Quzhou's policy on rehabilitation medicine

In order to implement the "Zhejiang Provincial Health Commission and other 12 departments on the in-depth promotion of the development of health care combined with a number of opinions" (ZHEWEIFA 〔2021〕 No. 34) spirit, accelerate the implementation of the positive response to the national strategy of population aging, in-depth promotion of health care recreation integrated development, to better meet the rapid growth of elderly people's health care service needs, to create a "ZHEILI health", "ZHEILI recreation" golden name card, playing the "world longevity capital" city brand, combined with the city's actuality, the "world longevity capital" city brand. "" Zheli recreation "golden card, playing the" world longevity city "city brand, combined with the actual city, put forward the following implementation views.

First, the target

By 2022, to improve the primary health care institutions rehabilitation, nursing beds accounted for the proportion of primary health care institutions rehabilitation, nursing beds accounted for 30%; more than 80% of the general hospitals, rehabilitation hospitals, nursing homes and primary health care institutions to become a geriatric-friendly medical institutions. Each township (street) are built with both day care and full service function of the model type of home care service center; to promote the city's elderly homes three-year upgrading and renovation project, to complete the stock of difficult elderly family aging transformation; social workers and the community ratio of older people reached 1:500, caregiver senior, technician ratio reached 15%.

By 2025, to cultivate a geriatric medical discipline characteristics of outstanding tertiary hospitals, the city's second-class and above general hospitals, Chinese medicine hospitals set up geriatrics ratio of more than 85%, per 10,000 elderly people have 55 beds in medical institutions for rehabilitation and care. Municipal establishment of a hospice guidance center (training base), each county (city, district) at least 1 hospice ward, more than 20% of township health centers (community health service centers) to carry out hospice services. By 2025, the proportion of nursing-type beds in old-age institutions will reach 60%, and every 10,000 elderly people will be provided with 20 cognitively impaired care beds. The ratio of social workers to elderly people in the community has reached 1:450, and the proportion of senior caregivers and technicians has reached 18%.

Second, the main tasks

(a) to strengthen the combination of medical institutions and facilities.

1. Strengthen the construction of health care institutions. Encourage large or mainly accept the disabled elderly nursing institutions within the medical institutions, to provide basic medical care for the elderly, chronic disease management, rehabilitation and nursing care services, and encourage more idle beds in the nursing institutions and medical institutions to cooperate to carry out medical integration services. Supporting medical institutions to set up medical service stations in old-age institutions in accordance with the law and regulations, utilizing relevant resources to carry out rehabilitation care, long-term care, hospice care and medical and nursing services. Comprehensively promote the construction of recreational and nursing consortiums, push more medical rehabilitation resources into the field of nursing services, and form a network of recreational and nursing services covering both urban and rural areas. Encourage all kinds of subjects to set up embedded medical and nursing institutions in the community, integrating medical care and life care services, etc. By 2025, 50 recreational and nursing associations at different levels will be established in cities, counties and townships, and rehabilitation rooms will be commonly established in nursing institutions with more than 100 beds. Optimize the bed structure of nursing institutions, by 2025, the proportion of nursing beds in nursing institutions will reach 60%, and every 10,000 elderly people will be equipped with 20 beds for cognitive impairment care. (Municipal Civil Affairs Bureau, Municipal Health Commission in accordance with the division of responsibilities. The following tasks are the responsibility of the people's governments of the counties [cities, districts], no longer marked one by one)

2. Coordinate the promotion of community home health care facilities. Promote community health service centers, township health centers and nursing service institutions integrated planning, adjacent to the construction. Carry out community health care combined capacity enhancement action, support the conditions of the community health service institutions, township health centers or home care service centers, special hardship case service facilities (homes for the elderly), etc., using existing resources, internal reconstruction and expansion of community (township) health care combined service facilities, focusing on the disabled, chronic diseases, old age, disability and other elderly people to provide health education, preventive health care, diagnosis and treatment of illnesses, rehabilitation and nursing care, Hospice care is the mainstay of the medical and nursing services, taking into account daily life care. Newly built community health service organizations in urban areas are allowed to build community medical and nursing care facilities, and newly built "communities of the future" are required to build medical and nursing care facilities. New and expanded community health care combined service facilities within the elderly service area should be set up in an independent building or building subarea, the strict implementation of zoning management. (Municipal Health Commission, Municipal Development and Reform Commission, Municipal Civil Affairs Bureau, Municipal Finance Bureau, Municipal Resources Planning Bureau, Municipal Housing and Construction Bureau, Municipal Health Insurance Bureau in accordance with the division of responsibilities)

