Medical network - on April 1, March 28, 2017, the national health work picturephone meeting held in Beijing, vice premier of the state council, reform of the state council leading group leader liu yandong made important speeches. , director of the national health and family planning commission, the state council reform leading group deputy team leader li bin to attend the meeting and inform to 2016 reform work progress, and the 2017 key work arrangement. 

 

Subsequently, fujian, zhejiang, sichuan province, shenzhen city, guangdong province, and anhui tianchang, the head of the local health reform train of thought are introduced and typical respectively. 

 

Health care system reform: fujian formed an independent operation of health care institutions 

 

In the TV conference call site, fujian province, vice chairman of the Chinese people's political consultative conference, provincial health reform leading group deputy team leader li hong highlight the province medical insurance system reform are introduced. 

 

There are three main measures to the local: 

 

First, consolidation, optimization function. On the basis of "the unity of" miho, continue to group related people club department medical birth insurance, civil affairs department, business department and drug distribution functions such as merging, changing medical care "Kowloon water conservancy", divided by the department of the situation. More importantly, will the drug bidding and price of family planning department of public health departments of medical price management function into health care, focus on the "medicine, price and protect" the public hospital three leading factors of economic operation, enhance the restriction and incentive on medical behavior. 

 

Second, a relatively independent operation mode. Set up provincial health care management committee, consisting of 13 departments, director of the who in charge of the vice governor. There are health care department, at present the affiliated provincial departments, relatively independent operation. 

 

Third, straighten out the cities and counties in health care system. Integration mode of the city divided into districts with reference to the provincial health care institutions, health care administration, set up city affiliated city finance bureau, form unified health management system in the province. At present, all provinces and cities have two levels of health care institutions in our province integration in place. 

 

They are using these strategies, from realized in the process of reform, health care is the basis of the basic medical and health system, is a key, the core of the reform is "3 d linkage" key. Moreover, sanming reform experience has shown that the compression and drug supplies and artificially high cost in hospital fee free space, used to improve the medical service price, increase doctors pay treatment, optimize the hospital income structure, promote the benign development, we must to buy drugs, medication, pay from decentralized management to centralized management. Therefore, the reform must first change health care, health care institutions of the operation of the establishment of an independent let "pay" tube "to order", make money to medical practice. 

 

Citing information from li hong, so far, in perfect health care system in fujian province made four work focus on: 

 

One is the "medicine, price," the three linkage, establish a public hospital compensation mechanism. In the second half of 2016, the use of drug bidding, hospital cost control, and health care institutions after the merger, the balance plate increases the cost of the room, such as provincial 15 hospitals for the three medical service price adjustment, the amount of 200 million multivariate, follow up with the health care reimbursement, does not increase financial input, and no burden on patients. 

 

The second is based on the medical insurance payment settlement price, reform the system of drug purchase. Health department based on "two", formulate measures of two kinds of prices, promote the reform of drug purchase. Led by provincial health office, for example, to develop health care payment settlement price, about 80% of therapeutic drugs, health care for the same variety drugs to determine a representative drugs to pay, pay standards as settled with varieties of drugs. Beyond the part by the hospital pays, balance retain part of the hospital. 

 

Three is the press disease to collect fees, promote the medical service price reform. At the end of 2016, according to the synchronization of fujian province in 100 diseases diseases fee and payment reform. Be determined by the provincial health office to negotiate with the hospital patients with these diseases to the charge standard, let people clearly consumption, inhibition of hospital collects fees in disorder behavior. In 2017, the province's press disease to charge and pay range of disease will expand to more than 600. 

 

Four is to the regulation, constraints and regulating medical behavior. Health care integration, after giving the provincial health office regulation hospitals, doctors, drug circulation and service, the price of four big responsibility, regulation force. Measures include: 

 

(1) strengthening the safety supervision. A crackdown on defrauds insurance fund and the violation of patients' behavior, will be illegal enterprises, medical institutions and individuals in the province "blacklist" medical security management system. 

