Interview | What should we focus on in the next decade of new health care reform?

In 2009, the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical and Health System were issued, marking the official entry of China into a new era of medical reform.
A new round of medical reform to "establish a basic medical and health service system, comprehensively strengthen the construction of public health service system, further improve the medical service system, speed up the construction of medical security system, the establishment of a basic medical security system covering urban and rural residents" as the main core construction content, the program also stressed the construction of eight mechanisms, referred to as "one goal, four pillars and eight pillars."
the "last three beams" in the "four beams" also in the process of medical reform, evolved into today's familiar, and in the overall medical reform has played a huge value of the "three medical linkage."
images come from the Internet Now a decade has passed, and the goal of "basically establishing a basic health care system covering urban and rural residents by 2020" mentioned in the document has been achieved.
And with the 13th Five-Year Plan drawing a successful conclusion, deepening medical reform will enter a new stage of development during the 14th Five-Year Plan period, and the "Recommendations of the CPC Central Committee on the Formulation of the 14th Five-Year Plan for National Economic and Social Development and the Vision for 2035" have also defined the objectives of medical reform based on the strategic framework of "Healthy China".
, however, as a worldwide conundrum, every step of the way involves the adjustment of interests in all its aspects, and its intricacies are by no means summed up in a few words of the goal.
are the "hard bones" in the world? How should the road of the future go? What new enlightenment does epidemic prevention and control bring to medical reform? With these questions in question, China Health Insurance (ID:zgylbxzzs) recently conducted an interview with Fu Wei, director of the National Health and Health Commission's Center for Health Development Research.
, Director of the Health Development Research Center of the National Health and Health Commission, China Medical Insurance: The last "decade" of new medical reform has ended, can you give a brief evaluation? Fu Wei: When the new medical reform was launched, it put forward the reform goal of "effectively reducing the burden of residents' medical expenses, effectively alleviating the 'difficult and expensive to see a doctor'", and "establishing and improving the basic medical and health system covering urban and rural residents and providing safe, effective, convenient and inexpensive medical and health services to the masses".
After ten years of efforts, we have achieved great results, the basic medical and health system with Chinese characteristics has been basically established, the system has been continuously improved, the medical security system has achieved the full coverage of more than one billion people, the implementation of basic public health projects, the realization of a wide range of public health interventions, the improvement of the health level of residents, the phenomenon of poverty due to disease has decreased significantly, many achievements are difficult for other countries in the world to achieve.
But on the other hand, we should also see that some of the deep-seated institutional mechanism problems to be solved by the medical reform are long-term accumulation, many factors, involving the interests of all parties, the solution also needs a process, we have repeatedly said before the medical reform "deep water area" mainly related to this aspect of the problem, the future medical reform will continue to deepen.
: After the establishment of the National Health Insurance Administration, what do you think has been done to advance the reform? Fu Wei: The establishment of the Health Insurance Bureau is a very important thing, changed the original situation of the decentralized functions related to health insurance, more highlighted the impact of the health insurance system on the entire national health and medical services, and in recent years in the health insurance system at the top of the design of a lot of breakthroughs, the health insurance system overall planning, overall management has a relatively large promotion.
I think there are four aspects that are more obvious: First, to strengthen the overall planning and management of health care.
In particular, the opinions issued by the State Council of the CPC Central Committee at the beginning of this year on deepening the reform of the medical insurance system are very important top-level designs in the field of medical insurance, which have a very important guiding role in the next step of deepening medical reform and jointly promoting the "three-medical linkage", and also make the construction of the medical insurance system and the path of reform clearer.
second is to promote the "three-doctor linkage" reform.
at the level of medical insurance and pharmaceutical linkage, we will give full play to the role and advantages of third-party strategic purchases, and make great progress in strengthening the price control of medicines and consumables, so as to promote the return of their market prices to a reasonable level.
at the level of health care and health care linkage, the reform of the health care payment system has increased significantly, including regional packaged payments have also begun to start pilot.
is to improve the ability of health care governance.
including the supervision of medical insurance funds, the direct settlement of off-site medical treatment, the intelligent supervision of medical insurance, and the establishment of a unified national health insurance information system, all of which have been significantly accelerated since the establishment of the National Health Insurance Administration.
fourth is to help promote healthy China.