3. Enhancement of the social forces to provide services. The government does not make planning restrictions on the total number of areas where social organizations are combined with medical care. In accordance with the principle of "no ban is to enter", shall not set up and comprehensively clean up and cancel no laws and regulations and unreasonable pre-approval matters, there is no law or regulation shall not limit the nature of the operation of the social health care institutions. Support social forces through the market-oriented operation of health care institutions. On the basis of "guaranteeing the basics and covering the bottom line", continue to promote the increase of the effective supply of universal elderly care services. Support for qualified social medical institutions and health care institutions to undertake local public **** health, basic health care, basic elderly care, as well as needs assessment, personnel training and other services. (Municipal Development and Reform Commission, Municipal Civil Affairs Bureau, Municipal Finance Bureau, Municipal Resources Planning Bureau, Municipal Health Commission, Municipal Taxation Bureau, Municipal Market Supervision Bureau in accordance with the division of responsibilities)

(2) to enhance the integration of health care recreation and health care service capacity.

1. Accelerate the development of geriatrics. In accordance with the "geriatrics construction and management guidelines (for trial implementation)", to strengthen the construction of geriatrics, 2025, more than 85% of the city's second-class and above general hospitals, Chinese medicine hospitals set up geriatrics, to cultivate a geriatrics discipline characteristics of the tertiary hospitals, to promote the construction of municipal and county-level geriatrics medical centers, to play the center of the regional medical institutions of the geriatrics discipline construction, personnel training, business guidance, quality management and other aspects of the guidance of the center. By 2025, municipal hospice guidance centers (training bases) will be established, at least one hospice ward will be constructed in each county (city and district), and more than 20% of township health centers (community health service centers) will carry out hospice services. First- and second-tier hospitals and specialized hospitals are being guided to make reasonable use of idle medical resources in their structural and functional adjustments, to create conditions for the development of elderly care, nursing care and rehabilitation services, and to strengthen the construction of nursing homes, rehabilitation hospitals and other successive medical institutions. Actively exploring the development of elderly care needs assessment, targeted for the elderly to provide integrated medical care services. Vigorously develop traditional Chinese medicine health services for the elderly, strengthen chronic disease health management and comprehensive prevention and control, the full implementation of over 65 years of age, essential hypertension, type 2 diabetes and other chronic diseases, outpatient free medication policy. (Municipal Health Commission, Municipal Finance Bureau, Municipal Health Insurance Bureau in accordance with the division of responsibilities)

2. Support the development of home medical services for the elderly. Implement the "Notice on Strengthening Medical Services for the Elderly at Home" (State Health Office Medical Development [2020] No. 24), support qualified medical and health institutions and capable of combining medical and nursing institutions for the mobility of the elderly home elderly, disabled and other elderly people, as well as chronic diseases, disease recovery or terminal stage, the elderly patients who are still in need of medical care after discharge from the hospital to establish a home hospital beds, door-to-door services. The content, standards and specifications of home health care services are being established, and standards for consultation fees and home bed visiting fees are being rationalized. A sound safeguard mechanism has been established, and the level of treatment for door-to-door service personnel has been raised appropriately. Provide door-to-door service organizations to take out medical liability insurance, personal accident insurance, etc., to prevent and deal with the risk of practice and personal safety risks. (Municipal Health Commission, Municipal Finance Bureau, Municipal Civil Affairs Bureau, Municipal Health Insurance Bureau in accordance with the division of responsibilities)

3. Promote urban and rural medical resources **** enjoy. Deepen the remote mountainous areas to send medical aid services, configuration "traveling medical car", relying on the county medical **** body to continue to send medicine, health checkups, chronic disease follow-up, home visits and other traveling medical services. The leading hospitals of the county medical **** bodies promote the construction of geriatric medical care and rehabilitation, nursing teams and specialty departments in their member units through the selection of backbones and the strengthening of training, so as to enhance the contracted services of family doctors and the ability to combine medical and nursing services. We have done a solid job of providing basic public **** health services, implemented the geriatric health and medical care integration service program, and promoted disease prevention and early intervention work such as free screening for colorectal cancer and chronic obstructive pulmonary disease and free influenza vaccination. Township health centers (community health service centers) are actively opening beds for rehabilitation, nursing care, long-term care, hospice care, etc. By 2022, the proportion of nursing beds in primary health care institutions will reach 30%. (Municipal Health Commission, Municipal Finance Bureau, Municipal Health Insurance Bureau in accordance with the division of responsibilities)