 

(2) to take drugs sunlight procurement price fixing, drug catalogue, head of the selection process and openly, publicly drug procurement process. 

 

(3) strengthen the supervision of medical practice. Health care physicians code management, built the entire province unified health care physician code base, doctor medical behavior for the whole process of management. 

 

(4) strengthen the supervision of information. Establish a health care service management platform, to provide technical support for health care regulation. 

 

Urban reform of public hospitals: zhejiang exploration of modern hospital management 

 

According to ChengYue rushed, vice governor of zhejiang, the province in 2011 to launch the "drug zero rate" as the breakthrough point of the comprehensive reform of public hospitals at the county level, then gradually the municipal, provincial public hospital reform. In April 2014, the province comprehensive cancel all public hospital drug addition, synchronous implementation services, health care, financial security, such as management system reform. 

 

Their main way is: 

 

It is a perfect public hospital management system. Formulate provincial public hospital operational target responsibility system assessment method and index system, strengthen the appraisal of dean and hospital evaluation. Strictly control unreasonable medical expenses increased, public hospital medical expenses growth indicators for successive years below the national average. 

 

The second is to improve public hospitals operating mechanism. According to the empty rooms, structural adjustment, the basic path of cohesion, gradually straighten out the medical service price. For pediatric medical services "short board", in a few years ago, on the basis of price reform in pediatric outpatient service charge again examined, hospitalization fee and accurate.in adjustment, after the adjustment of medical service prices into the medical insurance to pay limits, do not increase the burden of patients. To purchase new drug classification as the guidance, to carry out the "two votes" requirements, promote the collection of goods flow, information flow, capital into one of the provincial YaoXie comprehensive procurement platform construction, all public hospital drug procurement will be incorporated into the new platform operation and management. Accelerate reform of the medical insurance payment system and the perfect amount of advance management at the same time, expand the macro-reforms responsibility and capitation payment and signed at the grass-roots level of outpatient service doctors all-in health care costs such as pilot reform. 

 

Three is to carry out the public hospital operation management autonomy. The transformation government function, cut for medical examination and approval matters, to promote the implementation of the hospital internal personnel management, organization setup, income distribution, such as annual budget execution autonomy. To establish a flexible mechanism of choose and employ persons, trial reform of public hospitals prepare records will be carried out in an all-round way. For shortage or high-level personnel, professional and technical personnel in accordance with the provisions, independent recruitment by the hospital. 

 

In addition, the zhejiang province also comprehensively deepen "double sinks, two promotion", actively promote the city high quality medical resources to the grassroots level. 

 

One is the strict control of city public hospital scale expansion. Formulation and strictly implement the medical service system planning, clear during the period of "much starker choices-and graver consequences-in" provincial hospital only reduction does not increase, one thousand beds from 0.47 to 0.45, districts and the city will not be held in principle of a new comprehensive city hospital. 

 

The second is to promote urban medical resources longitudinal joint. The 15 provincial hospital, 39 municipal hospital, respectively, and 122 county-level hospitals do medical cooperation, urban medical resources at the county level to achieve full coverage. Vigorously promote urban hospitals and the hospitals at the county level shall establish a couplet of assets as a link of medical group or medical, there have been seven provincial hospital and 8 counties (city) government to build 11 college (ZhuanBing) center, the provincial hospital has invested 300 million yuan. 

 

3 it is gradually formed into a pattern of county-level hospitals gradient sinking. In recent years, the province's focus on relying on county hospital, promote the establishment of the county medical imaging, clinical examination, ecg examination, slow disease management such as sharing center. On this basis, the hospital in provinces and cities at the county level hospital support at the same time, take the initiative to sink, dispatching resident medical personnel at the grass-roots level, set up the basic unit hospital division, arrange experts on a regular basis to teaching ward round at the grass-roots level, and in towns and townships, community health center construction of medical service collaboration body and complex. 

