4 key points to do a good job in community chronic disease management payment system.

Wen . . . Zhang Qun's two comprehensive medical reforms in Beijing in the past three years (the comprehensive reform of medical separation in 2017 and the comprehensive reform of medical consumption in 2019) have played an important role in rationaling the price system of medical services and improving the medical experience of insured persons.
, Beijing has designed a community-leaning reimbursement policy in the medical reform plan, with a view to guiding patients to the grass-roots level for medical treatment.
although the policy did have some effect in the early stages of implementation, the effect of subsequent implementation was not satisfactory.
the author's analysis of the following reasons: First, the proportion of general practitioners is small, the capacity of primary health care services is insufficient.
has always attached great importance to the development of community health service centers, especially in hardware, but the soft power of primary health care institutions has yet to be improved.
In comparison with the number of contracted GPs, the average GP in the UK manages 2,000-3000, while there is still a huge gap in GPs in our country, with only 2.21 GPs per 10,000 people, 10,000 more difficult to meet the demand for common and chronic diseases.
, primary health care institutions are limited in size and lack of varieties of medicines.
The National Basic Medicines Catalog defines the types of medicines that primary health care institutions should be equipped with, but some community health service centers are small in size and cannot be consistent with large hospitals in terms of drug reserves;
, the geographical advantages of some primary health care institutions are not obvious.
a survey on the current situation of community hospitals in Beijing and the satisfaction of residents showed that "closer access and more convenient access to medical care" is the main reason why people choose community hospitals for medical treatment, accounting for up to 80.65 percent.
However, the author found in the research, in recent years, Beijing Fengtai District, Chaoyang District and Haidian District community health service center visits and prescriptions are clearly on the rise, while the Dongcheng and Xicheng relevant data are relatively low, because people living in these two urban areas think that community health service centers are far away from the community, or the distance is similar to the large hospital, so tend to choose higher-level hospitals.
, insured patients and specialists in large hospitals are more sticky.
because most disease diagnosis still occurs in high-level hospitals, so the insured patients have strong trust and dependence on the experts in large hospitals, and will seek specialists in large hospitals as an inherent model.
the above these impact graded diagnosis and treatment policy landing reasons, although it does not seem to have much to do with the health care policy, but in fact, there is a certain chain effect, through further improve the payment system to guide graded diagnosis and treatment.
, the establishment of a scientific community slow disease management payment system Government departments have been hoping to establish a slow disease fee package payment system, and repeatedly organized medical experts and hospital health insurance managers to discuss.
The author believes that this system should include at least four aspects: First, according to the annual examination, treatment and drug use of primary health care institutions to implement a quota payment per head, through the implementation of the "balance retention, reasonable overstress sharing" incentive policy, to encourage community health service centers to carry out scientific and fine management.
, the establishment of the total payment system of the Medical Community, to stimulate the high-level hospitals and primary health care institutions of the benign interaction.
Once the community health service center appears slow to serious illness, the higher hospital in addition to taking over the patient, but also to include the related cost consumption into its total medical insurance payment, only in this way can the second-level medical institutions take the initiative to drive the community health service center to improve the quality of medical services, reduce the endogeneration of medical costs.
third, appropriately increase the proportion of people who are reimbursed for chronic disease management at the grass-roots level.
For those patients who voluntarily receive slow disease management services at the grass-roots level, different proportions of medical insurance reimbursement can be divided according to age, and combined with the cumulative use of medical insurance funds, to give certain reimbursement incentives, thereby encouraging the slow patient group to strengthen their own management, establish good living habits and scientific medical treatment concept.
fourth, the quality of service and patient satisfaction into the assessment.
kind of supervision and appraisal system, will guide what kind of behavior.
Community health service quality will directly determine the choice of patients and the effectiveness of the use of funds, so the quality of service and satisfaction assessment as the key criteria, supplemented by balance incentives, will be more than the cost of over-standard assessment can stimulate the enthusiasm of primary health care workers and managers, the training and introduction of talent will also be beneficial.
2. Combining administrative intervention with the policy of benefiting the people, although service pricing and gradient reimbursement can lead to graded treatment to some extent, from the current implementation effect, it is not enough to encourage the majority of patients to consider community services for cost reasons.
Therefore, if we want to give full play to the role of "health gatekeeper" in community health service centers, we should consider some administrative intervention in the medical behavior of the insured at the same time as establishing a scientific system for the management and payment of chronic diseases in the community.
This third, the overall use of medical insurance funds and public health service funds, pay attention to the investment in community health management has been, health insurance funds and public health service funds have their own responsibilities, the current system arrangement is the public health service system to focus on disease prevention and control, health education and other issues, and the main responsibility of the basic health insurance system is to gradually improve the level of disease treatment and protection.
, although the two uses are different, but the purpose is to solve the people's health problems.
at present, our "prevention" and "cure" to a certain extent there is a problem of management decoupling, the overall use of health insurance funds and public health services funds, to a certain extent, can achieve an effective link between public health services and medical services.
, we can also consider joint commercial insurance to open up the health management market, so that commercial insurance to assume the health management of the insured health promotion work.
(ZGYLBX2020-7) Original title: Establishing a scientific community slow disease management payment system to assist in graded diagnosis and treatment.