and gradually realizing basic medical and health services for all. Opinions for the realization of this goal, planning out the "roadmap" to benefit the people. (Dou Hanzhang) "Public hospitals to provide special services in the proportion of no more than 10% of all medical services." This is the 7 released the "medical and health system reform in the near future focus on the implementation of the program (2009-2011)" in the provisions.
Some public hospitals have set up too many VIP wards, special outpatient clinics and other special medical services, causing social controversy. Insiders pointed out that the limit public hospitals set too many special services, is to make public hospitals return to the public interest of an initiative, but also conducive to the full use of scarce public **** medical resources for the people to provide services.
In order to maintain the public hospitals public welfare, alleviate the people's access to medical problems, the "implementation of the program" is also clear to promote the reform of the compensation mechanism of public hospitals. Gradually public hospitals compensation from service charges, drug markup income and financial subsidies for three channels to service charges and financial subsidies for two channels. The government is responsible for public hospital capital construction and large equipment purchases, key disciplines development, in line with national regulations of the retired personnel costs and policy loss compensation, etc., public hospitals to undertake public **** health tasks to give special subsidies to ensure that the government designated emergency treatment, foreign aid, support for agriculture, support for the border, and other public **** service funds, Chinese hospitals (nationalities hospitals), infectious disease hospitals, occupational disease prevention and treatment hospitals, Psychiatric hospitals, maternity hospitals and children's hospitals, etc. are favored in terms of input policy.
The "Implementation Program" pointed out that the promotion of medicine separation, the gradual abolition of drug markups, and shall not accept discounts on medicines. Hospitals thus reduce the income or loss through the addition of pharmaceutical service fees, adjust some of the technical service fees and increase government investment and other ways to solve the problem. Pharmaceutical service fees are included in the scope of basic medical insurance reimbursement. The price of medical technology services will be raised appropriately, and the price of medicines, medical consumables and large-scale equipment inspections will be lowered. Can medical insurance reimburse across regions? In response to this expectation of many people, released on the 7th of the "medical and health system reform in the near future key implementation plan (2009-2011)" clearly, China will improve medical insurance services, promote the participants in the "one card" to realize the medical insurance agencies and designated medical institutions to directly settle the bill.
With the intensification of population mobility, such as the retirement of children, stationed in other cities to work, migrant workers, more and more people in the health care encountered problems - reimbursement procedures are cumbersome, back and forth in different cities. Many people have suggested that the different medical insurance is not resolved will restrict the flow of talent in the market economy and welfare social framework of the different medical, hope to introduce medical insurance transfer, articulation, the practical and feasible program of the different places to see a doctor, the establishment of inter-region, inter-provincial basic medical transfer and settlement, the formation of a unified national medical information network.
To this end, the "Implementation Program" points out that the establishment of the settlement mechanism for medical treatment in other places, and the exploration of local medical treatment and settlement methods for retirees resettled in other places. Formulate methods for transferring and continuing basic medical insurance relations, and solve the problem of transferring and continuing basic medical insurance relations across systems and regions for migrant workers and other mobile employed persons. It will also do a good job of connecting urban workers' medical insurance, urban residents' medical insurance, the New Rural Cooperative, and urban and rural medical assistance. The Implementation Plan makes it clear that farmers participating in the New Farmers' Cooperative are allowed to independently choose designated medical institutions for medical treatment within the coordinated area, and that referral procedures for medical treatment outside the county are simplified.
In addition, in order to improve the level of basic medical insurance management services, the Implementation Plan also proposes to encourage localities to actively explore the establishment of the negotiation mechanism between medical insurance agencies and medical service providers and the reform of payment methods, to reasonably determine the payment standards for medicines, medical services and medical materials, and to control the cost of expenses. They are exploring the establishment of integrated urban and rural basic medical insurance management systems, and are gradually integrating basic medical insurance administration and management resources. On the premise of ensuring fund safety and effective supervision, the government is actively advocating the purchase of medical insurance services and exploring the commissioning of qualified commercial insurance organizations to handle various medical insurance management services. The upcoming official opening of the Beijing health care reform, has been mentioned for nearly three years, "small illnesses into the community, serious illnesses (referral) to the hospital" concept, due to the lack of large hospitals in the reform of the supporting, difficult to play the "channeling of patients to rationalize the effectiveness of medical treatment", will be in the large hospitals and community The "diagnosis and treatment **** the same body" in the "correction".
Perhaps we can also do a generalized understanding: "small illnesses into the community" such a good intention, because it is difficult to really enjoy the community to large hospitals specialist outpatient high-quality services, resulting in the original "from January 1 this year did not have a first visit to the community and go directly to a large hospital The system will not be reimbursed for the medical expenses of those who go directly to the big hospitals without the first consultation in the community from January 1 this year," the system has to be "reinterpreted" due to the resistance of the patients.
