Each of the 26 major events in primary care in 2021 is related to you

In an instant, in the busy schedule, another year is about to turn over
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This year, people at the grassroots level are undoubtedly busy with epidemic prevention and control and vaccination more often
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Many people, in addition to burying their heads and struggling with physical and mental exhaustion, may rarely have the time to look up to see the road, and rarely pay attention to the future, because it is often more extravagant to talk about the future
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But everyone does not know, in fact, our future and destiny may be inadvertently controlled by some important events
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Just as 2021 is about to pass, let us analyze and count the important events of primary medical care this year.

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Full-text catalog overview 1.
Educational background and development 1.
Rural general practice assistant physician qualifications become the lowest entry threshold for village doctors 2.
Primary medical care in rural revitalization is expected to receive a new round of development 3.
"Integrated rural management" will be promoted in an all-round way 4.
Technical secondary school doctors are about to withdraw from the stage of history 2.
Rules and regulations 1.
The Civil Code follows the principle of liability for medical damages 2.
Special treatment actions for unreasonable medical examinations have begun 3.
Hospitalization in bed will be listed as correcting malpractices in medical services in 2021 Key points of the work of the wind 4.
The four-year national medical institution and its staff's clean practice operation started 3.
Treatment income 1.
Preferential treatment of rural medical and health personnel, protected by law 2.
The basic public health subsidy was further increased, and this year was increased to 79 Yuan 3.
The promotion of grass-roots personnel’s professional title ushered in a new policy 4.
Sanming’s experience is expected to rejuvenate the grass-roots level 4.
Future trends 1.
The basic-level health reform will explore comprehensive experimental areas 2.
The construction of a compact medical community should pay attention to the "four preventions" 3.
Guidance on the reform of the salary system in public hospitals has come.
4.
The medical waste classification catalogue (2021 edition) is more scientific, reducing the burden on the grassroots 5.
The grassroots rehabilitation doctors will become popular 6.
The grassroots will do a lot in the elderly medical care services 7.
Community hospital construction again Speed ​​up 8.
Cancel the approval of the establishment of national clinics 9.
Conditional township health centers and community health service centers set up fever clinics 5.
Medical insurance related 1.
"Medical Security Fund Unannounced Inspection Management Measures (Draft for Comment)" began to solicit opinions 2.
Medical insurance The special rectification of fraudulent insurance issues will be extended for another year.
The grassroots level is one of the key points.
3.
Gradually restore the scope of payment for drugs in the medical insurance catalogue to the scope of the instructions.
4.
The medical insurance catalogue will be adjusted and the restriction of primary medicines will be a general trend.
5.
The use of medical security funds The Regulations on Supervision and Administration are formally implemented.
1.
Educational background and development 1.

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In fact, this provision was introduced as early as March 2015 in the implementation opinion of the General Office of the State Council on further strengthening the construction of the rural doctor team (Guobanfa [2015] No.
13).
The implementation opinions put forward: To enable rural doctors to have a technical secondary school education or above as a whole, and gradually have the qualifications of practicing assistant physicians and above
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Today, these places are just putting implementation opinions into practice
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It can be seen that in the future, village doctors should have at least the qualifications of village general practitioner assistant physicians.
From a nationwide perspective, this is a general trend
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2.
Primary medical care in rural revitalization is expected to get a new round of development.
On February 21, 2021, the No.
1 Central Document: "Opinions of the Central Committee of the Communist Party of China and the State Council on Comprehensively Promoting Rural Revitalization and Accelerating Agricultural and Rural Modernization" was issued
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In terms of improving the level of basic public services in rural areas, the opinions proposed to comprehensively promote the construction of healthy villages, improve the standardization of village clinics and health management levels, promote the transformation of rural doctors into practicing (assistant) doctors, and adopt methods such as stationing and rounds to improve the level of primary health services.

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Improve the medical service capabilities of township health centers and select a batch of central health centers
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Strengthen the construction of county-level hospitals, and continue to improve the capacity of county-level disease control institutions to respond to major epidemics and public health emergencies
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Strengthen the construction of close medical community in counties and implement budget management of total medical insurance
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Strengthen health services for key groups such as women and children, the elderly, and the disabled
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Subsequently, the State Council issued the "Opinions on Accelerating the Rejuvenation of Rural Talents", which proposed that "the total staffing of township health centers should be dynamically adjusted every 5 years based on the proportion of the service population of about 1‰, and the staffing should be coordinated within the county.
