Grading diagnosis and treatment into the "first priority" of medical reform

Source: economic reference report: on September 12, 2016, the major hospitals were in "wartime state" Medical staff kept high workload for a long time At the same time, grass-roots medical institutions were sparrow The reporter of economic reference learned that in order to reverse this pattern, hierarchical diagnosis and treatment has been established as the top priority of this round of medical reform In recent days, the health and Family Planning Commission has intensively promoted the experience of multi-level diagnosis and treatment in many places, and various places have launched a series of measures to limit the excessive expansion of large hospitals and improve the capacity of basic health services, which will be further promoted Experience: the health and Family Planning Commission intensively promoted the hierarchical diagnosis and treatment of typical health and Family Planning Commission recently held a press conference to introduce the experience of medical reform in many places The content of the conference shows that hierarchical diagnosis and treatment has become the top priority of this round of medical reform, and a number of typical and bright spots have emerged in practice "Internet + medical treatment" is a hot word in the current pharmaceutical industry Sichuan Province, with the help of the Internet, launched a plan of "building a platform, setting up two centers, and building three systems" Remote diagnosis and treatment, chronic disease management, have become the entry point of Internet combined with hierarchical diagnosis and treatment According to the person in charge of the health and Family Planning Commission of Sichuan Province, "one platform" is to take the lead in building the "healthy Sichuan" convenient service cloud platform, access 350 hospitals, import 70 million health files and 40 million new rural cooperative medical records, and provide more than 900000 sources each month "Two centers" are two provincial internet medical centers, namely, Sichuan internet medical management and guidance center, West China Hospital of Sichuan University and provincial people's hospital The "three systems" are to establish the filing system, CA certification system and patient real name appointment and medical record keeping system Since September last year, there have been 4.953 million online registration appointments, 1.796 million online payments, 3.347 million inquiries of inspection results, 827000 remote consultation, imaging and ECG diagnosis, and 132000 chronic disease management services If the Internet can integrate the medical needs of a city and a province into a platform, the medical association is an important way for hospitals to implement hierarchical diagnosis and treatment Yan'an City in Shaanxi Province and Muzhong County in Henan Province are typical examples of this Yan'an medical group was established with the Affiliated Hospital of Yan'an University as the general hospital and the public hospitals of the city and county as the branch hospitals Compared with 2014, the number of outpatient, discharge and operation cases in the general hospital decreased by 12.9%, 6.52% and 10.3% respectively in 2015 In the first quarter of 2016, the number of outpatients decreased by 9.8% over the same period of last year Three county-level public hospitals in Muzhong county and 13 township level medical institutions respectively established Counterpart Assistance and collaborative development cooperation, jointly built collaborative ward, established two-way referral green channel, and provided efficient and quick referral services for patients Nearly 13000 patients were transferred from township level medical institutions to county-level medical institutions, and 3150 patients were transferred from county-level medical institutions In addition, in the third quarter of this year, the health and Family Planning Commission has investigated in many places and selected a number of pilot cases of hierarchical diagnosis and treatment in Xiamen City, Fujian Province, Huai'an City, Jiangsu Province, etc Core classification diagnosis and treatment has been established as the "first priority" classification diagnosis and treatment generally refers to the classification according to the light, heavy, slow, urgent and treatment difficulty, different levels of medical institutions undertake different treatment of diseases In order to improve the allocation efficiency of high-quality and scarce medical resources, the mode of "first diagnosis at the grassroots level, two-way referral, acute and slow treatment, upper and lower linkage" is adopted to separate the diagnosis and treatment of some common and chronic diseases in the grassroots hospitals It is understood that hierarchical diagnosis and treatment has been identified as the first and most important task of this round of medical reform in fact According to the working idea of medical reform determined at the recent national health and health conference, five systems should be established in the medical reform, the first is the hierarchical diagnosis and treatment system, the second is the modern medical management system, the third is the national medical insurance system, the fourth is the drug supply security system, and the fifth is the comprehensive supervision system 2017 will be a key time node for the promotion of hierarchical diagnosis and treatment According to the guidance of the general office of the State Council on promoting the construction of hierarchical diagnosis and treatment system, in 2017, the hierarchical diagnosis and treatment policy system was gradually improved, the division of labor and cooperation mechanism of medical and health institutions was basically formed, and the high-quality medical resources were orderly and effectively sinking, which is reflected in the core task requirement that the standard rate