Sanming Medical Reform: A sample of reform to solve the world's difficult problems

Medical network December 18th, medical reform is a worldwide problem.
the difficulty and challenge of "answering questions" is self-evident to a large developing country such as China.
Since 2012, Sanming City, located in the inland mountains of Fujian Province, has dared to wade into the "deep water zone" and gnaw "hard bones", constantly breaking through the old barriers of interest and institutional mechanisms, breaking a new way to crack the medical reform problem, and contributing to China's new round of medical reform in the process of high-profile local samples.
why small cities are pushing for big reform and Sanming's health care reform? Many Sanming people believe that Sanming is an industrial city emerging because of the construction of the third line, with a small population, a small economy and a higher proportion of retirees, the phenomenon of "not rich and old" is obvious, and the health insurance fund has faced the risk of "wearing the bottom".
, Sanming's reform is a "forced reform".
However, the deeper cause is the long-standing "persistent disease" of the medical and pharmaceutical system: the huge waste of medical insurance funds, unreasonable medical system, contrary to the purpose of hospital treatment and rescue, so that some patients suffer from "seeing the wrong disease, taking the wrong medicine, spending the wrong money" of the "secondary injury".
's health care reform in all its places, where did you get the first shot? Sanming aimed at inflated drug prices.
2012, Sanming through the focus on monitoring drug use behavior, the implementation of zero-rate drug sales, that year, the city's average annual growth of 15% of pharmaceutical revenue momentum fell to about 7%.
2013, Sanming has increased its medical service revenue by 4.87 billion yuan through price adjustments for pharmaceutical supplies.
same time, the proportion of drugs in public hospitals at or above the county level fell from 46.77 percent in 2011 to 24.57 percent in 2019, while medical income rose from 18.37 percent to 40.59 percent.
Yuanming, deputy mayor of Sanming City, believes that squeezing the inflated price of drugs is a key step in the promotion of medical reform, and the most difficult step.
as leverage, Sanming then implemented the reform of the "three-doctor linkage" of medicine, medical insurance and medical care, which effectively solved the problem of "fragmentation" of medical reform.
in the area of medical services, Sanming has reformed the method of total compensation, and the amount of medical services such as outpatient and surgical services for medical personnel is directly linked to remuneration.
from 2011 to 2018, the average annual salary of public hospitals at or above the county level rose from 422,000 yuan to 113,400 yuan, and the enthusiasm of medical personnel increased significantly.
" let the vast number of angels in white with clean and decent income, focusing on the mission of healing and saving people, by the respect of the whole society.
Xiaoliang, party secretary of Yuxi County General Hospital in Sanming City, broke the first heart of medical reform.
For the medical insurance fund management "Kowloon water treatment" of the general disease, Sanming in the country to take the lead in the original under the people's society, health and other departments of the 24 health insurance fund agencies to integrate, the formation of Sanming City Medical Security Fund Management Center.
2016, it also took the lead in unifying functions such as drug procurement and pricing of medical services into the nation's first health insurance bureau.
Three Insurances in One", Sanming pushed forward the reform of various compound payment methods, such as pay-per-view, pay-per-disease, pay-per-head, and give full play to the leverage of the medical insurance fund, guide the people to seek correct medical treatment and control unreasonable medical expenses.
Xiuzhen, a villager in Yuchi village in the western town of Yuxi County, was screened for a malignant tumor during a health check-up last year and chose to have surgery at a county hospital.
, surgery and medication totaled 38,000 yuan, through reimbursement after self-payment of less than 1000 yuan.
" in the county to see a doctor, not only a high proportion of reimbursement, medicine is the same, medical reform is really the gospel of ordinary people.
," Zheng said gratefully.
A set of data reveals the intuitive "dividend" of health care reform: in 2019, Sanming's per capita medical expenses were 1,734 yuan, only 46% of the national average, while the grass-roots visit rate continued to rise, such as Sanming's county, where the rate of visits increased from 79.5% in 2015 to 93.6% today.
"moving hard" and "deepening reform" has not been completed in the wind and rain.
", which is the sanming medical reform experience said the most words.
measures of the Sanming Medical Reform involve complex and sensitive adjustment of interests.
to this end, reformers and even the whole Sanming once under great pressure: there are individual health care workers in the negative treatment of medical reform, a few patients do not understand medical reform;
In the early days of the reform to "cure chaos", Sanming established a cross-regional drug supplies joint price limit procurement of the "Sanming Alliance", through a large purchase of the total amount in exchange for the drug companies to take the initiative to reduce prices, this reform initiative has made many pharmaceutical representatives exclaimed "Sanming real" "the pharmaceutical industry to reshuffle."