Use, make good use of the spare preparations
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" 3.
"Integrated rural management" will be fully promoted.
On March 2, the 2021 National Primary Health Work Conference will be held in Beijing
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The work priorities determined by the meeting are: deepen the promotion of the compact county-level medical community; comprehensively promote the "integrated rural management" work; standardize the village doctor team and strict access to the practice of rural doctors; continue to promote the "high-quality service grassroots practice" activities; and continue to expand The grassroots is suitable for health talents to improve the quality of talents; strive to improve the quality of family doctors signing and public health services
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4.
Technical secondary school doctors are about to withdraw from the stage of history On August 20, the full text of the "Physician Law of the People's Republic of China" was officially released, and technical secondary school education will no longer be used as the basis for physician qualification examinations
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The "Physician Law" stipulates that the physician qualification examination is divided into the qualification examination for practicing physicians and the qualification examination for assistant practicing physicians
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It also clarifies the qualifications for the doctor’s examination, and the junior college is the lowest threshold for applying for the examination
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2.
Rules and Regulations 1.
The "Civil Code" follows the principle of liability for medical damages.
On January 1, 2021, the "Civil Code" was formally implemented.
This is the first legislation implemented in the form of a "code" in China
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The law follows the principle of liability for medical infringement damages and faults set by the Tort Liability Law, which stipulates that “if a patient suffers damage during diagnosis and treatment activities, and the medical institution or its medical staff is at fault, the medical institution shall bear the liability for compensation
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” The fault here does not only refer to errors in diagnosis and treatment, but also includes eight major acts such as improper explanations, incomplete medical records, refusal to provide medical records, leaks of privacy and information, and defects in medicines and disinfection products
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2.
The special control action for irrational medical examinations began.
On April 6, the General Office of the National Health Commission and other six departments jointly issued the "Notice on Carrying out Special Control Actions for Irrational Medical Examinations" for all medical institutions for a one-year period.
Inspection action
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It is reported that the action was carried out in accordance with the "Guiding Opinions on Further Regulating Medical Behaviors and Promoting Reasonable Medical Inspections" which has been reviewed and approved at the 15th meeting of the Central Comprehensive Deepening Reform Committee and approved by the State Council
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The key content includes five items: (1) Controlling violations of laws and regulations and conducting medical inspections
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(2) Govern unreasonable inspections such as unfounded inspections and repeated inspections
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(3) Control the conduct of inspections that violate the principle of informed consent
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(4) Governance may induce excessive inspection indicators and performance distribution methods
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(5) Controlling the disposition of large-scale medical equipment in violation of the plan
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For the grassroots, every item should be paid attention to
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For example, hiring non-health professional and technical personnel to carry out medical inspections, conducting unfounded inspections, and unnecessary repeated inspections.
For special inspections, it is necessary to obtain written consent from patients or family members, setting business income indicators and directly linking them to the income of medical staff
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3.
Hanging bed hospitalization will be listed as the key points for correcting malpractices in medical services in 2021.
On April 25, the National Health Commission issued the "Notice on Printing and Distributing the Key Points for Correcting Malpractices in the Field of Medicine Purchase and Sale and Medical Services in 2021 "
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These 8 behaviors are the focus of the crackdown: ①Fraud and insurance fraud behaviors such as bed hanging in hospital, repeated prescription of drugs; ②Counterfeiting, false propaganda, commercial bribery, and publishing of illegal medical advertisements; ③Receiving "red envelopes", curing minor illnesses, and repetitions Checking, bundling sales of medicines and consumables, and recommending common foods to patients as special medical foods; ④Receiving rebates; ⑤Accepting financials from profitable enterprises, accepting entertainment, etc.
; ⑥False invoices, tax evasion, etc.
; ⑦Use vaccination as an excuse Illegal practice of medicine; ⑧The price of false standard nucleic acid testing may exceed the standard charge
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For the grassroots, special attention should be paid to "hospitalization in hanging beds
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" 4.
