Since the deepening of the medical reform, various places have been increasing their exploration efforts and pushing forward the work of medical reform in depth. These explorations are in line with the direction of healthcare reform and have obvious results, which are of general guidance and promotion significance. In order to solve the problem of talent shortage at the grass-roots level, so that doctors from large hospitals can go down to the grass-roots level, localities have explored a variety of forms such as up and down linkage and close integration.
Shenzhen City, Guangdong Province, has improved the government-led "hospital-run, hospital-managed" community health service center management system, established a general practice team with responsible physicians as the main body, and perfected the multi-position service system for technicians. The community health centers can directly access the talent and technical support of the host hospitals, and residents can enjoy the medical and health services provided by retired Chinese medicine practitioners and renowned experts from large hospitals nearby.
Xiangxiang City, Hunan Province, the implementation of health personnel "county management township with". Merit recruitment of medical school undergraduates and practicing physicians to work in township health centers. Recruitment of staffing by the Municipal Health Bureau escrow, basic salary and pension, medical, maternity insurance and other units to pay part of the municipal finance to be guaranteed. Recruiters enjoy the performance bonuses and benefits of the township health centers in which they work. Appointment term of five years, after the expiration of the period, upon my application, the City Health Bureau assessment qualified, can be arranged to work in urban health care institutions.
Tianjin city in the second and third level hospitals to establish involving 18 disciplines of 143 general practitioners and residents standardized training base. All fresh graduates engaged in clinical work in medical institutions below the second level are required to take part in the two-year training of general practitioners.
Zhenjiang City, Jiangsu Province, has established a free further training system for community physicians, a standardized training system for general practitioners, and a system for physicians from higher-level hospitals to sit in the community, and has sent doctors of internal medicine and pediatrics to carry out full-time diagnostic and therapeutic services at its community health service centers. Reform of payment methods is of great significance in controlling medical costs, standardizing medical behavior, and promoting comprehensive reform. Several different payment models have been explored around the world.
The Ningxia Hui Autonomous Region has implemented the "Innovative Payment System, Improving Health Effectiveness" project in Yanchi, Haiyuan and other counties and cities, and has implemented a lump-sum prepayment system for outpatient and inpatient expenses. A quarterly advance of 70% of the lump sum is allocated to healthcare organizations, and the remaining 30% is based on the results of annual performance evaluations.
Yiyang County, Henan Province, in accordance with the "a disease, three sets of pathways," the idea of the implementation of the comprehensive payment system reform of the New Farmers' Cooperative: Group A for patients with common symptoms, Group B for patients with more serious comorbidities, Group C for patients with serious and complicated conditions. The actual costs are settled and controlled on a sliding scale.
Hunan Province has implemented the "limited fee medical care", which sets a certain limit on the outpatient and hospitalization expenses of participating farmers in township health centers. If the medical expenses are within the limit, the participating farmers will pay according to the actual expenses; if the expenses exceed the limit, the participating farmers will pay according to the limit, and the excess will be reimbursed in full by the New Rural Cooperative. For example, Lanshan County has implemented the "10+100" model, whereby participating farmers seeking medical treatment in township health centers within the county need only pay 10 yuan out of pocket for outpatient care, and 100-150 yuan out of pocket for inpatient care, with the rest of the costs being fully reimbursed by the New Farmers' Cooperative Fund. Exploration is currently under way to extend the "limited fee medical care" model to county-level public hospitals. After the abolition of the public hospitals to compensate for medicine, localities have explored the establishment of multi-channel compensation methods, and the implementation of comprehensive reforms.
Price leveling method: Beijing Friendship Hospital and Chaoyang Hospital launched the "separation of medicine" reform on July 1 and September 1, 2012, respectively, and Tongren Hospital, Tiantan Hospital, and Jishuitan Hospital officially launched it on December 1st. In addition to the abolition of drug markups, registration fees and consultation fees, the medical service fees for patients in outpatient clinics will be determined according to the rank of the physician. The Beijing medical insurance fund will reimburse the "medical service fee" at a fixed rate of 40 yuan per person.
Financial compensation law: Shaanxi Province, on the basis of government investment and medical service fee adjustment in place, the abolition of the drug markup policy, the implementation of zero-differential rate sales. The county hospitals thus reduce the reasonable income, in accordance with the principle of "cancel how much, compensate how much", by the provincial, municipal and county governments to give full subsidies proportionally.
