In this chess game, public hospitals are the main force. This is the same at home and abroad.
Zooming into the whole public health system, what is the position of public hospitals in this system? What role should it play in the construction of this system? What kind of responsibility do you undertake?
In the 2020 Health Summit officially launched on July 20th, the international sub-forum in the field of new medical care-"The mission of public hospitals in the construction of public health system" gave the answer.
The sub-forum was presided over by Fu Qiang, deputy director of the Health Development Research Center of the National Health Commission. Speakers included FrancoisCremieux, Vice President of Paris Public Hospital Group, Fang Laiying, Vice President of China Hospital Association, and Huang Erdan, Director of Health Service System Research Department of Health Development Research Center of National Health Planning Commission.
Public hospitals are the center of joint epidemic prevention.
Paris Public Hospital Group is the largest public hospital "medical association" in France and even Europe, with 37 public hospitals and 92,000 employees.
When the epidemic came, the Paris Public Hospital Group not only formed a linkage among the major internal hospitals, but also joined hands with community hospitals and major private hospitals to stop the epidemic.
FrancoisCremieux, vice president of Paris Public Hospital Group, believes that it is based on the experience provided by medical staff in China that they can "prepare for war" relatively after the outbreak of the epidemic in Greater Paris in early March.
According to FrancoisCremieux, the hospitals of Paris Public Hospital Group began to prepare in early 10. The first is the reserve of epidemic prevention materials and the increase in the number of beds. Secondly, the training of medical staff, focusing on ICU doctors and nurses in February, expanded to all medical staff a few weeks later.
After the outbreak, all COVID-19 patients were first admitted to public hospitals. After that, the number of patients was too large, and the Paris Public Hospital Group organized and coordinated other types of medical institutions such as private hospitals to improve their admission capacity. "If public hospitals do not organize and coordinate, it is hard to say that other types of medical institutions actively participate in fighting the epidemic." FrancoisCremieux said.
With the increasing number of patients admitted, public hospitals in Paris found that 95% of patients actually do not need to be treated in hospitals, but can be treated in community medical institutions or at home. Therefore, the Paris Public Hospital Group has joined hands with various community medical institutions to provide treatment for patients with mild COVID-19.
Public hospitals are the key to the national prevention system.
Extensively, public hospitals should not only organize and coordinate other medical institutions to jointly fight the epidemic, but also play their due role in the national prevention system.
According to Fang Laiying, vice president of China Hospital Association, after this epidemic, hospitals should pay more attention to national prevention, because:
1. Hospital is the key information source of infectious diseases and many public health events, which is often found in clinic;
2. The hospital is the "whistleblower" and the initial caller of the emergency system;
3. As one of the key links of emergency management and disposal, most public health incidents need clinical support;
4. General emergency is not only a public health system, but also a strategic force to maintain social operation.
Therefore, in the national prevention system, hospitals should first take the initiative to find information, make predictions in a professional spirit, make decisions on the basis of respecting science, and take the initiative to speak out, "say what the public can understand."
Fang Laiying said that under the major epidemic situation, public hospitals, as the main voice, need active public opinion guidance. This is not only conducive to establishing a positive image of medical staff and establishing a good doctor-patient relationship, but also conducive to promoting public physical and mental health and social stability.
Combination of preventive medicine and therapeutic medicine
Public hospitals should not only prevent, but also treat.
Huang Erdan, director of the Health Service System Research Department of the Health Development Research Center of the National Health and Family Planning Commission, believes that the focus of the hospital is to grasp the principle of combining peacetime and wartime and improve its ability. Based on peacetime, while filling in the shortcomings, we should focus on wartime, coordinate the mobilization response, regional linkage and personnel transfer of medical and health institutions in an emergency state, and improve the mechanism for handling major epidemics in a hierarchical, stratified and decentralized manner.
Huang Erdan gave seven suggestions in detail.
1. Integrating prevention and first aid with discipline orientation: starting from medical treatment, teaching, scientific research, prevention and health emergency.
2. Combine prevention and first aid with various plans: career development, disciplines, science and technology, human resources, infrastructure and medical equipment.
3. Integrate prevention and first aid functions with major projects: improve the service capacity of key diseases such as cancer, cardiovascular and cerebrovascular diseases and respiratory system. For example, in order to improve the ability of specialist services, we will carry out projects to improve the ability of diagnosis and treatment of difficult diseases; In order to improve the ability of public health prevention and control, infrastructure construction projects were carried out.
4. Combination of prevention and first aid with refined management: optimize process management and improve the level of standardization, refinement and informatization; Optimize personnel, post and salary management; Strengthen planning budget and planning monitoring to ensure landing.
5. Establish an integrated prevention and first aid system: a two-level and six-level integrated medical and health service system.
6. Strengthen financial management and financial investment guarantee: 40% of the income balance of regional medical centers is used for employee welfare and 60% for teaching and scientific research; According to the post setting, increase the financial guarantee of personnel funds; Infrastructure investment shall be borne by finance; The government purchases public services from medical centers.
7. Improve the guarantee of governance structure: improve the autonomy of operation and management, open new projects and technologies according to the needs of business development, and implement the price filing system; Strengthen performance supervision, increase the proportion of residents in radiation areas, the proportion of difficult and severe diseases, and the proportion of income related to medical technology research; Improve the governance structure, define beds and staffing, strictly control the scale, and strengthen budget management.
In the discussion session of the forum, the three guests also discussed how to balance preventive medical care and curative medical care in public hospitals.