 

YaoXie procurement reform: sichuan 6160 public medical and health institutions included in the regulation 

 

Charles Yang, vice governor of sichuan province people's government, in the practical work, insisted on the carrier of information platform of sichuan province, seized drugs, medical supplies, medical equipment, diagnostic reagents, 2 kinds of vaccines, such as key, push YaoXie supply security standard, orderly and effective. 

 

As for the specific methods, mainly five kinds: 

 

One is to carry out the classification of public hospital drug centralized procurement. In accordance with the purchase way, set in the country by the end of 2016 complete classification of new drug centralized purchasing task. Drug prices falling by 10.6% from a year earlier and is expected to reduce drug spending nearly 4 billion yuan. Directly purchase products more than 37000, the net price average drop of 16.1% compared to the same drug. 

 

2 it is to promote the medical consumables net sunlight procurement at the provincial level. In 2014 in the first, the current provincial net purchase up to 10 categories, 41, 56000 products, the basic realization of medical consumables all caliber procurement, the entire province average price year-on-year growth of 9.4%. At the same time, the province is actively negotiate medical consumables provincial cooperation procurement. 

 

3 it is to promote medical equipment sunshine for the record. In 20 categories, more than 200 species of 2015 large and medium-sized medical equipment on the basis of net work, in 2016 we added 17 categories, more than 80 kinds of equipment for the record, and realizing a complete category of large and medium-sized medical equipment procurement and use of regulation. 

 

Four is to carry out diagnostic reagents sunlight procurement of provincial screening. Launch in August 2016, has now completed six major categories, 458 species, more than 458 products hanging nets, the rest of the 796 kinds of net work will be completed in the first half of 2017. 

 

Five is to carry out the second vaccine sunlight procurement of provincial screening. In March 2016, the first implementation plan and implement in the provinces unit centralized network. Has now completed information system construction, the realization of all varieties, 122 products hanging network at the provincial level, with 120 products to carry out the price negotiation and execution at the provincial level. At the county level CDC all online purchases. 

 

It is worth mentioning that the YaoXie procurement mechanism established in sichuan province and at the same time, adhere to the regulation of port forward unceasingly, by the original post-supervision, to advance and now in timely early warning, timely correcting, realized YaoXie procurement process using real-time control. 

 

One is setting up a comprehensive procurement supervision platform. After the system upgrade platform for production and operation enterprises and medical institutions have been covered, the family planning administrative department of public health, such as pharmaceutical sales participants, implementation process supervision, monitoring data, the results of evaluation, information query and so on comprehensive supervision, is the province's public medical institutions at all levels on the Internet procurement YaoXie integrated information management platform. 

 

The second is to establish the price mechanism of early warning management. For medical consumables purchase price 50% higher than the province minimum purchase price, or higher than the average purchase price of the purchasing behavior of provincial key monitoring, timely send the purchasing price abnormal risk told book (2016, 405 medical institutions issued a notice, 1391), the effective control of the nonstandard purchasing behavior. 

 

Three is to establish enterprise record management mechanism. Will not be required to supply YaoXie unqualified sampling observation of quality products, such as violation behavior into bad record, and at the provincial medicine platform of the public, to urge enterprises to ensure the safety of product quality, reasonable price, timely supply (2016 62 YaoXie companies were included in the general bad record, disqualified from 221 illegal Internet products). 

 

Four is to establish medical institutions supervision mechanism. To basic medicine, Chinese medicine, medical institutions in the low price of drugs, expensive drugs purchasing behavior into the regulatory scope of use, the corresponding evaluation index, the integral evaluation management, monthly bulletin, season questioning, rectification within a time limit, tracking implementation. 

 

Sound health comprehensive regulatory reform: shenzhen "three subjects" regulatory system 

 

In the TV conference call, shenzhen municipal party committee secretary, mayor hsu shenzhen health comprehensive regulation of the main methods are introduced. 

 

First, improve the government, society and industry "three subjects" regulatory system. 

 

One is "separated", strengthen the government supervision. Across the country take the lead in the establishment of "the super-ministries" family planning department of public health, strive to build a great health, health service system. Promoting public hospital "separated", set up a public hospital management center, the administrative department of health from microscopic transaction management in public hospitals, strong planning, market access, strengthen industry standards such as the industry regulatory functions. 