Comprehensive compensation method: Anhui Province, the implementation of county hospitals all drugs zero-differential rate sales, the resulting reduction in costs by increasing government subsidies (25%) and charges (75%) to make up for the consultation fee; reduce the price of large-scale medical equipment, examination and treatment, in the total balance of the total amount of money through the adjustment of surgical fees, nursing fees and bed charges to make up for.
Zhejiang Province, the abolition of county-level hospital drug markup policy, and the simultaneous establishment of the "five rings linkage" mechanism, namely, adjusting medical service fees, reforming the health insurance payment system, improve financial input policy, strengthen the management of medical service behavior, and the establishment of the internal management mechanism of the hospital.
Shenzhen, Guangdong Province, 67 public hospitals to implement the "1 + 6" comprehensive reform. "1" that is the abolition of all public hospital drug markup; "6" that is the reform of public medical institutions compensation mechanism, reform of the medical fee payment system, reform of the system of competition in the circulation of medicines, reform of the system of procurement of medicines and consumables, to strengthen the prevention and control of commercial bribery in public hospitals, and strengthen the Supervision of public hospital behavior. At the grassroots level to improve the recruitment and procurement of a single, two-envelope system, centralized payment and other procurement policies on the basis of public hospital reform, with the reform of public hospitals, to accelerate the reform of the bidding and procurement mechanism of drugs.
Anhui Province adheres to the principle of giving priority to quality and reasonable prices, and adopts the bidding and purchasing method of "linking quantity and price and combining recruitment and purchasing" to formulate a centralized bidding and purchasing catalog of drugs for county-level hospitals and a catalog of basic medicines, and to implement a centralized bidding and purchasing method for the whole province online. County hospitals basic medication catalog from the national essential drugs (including provincial additions) directory and the provincial new rural medicine directory, urban health insurance drug directory selection, **** 1048 kinds.
Henan Province on essential drugs and medical consumables are the implementation of unified bidding and procurement, from pre-bidding, bidding to post-bidding are taken transparent operation, timely disclosure of relevant information; to take a combination of quantitative and qualitative evaluation, to comprehensive evaluation of the principle of giving full consideration to all levels of various types of health care institutions to meet the use of different groups of people's needs; standardize the operating system, to ensure that the bidding is fair and open. Exploring ways to control the excessive growth of medical costs is an important task in deepening medical reform. Around the world to explore a lot of practices.
Fujian Province to promote the general medical supplies centralized bidding and procurement, reduce procurement costs and purchase prices; expand the types of diseases and the pilot scope of single-patient payment, in more than half of the counties (cities, districts) to carry out the total prepaid system of the New Rural Cooperative, the pilot capitation payment, and effectively curbed the trend of excessively rapid increase in medical costs.
From 2010, Zhejiang Province, for three consecutive years, put forward the outpatient and hospitalization average cost of zero growth requirements, and into the annual health care reform responsibility for the implementation of the target. Through the implementation of administrative cost-control measures to promote hospitals to take the initiative in cost-control mechanism, medical insurance cost-control mechanism to establish and improve. Localities have actively explored the implementation of integrated management of rural areas, solving the problem of pension security for rural doctors and stabilizing the rural health service system "bottom of the net".
Jiangsu Province will gradually include eligible new additions to the village health office or those who have obtained the qualification of practicing (assistant) physician in the unified management of the township health center establishment, establish a system of rotational work of the township health center personnel stationed in the village health office, and incorporate rural doctors into the scope of the pension insurance for urban workers, with certain financial support.
Yuxi City, Yunnan Province, has established a mechanism for the withdrawal of rural doctors and improved the security mechanism. Rural doctors who go through the withdrawal procedure according to the age policy are given monthly retirement subsidies, which are paid in three grades according to the number of consecutive years of service. The training funds for rural doctors are included in the annual budget of district and county finances according to the standard of 0.5 yuan per capita of the agricultural population.
Qinghai Province, village doctors to implement special subsidies, the standard is 8,000 yuan per person per year. For village doctors who have obtained the qualification of practicing (assistant) physician or secondary school education or above, the subsidy will be increased by another 1,000 yuan per person per year. At present, all village doctors in the province have participated in the new rural pension insurance or other pension insurance according to different standard grades.