4. Enhancement of information technology support capacity. Accelerate the promotion of network hospital construction and remote medical services, the establishment of urban hospitals, county medical **** body lead hospitals and primary health care institutions interoperability, and extended to the village (community) and health care institutions to provide remote diagnosis and treatment services for the elderly and other mobility-impaired patients. Promote the second batch of national elderly health care combined remote collaborative service pilot institutions Longyou Longzhou Hospital, Jiangshan Zhuangyuanli Nursing Hospital standardized telemedicine services. Relying on "Internet + healthcare" to create "nail family doctor service", through the nail organizational structure of the community, family doctors, contracted residents for organizational matching, so that the family doctor for the residents to provide accurate, accessible health services. Developing "Internet+Nursing Service" and promoting the combination of online and offline services. Promote the development of intelligent healthy aging industry, promote the promotion and application of high-quality products and services, and provide the elderly with remote real-time nursing care, real-time positioning, health monitoring, and emergency assistance call services. Explore the use of wearable devices and portable, self-service health testing equipment to carry out real-time monitoring of the basic health status of key populations such as the elderly, living alone, disabled or partially disabled elderly. (Municipal Health Commission, Municipal Economic and Information Bureau, Municipal Civil Affairs Bureau, Municipal Health Insurance Bureau, Municipal Data Bureau according to the division of responsibilities)

1. Simplify the approval and registration of medical care institutions. The implementation of the National Health Commission and other ministries and commissions "on doing a good job of medical care combined with the notice of the work of the approval and registration of institutions" (State Health Office of the elderly hair [2019] No. 17) spirit, optimize the medical care combined with the approval process of the institutions, with the tier of health, civil affairs or market supervision and management departments to establish a joint working mechanism and operating procedures, will be included in the administrative service center "non-discriminatory acceptance "Window acceptance, to achieve" front comprehensive acceptance, back-end classification approval, integrated window out of the document ". Cancellation of the elderly institutions within the clinic, health clinic (room), infirmary, nursing station administrative approval, the implementation of record management. Medical and health institutions to use existing resources to provide elderly services, involving construction, fire, food safety, sanitation and epidemiological conditions, can be based on medical and health institutions already have the corresponding qualifications directly for the record, without affecting the safety of the premise to simplify the procedures. Qualified medical institutions in the combination of health care institutions into the scope of basic medical insurance designated, the official operation of 3 months after the designated application, designated assessment time limit of no more than 20 working days to complete. (Municipal Health Commission, Municipal Civil Affairs Bureau, Municipal Housing and Construction Bureau, Municipal Emergency Management Bureau, Municipal Market Supervision Bureau, Municipal Health Insurance Bureau in accordance with the division of responsibilities)

2. Deepen the contractual cooperation of medical care. In accordance with the Provincial Health Commission, the Provincial Civil Affairs Bureau, the Provincial Administration of Traditional Chinese Medicine "on the further strengthening of medical and health care institutions and elderly service institutions contracting cooperation services notice" (Zheshuifa 〔2022〕 No. 11) requirements, to encourage not set up a medical institution or medical and health care service capacity is weak of the elderly institutions and neighboring medical and health care institutions to carry out a variety of forms of contractual cooperation to deepen the home elderly service centers, home elderly care center and other institutions with medical and health care institutions, to deepen the home elderly service center, home elderly care center and other institutions and medical and health care institutions. Deepen the contractual cooperation between home care service centers, home care centers and other institutions and medical and health institutions. Both parties should sign an agreement specifying the contents, methods, costs and responsibilities of the cooperation. Elderly institutions can also provide medical and health services for the elderly through outsourcing and commissioning of services. Pension institutions with the conditions of medical institutions and contracted medical and health institutions to establish a two-way referral mechanism. By 2022, all nursing homes can provide standardized medical and health services for the elderly in different forms. (Municipal Health Commission, Municipal Civil Affairs Bureau, Municipal Finance Bureau in accordance with the division of responsibilities)