"Sanming medical reform can be described as a 'knife and blood', not simply moved others's 'cheese', but completely changed the 'always so' pattern of distribution of benefits, obstruction is inevitable.
," said Xu Zhixuan, director of the Sanming City Health Insurance Bureau.
opened the bow and did not turn back the arrow.
is that Sanming health care reform finally "quite" over.
talking about the "mystery" behind it, Sanming people owe it to the courage and courage of successive Party committee governments to stick to their original intentions, adhere to principles and Sanming's medical reform to dare to move the knife to medical corruption and say "no" to the unreasonable phenomenon of medical treatment.
as long as it is good for the common people, let go to do! "When Sanming Medical Reform was once snubbed, Zhan, then head of the Sanming City Health Reform Leadership Group, remembers that the main leaders of the Sanming Municipal Party and Government always gave support and courage to assume their responsibilities.
"Dare to be the first in the world" Sanming medical reform, after playing the "three-doctor linkage" combination of fists, has now entered a "cure the disease" as the focus of the new stage, is focusing on the construction of prevention-oriented, prevention and control combined with the national health service system.
2017, Sanming promoted the sinking of high-quality medical resources, formed a close-knit medical community linked up and down, formed 10 county-level general hospitals, 2 urban close-type medical associations, and established a regional health care organization.
through the implementation of medical insurance package payment, the general hospitals to implement the "total package dry, overspend out-of-pocket, balance retention", to promote county-level medical personnel, diagnosis and treatment of diseases, health resources sink to the countryside.
Talking about the changes in hospitals in recent years, Xiao Chunlin, deputy director of the department of heart internal health at Le County General Hospital, experienced profoundly: "Under the new system, doctors and nurses go down every week, not only to sit down, but also to guide health hospitals, health clinics to do a good job in patient health management, to the community, rural lectures."
people get sick less, the balance of health insurance funds, everyone involved in health management can also improve performance.
" Xiao Chunlin said, the direct dividend of slow disease management is that the number of people who develop into serious illnesses and even die has fallen.
, the county has achieved a two-year decline in the number of stroke deaths.
don't forget the first heart, reform and then start again" from start to finish, Sanming medical reform people always keep in mind why and for whom to change this fundamental problem.
, " said Lin Xinglu, secretary of the Sanming Municipal Committee.
In 2013, when Sanming centralized the health care functions previously dispersed in the social, agricultural, health and other sectors, there was disagreement as to whether the new department would be called the Medical Insurance Management Center or the Medical Security Management Center, and finally decided: it was called the Medical Security Management Center.
" insurance and protection, the word difference, reflects the government to assume the responsibility of protecting and protecting the people's health accurate positioning.
, " said Mr. Zhan.
Zheng Zhen a professor at the School of Public Health of Fujian Medical University, said that Sanming Medical Reform can constantly gnaw down all kinds of "hard bones" in the course of its progress, the fundamental lies in taking the people as the center, adhering to the unified leadership of the Party in the work of medical reform, and always putting people's life safety and health first.
November 2019, the Leading Group of the State Council for Deepening the Reform of the Medical and Health System issued the Notice on Further Promoting the Experience of Deepening the Reform of the Medical and Health System in Fujian Province and Sanming City, calling for the full play of the demonstration, breakthrough and driving role of typical experience in the overall reform.
, regarded as a new round of China's medical reform "experimental field" of Fujian Sanming, in December 2019 to launch a new exploration of comprehensive reform of disease control, the establishment of a "medical and prevention integration office" to promote the realization of professionals, business training, monitoring reports, medical resources, assessment methods, data information "six fusion", better play the role of health care organizations, so that people get less disease, late illness, not disease.
, director of the Sanming City CDC, said that before, there were problems such as lack of business integration between hospitals and CDC departments, barriers to communication, and lack of health management.
in the great war to deal with the outbreak of new crown pneumonia, the new mechanism of medical and defense coordination reflects the obvious results and advantages.
Plenary Session of the 19th Central Committee of the Communist Party of China put forward the strategic position of comprehensively promoting the construction of a healthy China and giving priority to the development of safeguarding the health of the people.
" new round of medical reform, Sanming Gan when the 'storm into the formation' of the people.
to the health of the whole people, Sanming will be conducive to the people's reform to the end.
," Lin said.
。