The 4-year National Action for the Clean Practice of Medical Institutions and Their Staff Started On August 6, the National Health Commission issued a notice on the Action Plan for the Clean Practice of National Medical Institutions and Their Staff (2021-2024)
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Subsequently, the nine standards for the clean practice of the staff of medical institutions were issued, which is also an upgraded version of the “Nine Prohibitions” in 2013
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It is worth noting that the staff in medical institutions subject to the nine standards include, but are not limited to, health professionals, management personnel, logistics personnel, and other social practitioners who provide services in medical institutions and receive management of medical institutions
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3.
Treatment income 1.
Preferential treatment for rural medical and health professionals, protected by law On June 1, the "Law of the People's Republic of China on the Promotion of Rural Revitalization" was formally implemented
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The law requires that people's governments at all levels should take measures to strengthen the construction of rural medical and health teams, support county and rural medical and health personnel to participate in training and further education, establish a career development mechanism across counties and villages, and implement preferential treatment for medical and health personnel working in rural areas.
Encourage medical college graduates to work in rural areas, support physicians to practice in rural medical and health institutions, open rural clinics, popularize medical and health knowledge, and improve rural medical and health service capabilities
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2.
The basic public health subsidy has been increased again this year to 79 yuan this year.
On July 12, the National Health Commission issued the "Notice on Doing a Good Job in Basic Public Health Service Projects in 2021", proposing the per capita expenditure for basic public health services in 2021 The subsidy standard is 79 yuan, and it is clear that an additional 5 yuan will be used in 2021 for basic public health services and epidemic prevention and control work of primary medical and health institutions
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The "Notice" emphasizes that, in principle, the township health center shall allocate the corresponding funds in advance according to 70% of the tasks undertaken by the village clinics within one month of receiving the subsidy funds for basic public health services, and according to the completion of the tasks, monthly or quarterly Appropriate the corresponding funds in time after the performance evaluation, and prohibit embezzlement and misappropriation
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In fact, this is an increase of 5 yuan per year for 8 consecutive years on the basis of 30 yuan in 2013.
Yuan)
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3.
New policy for the promotion of professional titles for grassroots personnel On August 4, the Ministry of Human Resources and Social Security and the National Health Commission issued guidance on deepening the reform of the professional title system for health professionals
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The guidance is to improve the basic evaluation standards, improve the evaluation methods, implement the basic service system, and encourage the flow of talents to difficult and remote areas and the grassroots.

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The guidance further relaxes other conditions for the evaluation of professional titles of grassroots personnel.
In addition to foreign language performance, the thesis and scientific research of grassroots health professional and technical personnel are not required, and the evaluation of the ability and level of grassroots medical services is focused
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Physicians and nurses working in township health centers and community health service institutions can take the intermediate-level health professional and technical qualification examination for the corresponding specialty one year in advance
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4.
Sanming experience is expected to rejuvenate the grassroots On November 22, the notice of the General Office of the National Health Commission on the promotion of Sanming’s experience in hierarchical diagnosis and treatment and the construction of medical consortia (Guoweiban Yihan [2021] No.
547) was issued
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The notice calls for the promotion of the construction of a close medical consortium, the implementation of a highly unified management of counties, villages, people, and property, realizing the sharing of medical resources and information, and forming a close medical consortium as a carrier of management, responsibilities, services, and interests
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The medical union shall coordinate the distribution of remuneration, establish a remuneration system that meets the characteristics of the medical and health industry and the development requirements of the medical union, reasonably determine and dynamically adjust the salary level of medical staff, and fully mobilize the enthusiasm of medical staff
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Implement the "two permits" requirements, reasonably determine the salary level and total performance wages of public hospitals at all levels in the medical association, reasonably determine the proportion of personnel expenditures in public hospitals' business expenditures, optimize the salary structure, and reflect the value of medical personnel's technical labor services
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This kind of real reform centered on salary reform is expected to change the practice of chanting slogans for many years, and truly achieve the goal of strengthening the grassroots
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IV.
Future Trends 1.
Primary-level health reform will explore comprehensive experimental areas.
On August 20, the notice of the General Office of the National Health Commission on the construction of primary-level health comprehensive experimental areas (Basic Level Letter [2021] No.
