From "anti-corruption" to "health" where exactly is Sanming's medical reform?

What is the power of Sanming medical reform? Sanming City, which is located in the mountainous area of central and Western Fujian Province, was originally a little-known Town, but because of a series of medical reform policies implemented in recent years, it has become a real "star of medical reform" On November 15, 2019, the notice of the leading group of the State Council on deepening the reform of the medical and health system on further promoting the experience of deepening the reform of the medical and health system in Fujian Province and Sanming City was released to the public, and the words "Sanming medical reform" were recorded in the document of the state bank The new policy has attracted the attention of practitioners in the field of health care Sanming has received many visits from relevant leaders of the national health and Health Commission, the National Health Insurance Bureau and the Central Committee's deep restructuring, as well as the key introduction of CCTV news broadcast What is the power of medical reform here? Recently, the health sector followed the national health and health commission into Sanming, trying to find the answer to the future "great health" pattern through its trilogy of reform Before the "drug reform", Sanming City, which had faced the risk of health insurance fund penetration, should be treated first In fact, Sanming City targeted at the drug field as early as 2013 and entered the reform stage with anti-corruption as the center In this year, first of all, at the end of drug use, Sanming City cancelled drug mark up in an all-round way, implemented zero margin sales of drugs in hospitals at or above the county level, broke the mechanism of supporting doctors with drugs, curbed the false high price of drugs, reduced drug waste, and promoted rational use of drugs In fact, as early as 2009, Fujian Province, as a pilot province of comprehensive medical reform, was the first to implement the "two vote system" in China In June 2013, Sanming required to strictly implement the "two ticket system" for drugs, and the goods tickets were the same, so as to prevent the inflow of fake and substandard drugs At this stage, Sanming alliance pharmaceutical and machinery joint limited price sunshine procurement platform was officially launched, including four general (general name, general specification, general dosage form, general packaging) procurement directory, maximum sales price limit and medical insurance payment settlement price The front page of the platform presents a map, which radiates from Sanming in a straight line, and becomes an alliance partner with 24 cities and 4 counties in 15 provinces, including Xinjiang, Yunnan, Hebei and Guangdong According to Xu zhiluan, director of Sanming Medical Security Bureau, on the trans provincial "drug exchange" set up by the government, the members of the alliance can share the directory and information, and the alliance city can consult the drug directory prices of Fujian Province and other areas on the platform, so as to realize the price sharing of medical resources The main achievements are to solve the problem of triangle debts of medical insurance, hospitals and pharmaceutical enterprises, reduce the false high drug price, stop waste, cut off the way for doctors to get kickbacks In June 2013, Sanming medical insurance fund management center (hereinafter referred to as the center) was established It took the lead in completing the integration of 24 medical insurance fund agencies affiliated to the human resources and social security department and the original health and family planning department in the whole province, taking the lead in opening the situation of "Three Guarantees in one", marking the beginning of the stage of taking treatment as the center Xu zhiluan said that on the basis of the past collection and payment of medical insurance funds, the connection of basic medical insurance and supplementary medical insurance, the center added the purchase settlement of drug price limit, the adjustment of medical service price, the audit and settlement of designated medical insurance institutions for urban and rural residents and urban employees, and the supervision, audit and management of medical behaviors of designated medical institutions Sanming has solved the problem of unclear medical insurance management with the way of "establishing another mountain", and obtained the right of purchase option and quality supervision on the basis of fund receipt and payment, including medicine, medical service and supplementary insurance, on the new "mountain" This is a concentration of power aimed at straightening out the management system and breaking the situation of multi management From February 2013 to August 2016, Sanming changed the pattern of multi department "Jiulong water treatment" of medical treatment, medicine and medical insurance with high-intensity functional centralized management, broke the rules and regulations of public hospitals to supplement medical treatment with medicine, medical personnel according to the personnel management of public institutions, straightened out the government management system, completely cancelled the drug (consumables) markup, implemented the joint price limit purchase of pharmaceutical consumables and other measures, and established "Four beams and eight pillars" in the reform of three medical linkage, two vote system, annual salary system and three guarantees in one At the same time, the health insurance regulatory platform has been launched one after another, which has become a powerful means to combat insurance fraud Over one year after the establishment of the center, the personal out of pocket expenses of Sanming Urban and rural residents decreased from 2194 yuan in 2011 before the reform to 1757 yuan in 2015; the medical income of 22 hospitals above the county level increased from 680 million yuan in 2011, accounting for 39% of the total income, to 1.53 billion yuan in 2015, accounting for 65% of the total income; the medical insurance fund changed from 208 million yuan in 2011 to 129968000 yuan in 2015 What is the difference between "treatment" and "health"? From September 2016 to now, Sanming's medical reform focuses on the prevention of disease, with the theme of "value medicine, value medicine and value medical insurance" as the main melody and the era of health as the center coming Sanming integrated all the public medical institutions in its County, set up 10 county-level general hospitals and 2 urban close medical consortiums, broke the financial, administrative, personnel and other barriers, implemented the centralized and unified management of people and property, took the establishment of the general hospital as the carrier and the implementation of the reform of medical insurance payment mode as the starting point, promoted the reform of health management, established health management and protection organizations, and promoted the "treatment of diseases" orientation The transformation of "prevention and treatment" should be carried out to build a national health service system with four levels of CO insurance, prevention first and prevention combined After three stages of efforts, the achievements of Sanming medical reform are obvious to all At a press conference held by the national health and Health Commission on December 6 this year, Zhang Yuanming, vice mayor of Sanming Municipal People ' From 112000 yuan to 324300 yuan in 2018, the annual average wage of medical staff increased from 42200 yuan to 113400 yuan in 2018; the fund is sustainable, reducing waste on the premise of ensuring the basic medical needs of the masses, and preventing income from not offsetting expenditure; in the case of the support ratio decreasing year by year, the urban employees' medical insurance fund turned to profit, and kept a slight balance for seven consecutive years Zhu Hongbiao, a first-class inspector of the Department of physical reform of the National Health Commission, also summed up at the conference that the core experience of medical reform in Fujian Province and Sanming City has six aspects: to establish an efficient and powerful leadership system and organization promotion mechanism of medical reform; to deepen the reform of medical treatment, medical insurance and medicine; to innovate the incentive mechanism of salary distribution; to strengthen the supervision and management of medical institutions; to reform and improve the management of medical insurance funds The combination of up and down promotes the sinking of high-quality medical resources "Drug reform" was the first step in the medical reform, Sanming obviously took the lead, but in this process, some people doubted that the reform measures of "doctors' free practice" did not play a role, and therefore, Sanming's future "health" pattern is expected.