The new reform no longer compels "specialists to support the community" or "patients to enter the community for minor illnesses". This is a pragmatic decision. But it is not the same as no longer exploring the community road to save medical costs, but to re-explore the use of market-oriented road to achieve the balance of medical resources between the community and the big hospitals, to achieve the purpose of not through the mandatory and realize the "community first diagnosis". In fact, the original "small disease into the community", what is a small disease, what is a big disease, the concept itself is fuzzy, a small cold behind may hide a big disease, the standard is difficult to determine, the patient is naturally uneasy.
The Secretary of the Beijing Municipal Bureau of Health said that the key to reform is to establish community health stations and tertiary hospitals with the same diagnostic criteria for diseases, "according to the patient's condition needs to be allocated to the appropriate level of doctors and appropriate medical resources", to build a large hospitals and community health services between "** the same body" and community health service organizations. **similarity" and smooth "referral channel", the patient no longer queue, in the community health service station can receive and large hospitals unified standard standardized diagnosis and treatment.
Such a goal is very attractive, but with what method to establish a unified standard of standardized diagnosis and treatment, the specific path is still vague. Is it through the improvement of community health station equipment? Or diagnostic "program" improvement, or through the form of telemedicine and large hospital experts direct interface? If we leave the people themselves, leaving the diagnosis and treatment process plays a decisive factor in the "experts", the two "convergence" how easy? Beijing's "difficult to see the doctor", is "success is also Xiao He, defeat is also Xiao He" reality interpretation: too concentrated quality medical resources will inevitably "trees attract the wind", and then the concentration of advantageous medical resources also The Beijing patients can only be stretched to the limit, and the whole country people together, into the "queuing waiting for treatment" long queue.
If you don't liberate the excellent specialist resources and medical equipment from the overly centralized allocation, and achieve a wider, more balanced and rational distribution, the establishment of health service stations and large hospitals unified standards of diagnosis and treatment norms may likewise be a pipe dream. Therefore, the central government, the Beijing municipal government, and large hospitals are obliged to proactively take on the responsibility of equalizing medical resources in areas where medical resources are scarce. Hardware investment is mainly borne by the government, while the software of medical personnel training and construction, need to be realized through the "liberation of doctors".
For the latter, the information revealed in Beijing's healthcare reform program gives us a glimpse of the future. It is reported that the program will encourage specialists in the completion of basic medical services in their spare time, voluntary part-time follow the laws of the market hospital "special needs service", or should be employed in the community to sit and practice medicine, or to attract social capital to run their own clinics to run hospitals, to meet the need for more patients to seek treatment for specialists.
The policy means that people who are qualified to practise medicine can do so across the country while taking care of their own work in hospitals, thus freeing doctors from their existing dependence on hospitals and making them free to practise in the community. The direct effect is to balance medical resources, change "a large number of patients to Beijing" to "a few doctors to the grassroots", not only for the grass-roots people, but also for the grass-roots training of talents, greatly reducing social health care costs, "difficult to see a doctor! "The problem is expected to ease; the indirect effect is the enhancement of the value of the doctor's labor, "big prescription" on the doctor's income to reduce the impact of the "expensive" problem gradually can be slowed down.
Watch: public hospital reform, patients can get what benefit?
The public hospital system is the "main force" of China's medical system. The layout and operation of the public health care system is reasonable, whether the public hospital service is good, whether the behavior is standardized, directly related to the people's life and health and medical experience. The General Office of the State Council recently issued a "comprehensive reform of urban public hospitals on the pilot guidance" proposed that in 2015 to further expand the comprehensive reform of urban public hospitals on a pilot basis, to 2017, the comprehensive reform of urban public hospitals on a pilot basis. Public hospital reform will change how? Patients can get what benefits from the reform?
Breaking up the medication, the establishment of a new mechanism for the operation of public hospitals.
Reform dry goods will be public hospital compensation from service charges, drug markup income and government subsidies three channels to service charges and government subsidies two channels. Strive to pilot cities in 2017 public hospitals drug ratio (excluding traditional Chinese medicine tablets) overall reduced to about 30%; 100 yuan of medical income (excluding drug income) in the consumption of health materials fell to less than 20 yuan. In order to ensure the healthy operation of public hospitals, medical insurance fund can afford, the overall burden of the masses does not increase the premise, the pilot city in 2015 to develop and introduce the public hospital medical service price reform program.
Experts comment on the Peking Union Medical College public **** School of Health Dean Liu Yuanli that, for a long time, public hospitals, three channels of financing there are a number of drawbacks, one is to force the medical industry to become a commodity sales industry; the second is to allow hospitals and manufacturers to form the interests of the **** the same body, rather than with the patient to become the interests of the **** the same body; the third is the existence of supply-side induced demand for the promotion of health care costs, resulting in a lot of unnecessary consumption of social resources. Caused a lot of unnecessary consumption of social resources; four is to increase the risk of patients suffering "medical harm"; five is to provide an easy breeding ground for corruption in the industry. Therefore, the public hospital reform of the biggest "surgery" is to eliminate the mechanism of medicines, and at the same time, through the appropriate increase in fees for services and government subsidies, the two gates, through the medical insurance payment interface, so as to solve the problem of reducing the income of public hospitals after the abolition of drug markups to a certain extent.