443 of the National Health Office) was issued
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The notice pointed out that in order to promote the high-quality development of primary health work, Jiexiu City, Jinzhong City, Shanxi Province, Haiyan County, Jiaxing City, Zhejiang Province, Suixi County, Huaibei City, Anhui Province, Changting County, Longyan City, Fujian Province, and Shouguang City, Weifang City, Shandong Province were selected and determined 8 counties and cities including Pingdingshan City, Henan Province, Lu County, Luzhou City, Sichuan Province, and Xinyuan County, Yili Kazak Autonomous Prefecture, Xinjiang Uygur Autonomous Region, are the primary health comprehensive test areas.

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2.
The construction of a compact medical community should pay attention to the "four preventions".
On April 8, the National Health Commission issued a notice on strengthening the monitoring of the construction of a compact county medical and health community
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The notice proposes to pay attention to the "four preventions", that is, to prevent county hospitals from "siphoning" primary health resources, prevent unreasonable increases in medical costs, prevent the reduction of suitable technology and cheap projects, and prevent only strengthening medical treatment while weakening prevention and public health services Tendency
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3.
The Guiding Opinions on the Reform of the Salary System in Public Hospitals Came On August 27, the "Guiding Opinions on Deepening the Reform of the Salary System in Public Hospitals" was announced
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The guidance requires the implementation of the requirements of “allowing medical and health institutions to break through the current wage control level of public institutions, allowing medical service income to deduct costs and withdrawing various funds in accordance with regulations to be mainly used for personnel rewards” (referred to as “two permits”), and implement to increase Knowledge value-oriented distribution policy, establish a public hospital salary system adapted to the characteristics of China's medical industry, and overall consider the income distribution relationship between public hospitals, public health institutions, and primary medical and health institutions
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It is required to reasonably determine the salary level of public hospitals and fully implement the autonomy of internal distribution of public hospitals
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4.
Medical waste classification catalogue (2021 version) is more scientific, reducing the burden for the grassroots level.
On December 1, the National Health Commission issued a notice (Guowei Medical Letter [2021] No.
238) of the medical waste classification catalogue (2021 version), and abolished at the same time 2003 "Medical Waste Classification Catalog"
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This is the first revision of the medical waste classification catalog in eighteen years
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The new version of the catalog stipulates that infusion bottles (bags) used in non-communicable disease areas or not used for infectious disease patients, suspected infectious disease patients and other patients who have taken quarantine measures, empty containers for disinfectants and dialysate, and disposable medical outer packaging Disposable sanitary products such as waste Chinese herbal medicines and decocted Chinese herbal medicines, medicine cups containing medicines, urine cups, paper towels, wet wipes, diapers, sanitary napkins, nursing pads, etc.
, medical fabrics and large, Urinals, etc.
are not classified as medical waste
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Disposable masks discarded in residents’ daily lives are not medical waste
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This more scientific understanding of "medical waste" will undoubtedly greatly reduce the pressure on medical institutions to deal with medical waste
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5.
Primary-level rehabilitation doctors will become popular.
On June 8, the National Health Commission issued the "Notice on Issuing Opinions on Accelerating the Development of Rehabilitation Medical Work
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" The notice believes that accelerating the development of rehabilitation medical work is of great significance to the implementation of the national strategy to actively respond to the aging of the population
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The notice requires that by 2025, there will be 8 rehabilitation physicians and 12 rehabilitation therapists for every 100,000 population
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Improve the rehabilitation medical service system and increase the number of medical institutions and beds that provide rehabilitation medical services
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Promote the transformation of some primary and secondary hospitals in areas rich in medical resources into rehabilitation hospitals
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Support and guide social forces to establish large-scale and chain rehabilitation medical centers, and increase the number of medical institutions that provide rehabilitation medical services within their jurisdiction
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Encourage qualified primary medical institutions to set up and increase beds for rehabilitation medical services as needed
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It is necessary to strengthen the training of the contracted team of general practitioners and family doctors to improve their rehabilitation medical service capabilities
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Actively develop community and home rehabilitation medicine
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Support grassroots medical institutions to enrich and innovate rehabilitation medical service models, and give priority to providing home rehabilitation medical treatment, day rehabilitation training, rehabilitation guidance and other services for people with urgent rehabilitation medical service needs such as disabled or elderly people, patients with chronic diseases, severely disabled people, etc.

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In terms of income, the assessment results are clearly linked to the employment of rehabilitation medical professionals, title promotion, performance distribution, rewards and awards, etc.