 

Second, deepening the reform of "pipes", strengthening industry self-discipline. In recent years, the cumulative cancel transfer down health matters 34 administrative functions. Encourage industry organizations to undertake the functions of the government transfer matters and legislation to form a clear association bear functions such as registration, medical practitioners examination. Introduce Chinese acad med sci medical information research institute of China and other third parties, the comprehensive evaluation of public hospitals will be carried out, in a more objective and scientific evaluation system to guide industry standard development. 

 

Three is more comprehensive information, strengthen the social supervision. Comprehensive public service projects, medical institutions, hygiene supervision and law enforcement result information such as price, establish illegal medical practice, illegal CaiGongXie report illegal behaviors such as reward system, improve the enthusiasm of public participation in supervision. 

 

Second, the innovation of standardization, informationization, normalized "three" regulatory model. 

 

One is to build industry standard of "shenzhen". Focus on to lead the industry standard development, the first to develop TCM pavilion, remote medical imaging diagnostic center, set up standard; 13 criteria of traditional Chinese medicine, seven for ISO standard project, 3 items into the national standard. A medical services, public health service quality evaluation standard, regularly every year to carry out the assessment. Rules for health administrative penalty discretion, regulate the behavior of administrative law enforcement. 

 

The second is to build the information regulatory network. Promote the medical treatment, health care, medical regulatory information such as connectivity, open sharing, establishes the basic cover all public hospital health intelligent audit system, the whole process of intelligent monitoring diagnosis and treatment of service, cost control, medical advertisement, etc. Public hospital information platform, regulation of hospital decision-making, personnel, finance, purchasing, equipment real-time supervision and management of "five rights". 

 

Third, we will improve the normalized regulatory mechanism. To strengthen market supervision, health and other departments to coordinate linkage, strengthening registration, professional engineer license, daily operation, such as dynamic regulation. Promote industry credit system construction, the implementation of medical institutions and physicians bad practice behavior score management and the system of "blacklist". The implementation of quantitative grading surveillance, prevention control industry key risk points. 

 

Third, strengthen the legislation, the guarantee of the system and law enforcement. 

 

Is a prominent legislation first. Give full play to the SAR legislative power, introduced the first comprehensive medical regulations, local for the operation management, dispute resolution, medical supervision etc. Make that clear. At the same time, successively, formulate rules for human organ donation transplantation, tobacco control regulations and other laws and regulations, is to accelerate the pre-hospital first aid, health promotion, and public hospital management legislation, focus on legislation to promote the healthy development of the medical industry. 

 

The second is highlighting institutional constraints. Comprehensive ShiCe curb excessive, overhaul, such as excessive medical behavior, strictly implement the prescription reviews, sunshine medical information registration report system, establish a regular medical expense reporting mechanism, guide the hospital initiative to standardize the treatment and control expenses. To carry out the drug the reform of the third party group purchasing, actively lower drug prices. 

 

Three is outstanding law enforcement support. To promote enforcement downward move, strengthen the "grid" regulation, implementation of the law enforcement system of "double random and a public". In 2016, 898 cases of medical and health institutions to make administrative punishments and fines of more than 1360 1360 yuan, to ban unlicensed medical institutions more than 470, more than 50 cases of illegal medical advertisement behavior, and to give bad practice behavior score of 259 physicians. 

 

County county medical service reform: anhui tianchang "d donor" 

 

According to the vice chairman of the Chinese people's political consultative conference, the last of chuzhou in anhui province party secretary Jin Wei plus, in the past few years, tianchang county community health services, through a preliminary build up with rural practical hierarchical diagnosis model. 

 

Its core practices including four points: 

 

First, the medical institutions and the "family". Led by three county-level hospitals, with the city's 14 towns and townships and two community health center, two-way choice, voluntary pairing, forming three county medical body. Hospital medical total body size to become "the family", the city hospitals, township hospitals and village clinics by "1:1:1" competitive relationship into a "1 + 1 + 1" cooperation. 