Patient feeling Xinyu City, Jiangxi Province, is the country's second batch of urban public hospital reform pilot cities. Frequently take his son to the hospital Xinyu citizen Xiao Lixia is one of the first patients to the hospital after the reform. She found that after the reform of the drug prices are indeed cheaper, such as the previous 33 yuan of Etanercept is now as little as 20 yuan, although the pediatric specialist number and consultation fees than before increased by 9 yuan, but all of these 9 yuan by the medical insurance reimbursement, so the reform is still letting their own expenses reduced.
Emphasizing the public welfare of public hospitals, reforming the management system of public hospitals, and establishing a personnel compensation system in line with the characteristics of the medical industry.
Policy dry goods to establish a public welfare-oriented assessment and evaluation mechanism. Health planning administrative departments or specialized public hospital management agencies to develop performance evaluation index system, regularly organize public hospital performance appraisal and annual and term of office of the director of the target responsibility assessment, the results of the assessment to the public.
According to the medical industry, long training cycle, high occupational risk, technical difficulties, heavy responsibility, etc., the relevant state departments to speed up the research and development of health care industry in line with the characteristics of the pay reform program. It is strictly prohibited to set income-generating targets for medical personnel, and the personal remuneration of medical personnel shall not be linked to the hospital's income from medicines, consumables, large-scale medical examinations and other operations.
Expert comment Liu Yuanli said, public hospital reform is not to revolutionize the life of public hospitals, more not to purge the majority of medical workers in the public hospital system, but to reform the constraints on public hospitals to play their normal social responsibility of the system and mechanism, so that the public hospitals to provide services to become more "fair and accessible, the masses benefit! "
Doctors are not the only ones who have been working in the public sector for years.
Doctors feel that "the establishment of a reform of the remuneration system in line with the characteristics of the medical profession means that medical personnel will be able to obtain a reasonable and legitimate income, from the root to the 'red packets' 'kickbacks' to say no! ". Chen Ying, director of pediatrics at Xinyu People's Hospital, said that deepening the reform of the establishment and personnel system will force hospitals to improve management and services, and will motivate medical staff to improve their service levels and attitudes so that patients can have a better experience of medical care.
Promoting the establishment of a hierarchical diagnosis and treatment model that includes primary care, two-way referral, emergency and slow treatment, and up-and-down linkage.
Reform dry goods gradually increase the number of urban public hospitals through primary health care institutions and general practitioners to book appointments and referral services, the higher hospitals to the grassroots and general practitioners to book appointments or referrals of patients to provide priority reception, priority checkups, priority hospitalization and other services. By the end of 2015, the proportion of booking referrals in outpatient visits to public hospitals should be increased to more than 20%, reducing the number of general outpatient visits to tertiary hospitals.
Improving two-way referral procedures, localities should formulate standards for entering and exiting hospitals for common diseases and two-way referral standards, so as to realize orderly referrals between different levels and categories of medical institutions.
Experts commented that for the time being, hierarchical diagnosis and treatment is a must, and it is not possible to jump this stage. "We need to reflect on how to improve the efficiency of resource allocation and utilization." Renmin University of China Healthcare Reform Research Center director, public **** management professor Wang Hufeng pointed out that hierarchical diagnosis and treatment is not a fixed form, in fact, a state of resource allocation and use. In this state, patients should be able to conveniently seek medical treatment, and the grassroots have the ability to provide quality primary medical services.
Patients feel that in the hemodialysis room of Pujiang County People's Hospital in Chengdu City, Zhong Jinwen, who is in his 80s and has suffered from diabetes for many years, can do dialysis at his "doorstep". In the past, when there was no dialysis machine in the county hospital, Zhong Jinwen could only go to Chengdu, 70 kilometers away, three times a week for dialysis. After the implementation of hierarchical diagnosis and treatment, the Third People's Hospital of Chengdu City hosted Pujiang County People's Hospital to realize the sinking of high-quality medical resources and establish a hemodialysis room through the "comprehensive hosting" of people, property and materials.
Investment in public hospital reform in 2015
Public hospital reform is the core task of the new round of medical and health system reform. To support the promotion of public hospital reform, the central government issued 11.124 billion yuan of subsidies for public hospital reform in 2015. First, according to the standard of 3 million yuan of subsidies per county, 5.931 billion yuan of subsidies were issued to support the comprehensive reform of county-level public hospitals. Second, subsidies of 1.32 billion yuan were issued at the rate of a one-time subsidy of 20 million yuan per pilot city to support the third batch of 66 cities to carry out comprehensive public hospital reform pilots, expanding the number of pilot cities to 100. Third, for the districts under the 100 pilot cities, subsidies of 273 million yuan were issued at a standard of 1 million yuan per district to support hospitals of the second level and below in carrying out the pilot comprehensive reform of public hospitals. Fourth, the standard of 30,000 yuan per capita per year issued 3.6 billion yuan of subsidies for the standardized training of resident doctors, to support 120,000 trainees to participate in the standardized training of resident doctors.