I. Progress of work
(1) Basic working state. According to the statistics of poverty alleviation departments in 20 18, at the beginning of 20 14, there were 395,000 poor people in the city, and the incidence of poverty was 3 1.8%. After tackling poverty in recent years, there were still 27,000 households with 96,000 people in poverty at the end of 20 17, among which 6,056 households were poor due to illness, accounting for 22.5% of the poor population. In 20 17, 752 households (293 1 person) returned to poverty, among which 496 households returned to poverty due to illness, accounting for 66% of the population returning to poverty. By the end of 2065438+May 2008, there were 18592 poor patients in our city, accounting for 39.4% of the whole region.
(2) Providing convenience services. Three working measures have been formulated, namely, seeing a doctor first and then paying, seeing a doctor with one certificate and one-stop reimbursement. We will implement the working mode of "six ones, two pushes and five understandings" and establish a green channel for the treatment of poor patients and a patrol follow-up system. Establish health records for the poor and implement dynamic management.
The implementation of family doctor contract service, the poverty-stricken population health filing rate and contract service rate reached100%; Compile a health handbook, issue a "medical service discount card for poor patients", publicize health knowledge and poverty alleviation policies, and let the poor people know their health status, diseases, treatment costs, responsible persons and causes of poverty. Comprehensively carry out the "one-stop" settlement of hospitalization expenses of poor patients, especially introduce the third-party payment of financial security funds to realize the service requirements of "don't meet, do it right away, and make a trip at most" between medical patients and medical institutions; Carry out "Internet+medical health". Some counties and districts in our city have fully applied the "Internet plus family doctor service platform" to gradually solve the problem of people's difficulty in seeing a doctor.
(3) Improve and perfect the safeguard mechanism.
First, strictly implement the policy of the medical government of the autonomous region on rural poor patients. With financial subsidies from autonomous regions and local governments, the government has set up a medical assistance fund. According to the principle of insurance first, assistance later and assistance later, poor patients can achieve the goal that the actual reimbursement ratio of hospitalization expenses in that year is not less than 90% or the total out-of-pocket hospitalization expenses in that year is not more than 5,000 yuan, benefiting the rural poor188,000 people.
The second is to formulate policies for the inclusion of general rural residents' medical care. Introduce the commercial health insurance mechanism for rural residents with diseases, establish a model that rural residents pay mainly by themselves, the government gives appropriate subsidies, and commercial insurance companies take risks, purchase commercial health insurance for serious and serious diseases, and improve the level of medical security, benefiting 6.5438+0.079 million rural residents.
The third is to establish a supplementary medical insurance system for serious and serious diseases. All urban workers and urban and rural residents who participate in the basic medical insurance in this city will be guaranteed to suffer from diseases that seriously endanger their lives and health and cost a lot of treatment. The number of major diseases that can be reimbursed will be expanded to 36, covering the whole city 1.3 1.2 million people. ?
(D) Health poverty alleviation has achieved results
The city has established a medical security system for different groups of people, carried out various convenience services and adopted targeted treatment measures to solve the problems of poverty caused by illness and returning to poverty due to illness. Has achieved phased results.
1, work innovation effect. In practical work, we have explored the mode of entrusting the third party to manage the government security funds for health poverty alleviation (using the institutions, personnel and payment processes of commercial insurance companies to realize the service requirements of "no meeting, one settlement at a time, no more than one trip" for the settlement of medical expenses between patients and medical institutions) and "Internet+medical health", which have better solved the problems of more illness and less illness among rural poor people. After 20 17 evaluation and 20 18 evaluation by the National Health Planning Commission, Pengyang County of our city was identified as the "advanced county (demonstration county) for health poverty alleviation" in China. The application of "Internet+Medical Health" in Pengyang County has been affirmed by Vice Premier Sun Chunlan.
2. The treatment effect is accurate. In 20 17, the city * * * approved poor patients 12553, including severe illness patients 1802 (9 kinds of severe illness patients 3 19), severe illness patients 1229, and chronic diseases 9522. By the end of 20 17, "three batches" of people were treated12,459, with a treatment rate of 99.25%, of which 1768 were treated for serious diseases (309 people were treated for 9 kinds of serious diseases, with a treatment rate of 96.87%). ), the cure rate is 98.65438 0%; 1207 people were seriously ill, and the treatment rate was 98.2%. 9484 people were treated for chronic diseases, and the treatment rate was 99.6%. By the end of June, 2065438+2008, 329049 people had been diagnosed with diseases, and 24369 people had been approved by * * *, with an approval rate of 93.65%. Among them, there were 2803 seriously ill patients, 2706 seriously ill patients and 1 1960 chronically ill patients. A total of 5436 patients with severe diseases, 5298 patients with severe diseases and 6309 patients with chronic diseases were treated. The average cure rate was 74. 1 1%.