From the point of view of strengthening medical security, we have done a lot of work in the whole life cycle of the people and the requirements of all-round health care, and made some adjustments to the treatment of medical insurance for the poor, the chronically ill, the elderly, the inseconomic and other special groups of people.
: Combined with the current situation of China's medical and health system and relevant national planning, for the next "decade" of new medical reform, what do you think need to focus on the direction? Fu Wei: In order to continue to deepen medical reform in the future, we should respond to the new requirements of the new situation, on the basis of inheriting and developing the achievements of the pre-reform, we should pay more attention to health as the center, promote the transformation of the development mode, emphasize the system integration of reform, promote the overall promotion, break down the deep-seated institutional and institutional barriers, promote the more mature and stereotyped basic medical and health system, promote the modernization of the health and health governance system and governance capacity, and promote the construction of a healthy China.
I think the next step of reform needs to focus on several aspects: First, public hospital pay, personnel system reform.
Thy is the key to mobilizing the enthusiasm of medical personnel, although the pilot work is now being carried out, General Secretary Xi Jinping's important instructions on "two permits" (allowing medical and health institutions to break through the current level of wage control in public institutions, allowing medical service income to deduct costs and withdraw funds according to regulations and mainly used for personnel incentives) are already being implemented in many places, but not enough.
The most obvious is that after the outbreak of neo-crown pneumonia, there was a period of hospitalization to limit the admission of patients, surgery to stop, outpatient services changed to the line, etc. , the number of patients reduced and the cost has increased, so that the overall income level and income structure of the hospital have been relatively large impact, many hospital performance has been reduced or even not.
This also confirms that our public hospital pay system is problematic, since to adhere to its "public welfare" positioning, there should be basic income security, not because of such an emergency led to a significant decline.
is price reform.
this is to break by medicine, consumption of complementary medicine, so that medical institutions from selling drugs, supplies, major inspection to rely on services and technology, to promote standardized medical behavior at the core.
Under the multiple adjustments of policies such as the abolition of the rate increase, volume purchase and medical insurance payment standards, the process of drug price reform is obviously much faster, and now the phenomenon of "big prescriptions" in hospitals is much less, because it is difficult to re-profit from them, and will also affect the assessment indicators of medical institutions.
and with the promotion of high-value consumables belt procurement, consumables costs are gradually being controlled.
So the core of the next step in price reform is how to speed up the increase in the price of medical services and technical services, so that hospital charges more reflect the value of technical services, which is now generally relatively low.
More importantly, in the process of adjustment to establish a systematic pricing mechanism and dynamic price adjustment mechanism, because the price is not a one-time adjustment on the end, after the new technology, new services, how hospitals charge, how to pay for health insurance, all need to have a systematic mechanism to ensure that these work scientifically carried out.
third is from "disease treatment" to "health management".
The CPC Central Committee's Proposals for the Development of the 14th Five-Year Plan for National Economic and Social Development and the Vision for 2035 put forward the proposal to "comprehensively promote the construction of a healthy China" and called for "the strategic position of safeguarding people's health as a priority for development and adherence to the precaution-oriented policy".
This is also the "14th Five-Year" health and health cause is facing an important change, meaning that we have to change from "disease treatment" to "health management" as the center, not only to treat diseases, but also to consider how not to be sick, how not to be seriously ill, to the greatest extent to delay the occurrence and development of diseases.
future reform goals must be in this direction, in the policy design should be aimed in this direction.
This requires our health care system not only to continue to improve equity, accessibility, and to set the foundation for "health for all", but also to pay more attention to systemic and continuity issues, through the integration of the service system to achieve a true "medical integration", "up and down linkage."
is the pursuit of high-quality development.
the "14th Five-Year Plan" period, China's economic and social development should promote high-quality development as the theme, the field of health care should also be developed towards this goal, in order to solve the "people's growing health needs" and "unbalanced, inadequate medical and health development" between the contradiction.
And for the meaning of "high quality", on the one hand, rely on medical science and technology progress, service system construction and service model innovation, improve the level of medical technology, improve the ability of medical services, on the other hand, we should strengthen the connotation of construction, deepen the reform of public hospitals, establish a modern hospital management system, improve operational management efficiency.