 

122 kinds of county-level hospitals, institutes of 50 kinds of ensure that were planted catalog, clear under the county-level hospitals 41 disease to plant diseases and 15 convalescence turns listing, build community responsibility. D the first option at the grass-roots level in the body, two-way referral, referral green channel is established. At the same time, implement differentiation policy coverage, increasing local and grassroots medical reimbursement ratio, reasonable guide private hospitals. 

 

Second, the medical resources of county and township government "chess". Proactively support services and development community: one is the resource sink. D, large equipment sharing common body in patients needs to make inspection of large equipment, by the institutes to open after the checklist, to the county hospital, the results immediately back to the hospitals. 

 

2 it is sinking. Medical doctors to carry out more in the body, applies a system of personnel "double delivery", namely the county-level hospitals set aside 3% of jobs, is used to send the physician to subordinate institutions teaching; Grassroots medical institutions set aside 5% of the jobs for physicians in the superior training institutions. Establish county-level hospitals, institutes and village clinics "1 + 1 + 1" mentoring 396 group, led by the hospital to send experts XiaZhu institutes of health, develop the expert visit regularly, teaching and surgical consultation and other services. 

 

Third, medical services, the "unity". 

 

1. Interests bind together. New farming and funds for medical, valuing the capitation amount shall be paid in advance, to take the lead in hospital management as a whole, the excess borne by county-level hospitals, balance by county-level hospitals, institutes, village clinics by 6:3:1 distribution ratio, building a community of interests. The original hospital managed to spend more from the hospital medical insurance fund "income" is a "cost", spend every penny is their own, outside the patient to spend money to also want to "tao" pockets, reversed transmission medical body medical institutions active control costs, reasonable referral from top to bottom, to participate in health management, to minimize the outer sickened and patients. 

 

2. Control cost quality together. The clinical pathway management and press macro-reforms "two synchronization", both blocked waste, and to protect the quality of medical treatment does not shrink. 393, has been the implementation of clinical pathway in macro-reforms disease to city people's hospital of 220 species, 146 kinds of traditional Chinese. 

 

3 d together. Public hospitals at the county level set up health management center, to carry out health promotion, and promote "double prescription", prescribe drugs to patients and personalized health prescription, has covered 276 diseases; Country signing the family doctor service, make the residents disease-free early prevention, early detection, early treatment unhealthily. 

 

4. Health information preliminary "made". Relying on hospital management, imaging, pathology examination, ecg, information platform, realize take the lead in the hospital and the medical total body center hospital information exchange, mutual recognition of test results. Development of telemedicine, has covered part of township hospitals and village clinics, led by medical body total hospital experts of medical imaging diagnosis, cases discussion and consultation guidance and other services. 

 

When it comes to success, Jin Wei add to be summed up in four aspects: 

 

One is a serious illness county. Currently tianchang county hospitals, 2254 kinds of treatable diseases, 357 species, more than 2012 new seven key specialty at or above the provincial level. Local JiuZhenLv reached 92.24%, higher than the entire province average of 22.6%. 

 

The second is ailment to stay at the grass-roots level. In 2016, in towns and townships outpatient visits accounts for 52.7% of the city's medical MenZhenLiang, towns and townships in the hospital people up 17.3% from a year earlier. In total body may turn on significantly more than turn, turn the 8037 person-time, turn on 3319 patients. 

 

Three is the development. According to statistics, at present the city towns and townships, 90 kinds of treatable diseases, 40 more than 2012 kinds. Through the medical help build specialized subject three institutes, total body to start a new technical one. 

 

Four is the real benefit. In 2016, in terms of growth rate of medical expenses, and the city people's hospital was 5.8%, the hospital was 7%, fell by 4.7% and 3.8% respectively compared to the same; New farmers and the actual compensation ratio of 70%, individual out-of-pocket expenses than the reduced up to 30%.