After the Sanming model, medical reform explores the re-emergence of the Ryan plan.

Editor's note: Three sets of data to look at Ryan's health care reform: Data 1: In 2019, Ryan's county visit rate was 91.4%, the primary consultation rate was 75.2%, and the public satisfaction rate was 95.2%.
Data II: From July 2018 to June 2019, the expenditure of the ryan urban and rural residents' health insurance fund increased by 2.75 percent year-on-year, down 14.4 percentage points, or 84 percent, from the previous year;
: From October 2018 to September 2019, RyanAir actually reduced medical costs such as medicines, consumables, inspections and other medical costs by 213 million yuan.
among them, drug supplies decreased by 190 million yuan, the proportion of drugs decreased by 3.68 percentage points, or 12%, compared with the same period last year;
reform of the Ryan Medical Community is to use the price mechanism to cut in, to solve the "three medicines" and "cure first" non-replicable problems, in Zhejiang Province has been recognized and promoted.
On April 12, 2019, the National Health and Welfare Commission held a press conference in Zhejiang Province to comprehensively promote the construction of county-level medical community and build an integrated medical and health service system, and Mayor Ma Sheng-chung, deputy secretary of the Ryan Municipal Committee, introduced Ryan's typical experience as the only county-level government representative in Zhejiang Province.
Overall, Ryan is grasping the "bull nose" of payment reform, adopting the multi-composite payment method of health insurance, following the internal laws of behavioral economics, and the 180-degree u-turn of hospital doctors' profit-seeking mode, which has profoundly changed the organization and management mode of medical resources.
Ryan Medical Community can achieve the goal of "three medical linkage, medical insurance-driven", adopted a set of combination fists: l the main leadership overall command, truly straighten out the "three medical unity" industry management system; Reform, the hospital to reduce the cost of medical care 100 yuan, can exchange 68 yuan technical service project upward space, Huimin 32 yuan, reasonable drug use incentives doubled;
In 2019, the reform of the Medical Community of Ryan City was shortlisted for the Zhejiang Provincial Government's real hard work incentive list (ranked first), and its experience was highly recognized by Yu Jianxing, Dean of the School of Co-Management of Zhejiang University and a special professor of Changjiang Scholars, who submitted it to the State Council in a special report on "Social Governance" and was confirmed in writing by the Secretariat of the National Health Reform Leading Group.
so how does the Ryan model work? How exactly does the main practice work? How do results come about? What are the reference significances for medical reform in various places? Please see below (the article is relatively long, but worth reading carefully): Since 2018, Ryan City to the county medical association provincial pilot as an opportunity to vigorously carry out public governance innovation, out of the "health insurance-driven, two-doctor linkage" of the new way, quickly pry the county comprehensive medical reform.
2019, ryan city and county visit rate of 91.4%, grass-roots consultation rate of 75.2%, the public satisfaction rate of 95.2%.
01. The reform measures of "Bull Nose" Ryan City, which grasps the reform of the medical association, can be summed up as three "clusters": focusing on "health insurance-driven" and making reform of the multi-payment method;
, focus on "health insurance-driven", do a real multi-payment reform 1, administrative leadership, straighten out the public governance system.
the main leadership of the Party committee of the city of Ryan to lead the overall grasp, high-level promotion;
to set up a medical association management committee to carry out the planning, input and supervision of the medical association.
health care, health insurance, finance, social and other relevant departments to decentralize authority, to give the medical community full management autonomy.
formulated three lists of responsibilities and responsibilities of the Meso-Society Management Committee, the health-care sector and the Medical-Commons, with clear boundaries and clear division of labour.
2, landing-based, to promote the reform of payment methods.
after examining and studying the national experience, we will implement the incentive and restraint mechanism of advance payment of total medical insurance, "residual retention and reasonable overspend sharing" and implement the whole area of medical insurance for urban and rural residents to pay by head.
Based on the simple structure of county diseases and the status quo with less data, the simple and inexpensive county version of DRG payment system (disease score method), according to the first diagnosis, main operation and main surgery of medical insurance settlement data, 813 groups of 1000 diseases combined with point method agreement payment, from the economic bottom logical change "medical income" to "cost expenditure", changed the patient's disease more serious medical treatment more favorable price system contradictions.