of the construction of primary medical and health institutions should be ≥ 95% The proportion of diagnosis and treatment amount of primary medical and health institutions in the total diagnosis and treatment amount is ≥ 65% By 2020, the service capacity of hierarchical diagnosis and treatment will be improved in an all-round way, the security mechanism will be gradually improved, the medical service system with reasonable layout, appropriate scale, hierarchical optimization, clear responsibilities, perfect functions and high efficiency will be basically constructed, and the hierarchical diagnosis and treatment mode of primary diagnosis at the grass-roots level, two-way referral, rapid and slow treatment, and upper and lower linkage will be gradually formed, and the hierarchical diagnosis and treatment system in line with the national conditions will be basically established The reporter of economic reference learned that for a long time, many large hospitals in China have been expanding rapidly, and the siphon effect on medical resources has become increasingly obvious There are still many problems to be solved in how to strengthen the grass-roots level, reduce the excessive expansion of large hospitals, and guide high-quality medical talents and patients to return to the grass-roots level According to the report on the development of China's medical and health services 2015 - Special Topic on the reform and development of China's public hospitals compiled by Fang pengqian, a professor of Huazhong University of science and technology, since the new medical reform, although the number of primary diagnosis and treatment has been the majority, the growth rate of large hospitals has been faster In 2014, the service proportion of primary medical institutions decreased from 59.1% to 57.4%, while that of large hospitals increased from 37.5% to 39.1% In terms of inpatient services, the gap between large hospitals and basic medical institutions is still widening By 2014, the number of inpatients in large hospitals was nearly four times that of primary medical institutions There is a consensus on the plan of "strengthening the grassroots level" According to medical reform experts, the hierarchical diagnosis and treatment system still faces many difficulties in the process of promotion The most fundamental problem is that the technical level of grassroots medical institutions is relatively weak, the patients are not trusted enough, which affects the implementation of hierarchical diagnosis and treatment "The weak capacity of the basic level is still a big short board, and the next step will be to make up for it more vigorously." Wang Yonghong, director of Jiangsu health and Family Planning Commission, said that while further strengthening the construction of grass-roots institutions, the next step will be to deepen and improve the reform of the operation mechanism of grass-roots institutions, improve service capacity, and fully mobilize the enthusiasm of grass-roots institutions and personnel In the hierarchical diagnosis and treatment system, the reform of urban integration and county rural integration will be carried out in an all-round way, so that all primary medical and health institutions can join the Medical Association as soon as possible, and a two-way referral green channel will be established To achieve the goal of "strengthening the grassroots", grassroots must have doctors recognized by patients Liang Wannian, director of the Department of health and family planning reform, said that this year, we will focus on the construction of medical consortia and the signing of family doctors' contracts, and implement hierarchical diagnosis and treatment First, the construction of medical consortia, to strengthen the grass-roots level, so that people can rest assured, the quality resources of large hospitals really sink to the grass-roots level The second is to sign a family doctor contract "The first diagnosis at the grass-roots level is to carry out continuous and responsible management of health responsibility, which must be established." He said In this field, Internet medicine can play a huge role Industry insiders suggested that relevant policies should be introduced as soon as possible to support Internet hospitals to link the primary medical structure and encourage private forces to enter the primary medical field At the same time, the Internet hospital remote diagnosis and treatment fee is included in the medical insurance, and online medical insurance payment is realized, which provides favorable conditions for the popularization of Internet hospitals Zhu hengpeng, director of the public policy research center of the Academy of Social Sciences, told the economic reference newspaper that 60-70% of outpatients in large hospitals do not need to visit large hospitals Some people can solve the problem through Internet consultation or consultation, which can reduce some patients who blindly visit the top three hospitals In addition, more than 60% of the patients went to the third tier a hospital for further consultation, and a considerable part of them could be intercepted through the Internet This not only saves people's costs, but also saves doctors a lot of costs, so that they have more time to serve patients who need them In addition, according to the current thinking of medical reform, the excessive expansion of the scale of public hospitals will be strictly controlled, so that the public hospitals will return to the standard, that is, to do a good job in the diagnosis and treatment of difficult and miscellaneous diseases, and to undertake the functions of Medical Center and talent training center At the same time, we should speed up the price adjustment of medical services, make room for the price adjustment of medical services based on the "cage for birds" after the cancellation of drug addition, and try our best to make up for the "diversion" loss of large hospitals with the income