, so as to achieve more work, excellent performance and rewards, and mobilize their enthusiasm
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6.
The grass-roots level of medical and nursing services for the elderly will make great achievements.
On November 22, the notice of the General Office of the National Health Commission on the pilot work of medical and nursing services for the elderly (Guoweiban Yihan [2021] No.
560) was issued
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The notice decided to launch pilot medical care services for the elderly in 11 provinces (cities, autonomous regions) including Beijing, Tianjin, and Shanxi to actively respond to the aging of the population
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The notice proposes that after one year of piloting, it will explore the formation of local experiences and typical practices that can be replicated and promoted
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By 2023, the pilot experience will be extended to the whole country
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The notice requires pilot areas to guide the transformation of some primary and secondary hospitals in the region based on the aging of the population and the actual needs of medical care services for the elderly, combined with the "14th Five-Year Plan" medical and health service system planning and the planning requirements for the establishment of medical institutions To increase the number of nursing homes (stations) and nursing centers by establishing large-scale and chained nursing stations and nursing centers for nursing homes or supporting social forces
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Encourage qualified primary medical institutions to set up and increase beds to provide elderly medical care services according to their needs
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This also indicates that primary medical and health institutions will become the main force in elderly medical care services in the future
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7.
The construction of community hospitals is accelerated again.
On June 10, the Department of Primary Health and Health of the National Health Commission issued a notice on accelerating the construction of community hospitals (Basic Letter [2021] No.
317 of the National Health Office)
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The notice pointed out that the construction of community hospitals has been piloted in 2019 and has been fully implemented nationwide in 2020, and positive progress and results have been achieved
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The notice requires that it be planned to build another 500 community hospitals before the end of the year, pay attention to process management, time obey quality, mature one by one, and consolidate one
.
8.
Cancellation of approval for the establishment of clinics nationwide From July 1, the "Notice on Deepening the Reform of "Separation of Licenses and Licenses" to Further Stimulate the Development of Market Entities" issued by the State Council has been formally implemented
.
In the future, the establishment of clinics will no longer be approved, but will be changed to practice filing; the practice of clinics will be changed from licensing management to filing management
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In fact, it is not new for clinics to change the examination and approval system into a filing system.
The key lies in implementation
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9.
Qualified township health centers and community health service centers set up fever clinics On December 7, 2020, the comprehensive group of the joint prevention and control mechanism issued the notice of Zongfa [2020] No.
267 on strengthening the establishment of fever clinics in primary medical and health institutions
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The notice requires the establishment of fever clinics in qualified township health centers and community health service centers based on the principles of "complete design, reasonable layout, qualified conditions, and standard work", combined with the prevention and control of infectious diseases and the actual medical needs of the people
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All primary-level medical and health institutions should strictly implement pre-inspection and triage and realize the function of “sentinel” to improve the ability of primary-level medical and health institutions to detect and warn patients of infectious diseases
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Although this policy was promulgated in 2020, it will definitely put forward new requirements for the planning and construction of primary medical institutions in the future
.
V.
Medical insurance related 1.
The adjustment of the medical insurance catalog will lead to a major trend in the restriction of primary medicines.
On March 1, the new medical insurance catalog was officially implemented.
In the new medical insurance catalog, a batch of medicines in primary medical institutions will be unavailable or restricted
.
Including 50 kinds of traditional Chinese medicine injections, 92 kinds of oral Chinese patent medicines with limited use, and 36 kinds of Chinese medicine decoction pieces are not reimbursed by medical insurance
.
It is worth noting that this change in the medical insurance catalog is not "temporary", but is based on the "Interim Measures for the Administration of Basic Medical Insurance Medications" promulgated by the National Medical Insurance Bureau on July 30, 2020
.
The Interim Measures stipulate that in order to maintain the safety of clinical drug use and improve the efficiency of the use of the basic medical insurance fund, the "Drug List" restricts the medical insurance payment conditions for some drugs
.
2.
"Regulations on the Supervision and Administration of the Use of Medical Security Funds" officially came into effect on May 1, the first administrative regulation in the field of medical security-the "Regulations on the Supervision and Administration of the Use of Medical Security Funds" was officially implemented, and it has miles on the road to the legalization of medical insurance.