3, Yili, to achieve doctor-patient incentive compatible. After the reform of
multi-multi-composite payment method, it has obviously alleviated the problem of excessive medical treatment caused by paying by project (quantity purchase), the three-way incentive compatible of medical treatment, insurance and patients (the interest direction is the same), and the medical service has moved towards continuous integration and integration of medical and defense.
From July 2018 to June 2019, expenditure on health insurance funds for urban and rural residents increased by 2.75 percent year-on-year, down 14.4 percentage points, or 84 percent, from the previous year.
, the cohesion of "medical linkage", do deep county medical reform 1, reorganization of public resources.
vertical integration of the city's public medical institutions, the formation of two medical bodies, unified institutional settings, personnel recruitment, resource allocation.
the standard modern hospital management system, the implementation of the sole legal representative governance structure, to give the general hospital to the branch of personnel, resource allocation and management rights.
the system of responsibility of the president under the leadership of the Party Committee, formulate a medical quality management system, and promote the homogenization of urban and rural management.
10 management centers and 5 shared centers to achieve grass-roots examination, central diagnosis and regional mutual recognition.
2, refactor the operating mechanism.
the implementation of full post management, scientific allocation and effective activation of talent elements.
implement the "two permits" to break through the total wage limit.
the annual salary system of the president, linked to the county visit rate, medical insurance control fees, up to 5 times the average salary of employees.
improve the two-way referral information platform system, develop a catalogue of graded diagnosis and treatment, up and down referral standards and procedures.
to implement differential reimbursement of medical insurance and guide the order of medical treatment.
establish a new mechanism for grass-roots compensation combining special subsidies with paid purchases, with fund compensation linked to service performance, with an annual subsidy of 170 million yuan.
3 and rebuild grass-roots capacity.
arrange for medical staff of the General Hospital to sit in the wards, open joint wards, and stabilize the mode of acquaintances.
to carry out unified training, guide the branch to carry out new technologies, participate in family doctor contract services.
2019, Ryan's two medical institutes will open 111 fixed specialist clinics, 6 joint wards and 10,239 working days for specialists.
the training center, the management team and general practitioners to carry out more than 40 modular training sessions.
the establishment of the "three divisions co-management" contracted service team 293, public health institutions into the medical community, strengthen the integration of medical and defense.
4 and reshape the medical experience.
the construction of Ryan City medical co-information platform, patients step on the point of medical treatment, mobile payment, real-time reimbursement.
2019 outpatient appointment rate of 94.98 percent, time-by-time appointment rate of 99.53 percent.
opened the largest primary health care business in Ryan's history, with 21 projects upgraded in three years, with a new area of 145,000 square meters and a total investment of 860 million yuan.
to jointly invest 400 million yuan in resources to start the construction of rehabilitation hospitals and health management centers.
third, the "medical linkage" to promote the price system reform 1, from "price reduction" to "reduce consumption."
To take a set tone, first Teng and then adjust and other comprehensive measures, innovative implementation of the "to use the link to space" of the price reform of medical services, hospitals to reduce medical costs of 100 yuan, can exchange 68 yuan of technical services project upward space, Huimin 32 yuan, reasonable drug use incentives doubled.
Innovation set up a "price adjustment fund pool", the hospital medical service project price increase new income, quarterly transfer to the city health bureau designated accounts, after assessment and evaluation, and then do distribution, to solve the hospital, medical insurance mutual trust and the balance of interests between the hospital community.
2, from "passive link" to "active link".
, the city of Ryan to the general hospital account as the only procurement account, the implementation of unified procurement of pharmaceutical supplies, distribution, pre-settlement.
On the basis of the procurement of the volume of the drug procurement complex in Wenzhou City, establish a normal monitoring mechanism, introduce the Key Monitoring Drug Tracking Management Program, the Notice on priority use of consistent evaluation of generic drugs, the Fair Prescription Review System, etc., and strictly control the proportion of self-costed drug supplies used.
rely on the "doctor's workstation" software system to strengthen the management and monitoring of drug prescriptions, and promote rational drug use.