3. Strengthen the supervision of health care institutions. Health, civil affairs, medical insurance and other departments to strengthen coordination and cooperation, in accordance with their respective responsibilities, to increase the combination of health care institutions industry supervision, to carry out the combination of health care institutions to improve the quality of service action to enhance the combination of health care standardization, institutionalized level, to ensure the quality and safety of services. Health care institutions to implement the main responsibility, establish and improve the management system and personnel duties, strict implementation of health care and pension services related policies and standards, norms, and promote the standardization of fire safety management, the implementation of fire safety responsibilities and safety systems; in accordance with the "Zhejiang Province, combined with the work of infection prevention and control of health care institutions", effectively do a good job in the prevention and control of infectious diseases such as new coronary artery pneumonia, the implementation of normalized prevention and control measures, the implementation of Normalized prevention and control measures, strengthen the staff emergency knowledge training and the elderly protection knowledge propaganda, enhance the emergency protection ability. To clarify the payment boundaries of medical and health services and elderly services, medical institutions should strictly follow the diagnosis and treatment norms, and the basic medical insurance fund should only be used to pay for the medical service costs of disease diagnosis and treatment, medical care and medical rehabilitation in accordance with the scope of basic medical insurance, and should not be used to pay for the costs of elderly services such as life care. (Municipal Health Commission, Municipal Civil Affairs Bureau, Municipal Emergency Management Bureau, Municipal Market Supervision Bureau, Municipal Health Insurance Bureau, Municipal Fire and Rescue Detachment according to the division of responsibilities)

(d) Promote the construction of human resources.

1. Strengthen the construction of medical care and recreation personnel. Strengthen the training of health care related professionals, support and guide the Quzhou Vocational and Technical College, Quzhou Nursing School, Quzhou Junior College and other schools with the conditions to open geriatrics, rehabilitation, nursing, hospice, nursing care and other specialties, training geriatrics, nursing care team. By 2025, no fewer than 5,000 elderly caregivers and 20,000 family caregivers will be trained. Construction of geriatrics, hospice care, medical care and recreation guidance centers, skills training bases, etc., with appropriate financial subsidies at all levels. Vigorously carry out vocational skills training for medical and nursing service practitioners, carry out vocational skills level recognition for medical and nursing services such as nursing caregivers, and encourage medical and nursing organizations to give priority to recruiting qualified medical caregivers, nursing caregivers and other skilled personnel. Expanding the team of social workers and volunteers for the elderly, and increasing the support for voluntary service projects and public welfare organizations to help the elderly. (Municipal Bureau of Education, Municipal Bureau of Civil Affairs, Municipal Bureau of Human Resources and Social Security, Municipal Health Commission in accordance with the division of responsibilities)

2. Support for medical personnel to engage in health care rehabilitation services. Medical personnel in the health care institutions and health care institutions enjoy the same title evaluation, professional and technical personnel continuing education and other treatment, health care institutions do not have the conditions to provide continuing education training for medical personnel, by the health care administrative department to coordinate the arrangement of centralized training. The implementation of the physician multi-practice institutions for the record system, support for medical personnel to the health care institutions to practice. Encourage retired medical personnel to participate in the medical care combination services, the eligible retired rehired personnel into the overall management of the workers' compensation insurance system. (Municipal Human Resources and Social Security Bureau, Municipal Civil Affairs Bureau, Municipal Health Commission in accordance with the division of responsibilities)

(E) Increase policy support and protection.

1. Improve the medical insurance support policy. Reasonably set up in line with the characteristics of the elderly health insurance cost settlement standards and methods, to carry out hospice group by the bed day payment of the group study, to promote the diagnosis of disease-related grouping (DRG), by the bed day and other multi-compound health insurance payment methods, and gradually improve the bed day payment standard. Implementing a long-term prescription system for chronic diseases for the elderly. Diagnostic and treatment and rehabilitation programs that meet the basic needs of the elderly are gradually incorporated into the scope of basic medical insurance payments in accordance with regulations, and a dynamic adjustment mechanism is being established. Continue to promote accidental injury insurance for the elderly, and support commercial insurance organizations to vigorously develop insurance products suitable for the elderly. (Municipal Health Insurance Bureau, Municipal Health Commission in accordance with the division of responsibilities)