The meaning of the cards
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The regulations stipulate that designated medical institutions and their staff shall implement real-name medical treatment and drug purchase management regulations, verify the medical security certificates of the insured persons, provide reasonable and necessary medical services in accordance with the diagnosis and treatment specifications, and truthfully issue expense receipts and related materials to the insured persons , Do not disassemble hospitalization, hang bed hospitalization, do not violate the diagnosis and treatment norms, excessive diagnosis and treatment, excessive examination, disintegration of prescriptions, over-prescription, repeated prescriptions, repeated charges, over-standard charges, disaggregated item charges, and no cross-exchange of medicines, medical consumables, Diagnosis and treatment items and service facilities, shall not induce or assist others to seek medical treatment or purchase drugs under false names or false names
.
3.
"Measures for the Management of Unannounced Inspections of the Medical Security Fund (Draft for Comment)" began to solicit opinions On December 1, the National Medical Insurance Administration issued the "Measures for the Management of Unannounced Inspections of the Medical Security Fund (Draft for Comment)"
.
After the establishment of the National Medical Insurance Administration in March 2018, in order to effectively solve the problem of irregular use of medical insurance funds, the National Medical Insurance Administration increased its efforts to combat fraudulent insurance in accordance with the deployment of the central government, including unannounced inspections and daily inspections, special inspections, key inspections, and expert reviews.
Together, it was established and improved as a multi-form medical insurance fund inspection system
.
However, there are also some problems during the flight inspection
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One is the excessive and excessive number of flying inspections, the second is the lack of professionalism of the flying inspection personnel, and the third is the suspicion of "finding faults"
.
As a result, there are often situations in which "as long as there is an unannounced inspection, there will be problems", which also makes medical institutions "at a loss
.
" Therefore, there is a high demand for the introduction of regulations for unannounced medical insurance inspections and the regulation of unannounced inspections by medical insurance funds
.
4.
The special rectification work on the problem of medical insurance fraud will be extended for another year.
The grassroots is one of the key points.
On December 8, the National Medical Insurance Bureau notified the relevant situation of the special rectification action against fraudulent insurance in the form of a media briefing
.
The meeting clarified that the end of the special rectification action on medical insurance fraud problems will be extended from the end of December 2021 to the end of December 2022, further focusing on key areas of medical insurance supervision, and continuously improving the breadth and depth of the special rectification action
.
On the same day, the National Medical Insurance Administration's official website also announced the "Notice of the Ministry of Public Security of the National Medical Insurance Administration on Strengthening the Investigation and Punishment of Cases of Fraudulently Obtaining Medical Insurance Funds", which confirmed the transfer of cases of fraudulently obtained medical insurance funds.

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In the next step, the National Medical Insurance Administration will further strengthen the supervision of medical insurance funds, focusing on designated medical institutions at the grassroots level, medical institutions set up in integrated medical and elderly care institutions, tampering with tumor patient genetic test results, hemodialysis fraudulent medical insurance fund behavior, medical insurance card illegal cash payment, etc.
In key areas, we will carry out in-depth special rectification work to combat fraud and insurance, strengthen departmental collaboration and data sharing, improve the working mechanism of execution and punishment, strengthen warning and deterrence, and continue to build a "dare to cheat, can't cheat, and don't want to cheat" with a zero tolerance attitude.
We will crack down on the high-pressure situation of medical insurance fraud and insurance, and earnestly safeguard the safety of medical insurance funds
.
5.
Gradually restore the scope of payment for drugs in the medical insurance catalog to the scope of the instructions.
For a long time, the scope of payment for drugs in the medical insurance catalog is not consistent with the scope of treatments in the instructions
.
The limitation of the scope of medical insurance drug payment has gradually become an important factor that affects clinical rational use of drugs and even triggers medical disputes
.
According to the latest news from the National Medical Insurance Administration, the payment scope of the 94 drugs successfully negotiated in the adjustment of the medical insurance catalogue in 2021 are all consistent with the instructions
.
At the same time, it was decided to launch a pilot medical insurance payment standard for other drugs that were originally paid in the catalog
.
In the next step, the National Medical Insurance Administration will gradually restore the scope of payment for more drugs in the catalog to the scope of the drug inserts in accordance with the principle of reducing the increase and digesting the stock based on the progress of the pilot program and ensuring the safety of the fund and the fairness of the patient's drug use
.
Obviously, this is good news
.