3. The effectiveness of medical insurance. First, the effectiveness of the government's protection for urban and rural poor patients. From 2065438 to 2007, 5,572 poor inpatients were settled, and financial subsidy funds and government guarantee funds were reimbursed15.97 million yuan. All kinds of reimbursement accounted for 93.2% of the total hospitalization expenses, and the average out-of-pocket expenses for individual hospitalization were 963 yuan. The reimbursement rate of hospitalization expenses for poor patients reaches the goal of not less than 90% required by the autonomous region, and the out-of-pocket expenses do not exceed 5,000 yuan. Second, the effectiveness of the policy of benefiting the people of urban and rural residents in the city. In 20 17 years, the city's urban and rural residents were hospitalized17160,000 person-times, and the total hospitalization expenses were1090.46 million yuan. The reimbursement rate of serious illness insurance reached 8.68%, including 4.28% of serious illness insurance and 3.49% of commercial health insurance. The number of other rural residents enjoying the two policies in our city reached 85,000, accounting for 49.5% of the total number of inpatients in 20 17 years. Guyuan serious illness insurance is reimbursed 269 yuan per capita, and commercial health insurance is reimbursed 848 yuan per capita. Both items are overstated 1 1 17 yuan. The third is the effectiveness of the 20 18 government. By the end of June, 2065438+2008, Shidong * * * had reimbursed government expenses by 35 18600 yuan, and enjoyed government policies for 3230 person-times, with an average personal payment of 725 yuan, and the reimbursement ratio reached 9 1%.
4. Improve the effectiveness of poverty alleviation. Since health poverty alleviation, the participation rate of residents in our city has increased from 95.4% in 20 14 to 20 18? 98.2%, an increase of 2.8%, and the average life expectancy is expected to increase 1.5 years during the five-year period. By the end of June, 2065438+2008, there were 3849 poor households in our city, and the poverty rate dropped to 7.66%. Great changes have taken place in people's health concept, and gradually formed a living habit that everyone pays attention to hygiene, pays attention to health, can be hospitalized in time for serious illnesses, can be treated in outpatient clinics for minor illnesses, contract management of chronic diseases at home, and prevent diseases in advance, thus improving health awareness. ?
Third, the current problems.
(A) the shortage of urban medical resources. The allocation of medical resources is lower than the national average, the academic structure of the medical team is unreasonable, the level is low, there are few academic leaders and practical talents, the rural health team is unstable, and there is a lack of general practitioners.
(2) The structure of health resources is not balanced. The allocation of medical resources in urban and rural areas is unbalanced, and the total amount of medical and health resources in rural areas is seriously insufficient. The development of traditional Chinese and western medicine is unbalanced, and the development of traditional Chinese medicine is relatively backward. The development of specialized hospitals is slow, especially in the fields of obstetrics and gynecology, pediatrics and geriatrics.
(3) There is still the problem of difficulty in seeking medical treatment. The cost of medical assistance cannot be solved. The remaining medical expenses, transportation expenses, accommodation expenses, escort expenses and food expenses of poor patients after seeking medical treatment outside the city and government reimbursement are very large; The medical expenses during the rehabilitation period cannot be reimbursed; There is no policy support for outpatient expenses; It is difficult to solve the problem of repeated "threshold fee" for patient referral; The situation of controlling the unreasonable increase of medical expenses is grim.
Fourth, what's the next step?
(a) the implementation of medical talents "return to six fixed" project. The state funded the establishment of an incentive fund to reward high-end medical talents who have returned home and local medical workers who have made significant contributions, and to encourage and attract medical talents in Guyuan. Strive for the country to give Guyuan policy inclination in many aspects such as enrollment, training and employment placement in colleges and universities. ?
(2) Establish a characteristic medical team. Strive for the state to set up a special local medical service fund, support Guyuan City to train and set up excellent medical teams at all levels, and build a medical treatment pattern of "minor illness at the grassroots level, serious illness not leaving the county, and incurable diseases not leaving the city".
(3) Building a high-end professional medical department. Strive for national investment in the construction of urology, stroke center, orthopedics, general surgery, ophthalmology, internal medicine and spine health centers of the Municipal People's Hospital, and build nine key departments and superior departments such as obstetrics and neonatology of the Municipal Maternal and Child Health and Family Planning Service Center (the Municipal Children's Hospital) to promote the medical diagnosis and treatment level and scientific research ability of the city and realize the leap-forward development of the overall medical level of the city. ?
(4) increase basic medical equipment and medical conditions. Strive for the state to give financial support to the development of "Internet+medical health" project infrastructure in our city.
(5) Pay close attention to the signing service. Implement the management of chronic disease contract service, realize the contract signing rate of poor patients with filing card to reach 100%, and the contract signing rate of ordinary residents meet the national requirements, realize one case of contract signing, manage one case and implement contract signing service.