3, from "do incremental" to "change the stock."
from October 2018 to September 2019, hospitals have actually reduced medical costs such as medicines, consumables, inspections and inspections by 213 million yuan in the past year, and increased the price of medical services by 67.96 million yuan, benefiting the public by 145 million yuan.
among them, drug supplies decreased by 190 million yuan, the proportion of drugs decreased by 3.68 percentage points, or 12%, compared with the same period last year;
02. The enlightenment of the problem-breaking medical reform, the reform of the deep-water area must be carried forward by the "pipe hat" of the first command.
" county rule, the world is safe.
" county and city is the landing operation layer of various policies, "a thousand hammers above, the next nail", the limited administrative force must be gathered to the main leadership of the party committee government on the matter of concern.
the "world's people's livelihood problems" such as medical reform, but also the institutional mechanism, moving is a deep-seated, multi-year curing of the interests of the pattern.
only if the main leaders of the local Party committee government personally promote, long-term work, can eliminate the accumulated ills.
Ryan City in a short period of 2 years can achieve such a reform dividend, can not be separated from the main leadership personally deployed, overall promotion, in the important nodes, major difficult issues to support exploration, clapboard decision-making, really straightened out the "three medical unity" of the industry management system, the construction of a unified distribution of administrative power pattern and governance system.
, integrated medical and health service system construction is the main line of work.
world experience and decades of exploration in China show that the construction of an integrated and integrated medical and health service system is a solution to the "Door court city" of large hospitals, township hospitals "Mencoro Finch".
Ryan City up and down the understanding of unity, firmly grasp the county medical union provincial pilot opportunity, effectively implement the province's county medical union construction of the "system reconstruction" "mechanism reconstruction" two-wheel drive, embarked on a new track of integration of medical care, basic health care public governance system is taking place qualitative changes.
Ryan City to the county medical community as the organization center, to strengthen the county-level "leader", make up the grass-roots "short board", through the service "chain" to promote the integration of basic health care and the second and third-level medical service system.
third, "health insurance-driven, two-doctor linkage" model "cure first" upgrade version.
the "three-doctor linkage" is the key to deepening medical reform.
New medical reform 11 years, mainly Sanming explores the "three-doctor linkage, treatment first" model, Ryan City to the county medical association as a platform, explore the "health insurance-driven, two-doctor linkage" path, indirect medical linkage, with better replication.
Its most valuable experience is to grasp the health insurance multi-composite payment method reform of the "bull nose" (medical reform experts also known as leverage / axis), follow the behavioral economics of the internal law, hospital doctors profit-seeking model occurred 180 degrees turn, and then profoundly changed the medical resources organization and management model, the real implementation from "disease-centered" to "health-centered."
, the reform of medical service prices is a "card neck" problem.
reform only starts from the space, the key is the supply-side structural reform, we must rely on the reform dividend increment to promote the stock reform.
Ryan City will "cure medicine" initiative to the medical community, take the "to use the link to take room" of the price reform of medical services projects, explore the "indirect medicine linkage" of the effective path, and procurement link reform to form an echo, and in 2019 in provincial hospitals and Hangzhou City to promote the application.
Ryan solved the problem of "three-doctor linkage, medicine first" replication and drug interests, and the comprehensive reform of health care has a policy overlay effect, resulting in much more than the current volume of procurement can cover the space.
, ryan has been running successfully for more than 10 years, replicating the "Huai'an model" of more than 50 provinces and cities.
, public health care services are also a kind of social insurance services, medical reform should follow the in-house law of insurance China is taking the road of social insurance, medical services are in fact medical insurance institutions on behalf of the insured (patients) to buy services.
the new medical reform, the biggest short board is that the service purchase model has not really been established, the strategic purchase has failed, the value of medical care has not landed.
from the principle of insurance, the core is the law of large numbers, the cost of medical treatment.
this requires that health care reform must have a certain population size and lay the foundation for help.
the purchase mechanism to promote the effective allocation (matching) of medical and patient resources, to provide high-quality medical security services for policyholders.
Ever, in the design of supporting mechanism, we must embody the responsibility of graded diagnosis and treatment and the self-health of the insured, establish a scientific medical order (process), guide the doctor by the primary professional general practitioner, and never let the patient blindly and freely seek medical treatment.
always said.