2. Improve the input guarantee mechanism. The implementation of medical and health institutions financial investment policy, support to enhance the ability to combine medical and nursing services. Give full play to the synergistic role of public **** health and basic health insurance, eligible primary health care institutions to carry out elderly health management, elderly health and health care services management and other basic public **** health service projects, the government in accordance with the provisions of the implementation of the purchase of services; eligible primary health care institutions to carry out the basic health insurance to pay for the scope of health care services, in principle, through the medical service Charges for compensation, where possible, charges for compensation for the shortfall can be included in the standardization of the equivalent work of the implementation of the purchase of services. Financial arrangements at all levels of medical care and recreational integration of development of special funds to support the standardization of geriatrics construction, to give the elderly medical center (training base), hospice guidance center (training base) a certain amount of subsidies. Medical institutions that have built and put into operation standardized geriatric medicine departments before 2025 will be given one-time construction subsidies. A one-time construction subsidy will be given to hospice wards (rooms) built and put into operation before 2025, according to the number of beds. Lottery public welfare funds at all levels of government for social welfare undertakings, to increase support for medical and health institutions and nursing institutions to carry out medical and nursing services, to give special funding support for medical and nursing integration. Elderly institutions within the medical institutions formally operated for two years, where the county (city, district) can give appropriate support through the lottery public welfare funds. Medical and health institutions to carry out elderly services, the part of its elderly services to enjoy the same support policies for elderly institutions. (Municipal Finance Bureau, Municipal Civil Affairs Bureau, Municipal Health Commission in accordance with the division of responsibilities)

3. Improve income distribution and pricing policies. Public medical institutions to carry out elderly services fees in principle based on the actual cost of services, comprehensive market supply and demand conditions, the public affordability and other factors approved. Public medical institutions and nursing institutions to carry out contracted services for the elderly at home to establish home hospital beds and home services income, after deducting the cost and extracting the funds in accordance with the provisions of the main incentives for personnel, is not included in the total amount of performance-based pay, the internal distribution of the unit should be engaged in the first-line work of the medical staff tilted. (Municipal Health Commission, Municipal Finance Bureau, Municipal Human Resources and Social Security Bureau, Municipal Health Insurance Bureau in accordance with the division of responsibilities)

4. Comprehensive implementation of various support policies. Seriously implement the state and the province to promote the development of health care integration of various support policies, effectively in the tax concessions, land guarantees, investment and financing for the relevant institutions and investment bodies to provide support, to cash policy dividends. Each region should be based on the future growth of the elderly population and the new needs of the elderly health and old-age care, integrated medical, old-age care and other facilities, planning and layout, to reserve the necessary space for development. Support for party and government organs and state-owned enterprises and institutions training and nursing institutions transformed into elderly service facilities, simplify the administrative approval, provide financial subsidies and other policy support to enhance the transformation of the elderly service institutions in the combination of medical and nursing service capacity. (Municipal Development and Reform Commission, Municipal Civil Affairs Bureau, Municipal Finance Bureau, Municipal Human Resources and Social Security Bureau, Municipal Resources Planning Bureau, Municipal Housing Bureau, Municipal Agriculture and Rural Affairs Bureau, Municipal Health Commission, Municipal State-owned Assets Supervision and Administration Commission, Municipal Taxation Bureau, Municipal Organ Affairs Center, according to the responsibilities of the division of labor)

Third, the requirements of the work

(a) Strengthening of organizational leadership. All relevant units should attach great importance to the combination of health care and recreation as an important tool to actively implement the national strategy to cope with the aging of the population, enhance responsibility, adhere to the problem-oriented, detailed decomposition of the task, and strengthen coordination and cooperation. Based on the actual situation of Quzhou, we should explore and practice in various fields, make use of digitalization, intelligence and other means, and strive to crack the bottlenecks restricting the development of medical care, recreation and health care, so as to create a development mode of "medical care, recreation and health care integration" with the characteristics of Quzhou.

(ii) Strengthen departmental coordination. The health department and the civil affairs department should establish a communication and coordination mechanism to promote the work of health care and recreation, respectively. The financial sector to implement a special funding guarantee. Medical insurance departments to ensure the safety of medical insurance funds under the premise, to support the combination of medical care and recreational work. Education, human resources and social security departments to carry out planned education and skills training for health care and recreation services personnel. Resource planning, development and reform, housing and construction departments should do a good job in the overall planning of institutions and facilities, land requirements and construction guidance. Market supervision departments should do a good job of business license registration and unlicensed operation supervision of the relevant business institutions.

(C) strengthen the assessment and supervision. Health departments should work together with civil affairs departments to strengthen supervision, inspection and assessment. To strengthen the integrity of health care institutions, according to the national system for determining the industry's credit default joint disciplinary object, identify the region's industry credit default joint disciplinary object, improve the health care services credit evaluation and cross-departmental cross-regional joint disciplinary mechanism. The implementation of policies proactive, outstanding achievements in the region and institutions, in arranging financial subsidies to give tilt support, play its role as a model to lead, and promote the city's health care health care combination of sustained and healthy development.

This opinion shall come into force on November 30, 2022, and shall be implemented as of that date.