China Health Insurance: What do you think is the root cause of the difficult reform, which you have just mentioned, "public hospital pay, personnel reform" and "price reform", which have been recognized by the medical reform industry for many years as "difficult bones"? Fu Wei: First of all, because of the long-standing shortcomings, these two work involved in the operation mechanism, policies have been running for many years, whether the relevant government departments or medical institutions have been accustomed to such a mode of operation, want to reform must break the original work of thinking inertia and path dependence.
Secondly, the public hospital as a public welfare second-class institutions, personnel, compensation system and China's institutions management is closely related, if you want to fundamentally reform the public hospitals will certainly involve the adjustment of the management policy of institutions, the difficulty will be relatively large.
Three is a large number of stakeholders, such as the current price reform, payment system reform in the Health Insurance Bureau, personnel, remuneration in the Ministry of Human Services, public hospitals are managed by the organization (preparation committee office), each side has a different foothold, the difficulty of forming a consensus.
Finally, there is a point that is relatively easy to ignore, is the people's awareness and habits, in the past medical expenses are mainly examination of laboratory tests, supplies and medicines, the people get real things, but also relatively easy to accept, if the future costs are mainly invisible in kind of technical labor charges, the common people are not easy to adapt, which requires the adjustment of medical habits, but also need the adjustment of medical insurance reimbursement policy.
: What do you think is the key to solving these difficulties? Fu Wei: I think emphasizing "wholeness" and "synergy" is the key.
in particular, interest-related reforms such as price reform, if these two aspects are not, it is easy to lose the "window period" of reform, some of the existing reform results will be greatly reduced or even disappeared.
for "wholeness" and "synergy", it involves both within and between departments.
For example, the reform of our health system started with a step-by-step push forward the reform of public hospitals and primary health care institutions, but now we should promote the establishment of a hierarchical diagnosis and treatment system at the overall level and improve the quality and efficiency of the medical service system as a whole by promoting the medical association and establishing an integrated service system.
se.g. "three-doctor linkage", we more emphasis on the linkage between departments and actions, the new medical reform at the beginning of our emphasis on "three-doctor linkage", and now we are still stressing that this is because it has not been done, has not done well.
In China, medical insurance is a very important source of financing for medical services, from the total cost of society, this aspect accounted for more than 1/3, public medical institutions can even account for more than 50%-60%, the provider of medical services has a strong influence - micro-level can affect the diagnosis and treatment behavior of individual medical institutions, the macro-level of the overall allocation of health resources also has a great impact.
so the link between health care and health care is critical.
Since the establishment of the National Health Insurance Administration, there have been many breakthroughs in policy coordination with the health sector, but I think there is still a need to further strengthen: First, to continue to build consensus on understanding and ideas, this is an important aspect, the two sides should move towards common goals, such as health China 2030, 14th Five-Year Plan Some of the objectives raised are the need for more communication and coordination in institutional mechanisms, where there are still some "separate" situations, the need for further strengthening of policy and institutional coordination at the implementation level, and the lack of sharing and mutual recognition of information collection and application, which can easily lead to implementation problems at the grass-roots level.
: Can you give an example of how health care and health should be more cooperative to improve the "synergy" of reform? Fu Wei: For example, just said the problem of information sharing and mutual recognition.
Now the health department and the health care department need medical institutions to report some data for their own supervision, but a lot of the work is repeated, today the department asked for data tomorrow may be reported to another department, this department after two days of assessment another department to re-examine.
this, on the one hand, will place a burden on medical institutions and grass-roots regulators, and will reduce the effectiveness of management, because there are so many data exports, it is likely that in the end any data is not allowed.
So health care and health can do some information sharing, mutual recognition of results, to improve regulatory synergy, and promote the relevant data reporting work towards "one export, one-time delivery" direction.
future is the information age, information is the basic support of a lot of work, it is very important to establish this mechanism.
: In addition to the above mentioned above, what new opportunities and challenges will the new health care reform face in the next decade? Fu Wei: I think there may be several aspects: First, the trend of aging population is becoming more and more obvious.
The Fifth Plenary Session of the 19th Central Committee put forward a national strategy to actively deal with the aging of the population, China's aging in the future is certainly not to be ignored, it will produce a large number of rigid demand for health care services, but also will inevitably bring about increased health care costs and increased health care expenditure.
is the increase in the diversified health needs of the people.
our country is about to enter a high-quality development stage, people's demand for medical services increased, the demand is increasingly personalized