On December 1, the people of Shaanxi Province held a press conference to introduce the progress of deepening the reform of the medical and health system.
At a press conference,Yang Lianchang, deputy director of the Shaanxi Provincial Health CommissionAccording to the introduction, medical reform is a major livelihood project, involving the vital interests of the masses. The Provincial Party Committee and the Provincial Party Committee have always put the protection of people's health in the strategic position of priority development, and incorporated the deepening of medical reform into the overall promotion of comprehensively deepening reformAnd from four aspects of the brief introduction of this year's medical reform work.
1. Further improve the leadership and promotion mechanism for medical reform
First, strengthen organizational leadership.
The governor of the province is the leader of the provincial medical reform leading group, and the member of the Standing Committee of the provincial party committee and the executive vice governor are the deputy leaders to promote the medical reform work at a high level. The leading groups for medical reform at all levels are headed by the party committee (the main responsible comrade of **), and a leader is in charge of the work of "medical care, medical insurance, and medicine", and the situation of linkage between the top and bottom has been further consolidated.
The second is to strengthen overall planning and promotion.
Each member unit performs its own duties and makes concerted efforts to promote the implementation of key tasks through various methods such as research and supervision, on-site meetings, and tour guidance. The Provincial Health Commission and the Provincial Medical Insurance Bureau signed an agreement on the collaborative governance mechanism of medical insurance and medical care, and held regular meetings to study and solve key issues of collaborative governance of medical insurance, medical treatment and medicine. The Provincial Health Commission and the Provincial Department of Education signed a cooperation framework agreement to jointly promote collaborative innovation in medical education and improve the quality of medical talent training.
The third is to increase investment.
From January to October 2023, a total of 227 special funds in the field of medical reform at the provincial level will be issued7.7 billion yuan, focusing on supporting the construction of the public health system, the improvement of medical and health service capacity, the reform of the national medical insurance system, the comprehensive reform of public hospitals, the inheritance and innovative development of traditional Chinese medicine, and the construction of county-level medical communities, etc., to ensure the smooth progress of medical reform. Arrange provincial special funds 30.7 billion yuan to support the National Regional Medical Center, the National Medical Center, the Yan'an Public Hospital Reform and High-quality Development Demonstration Project, the Tongchuan Traditional Chinese Medicine Innovation and Development Demonstration Project and 12 county-level sub-center construction projects.
2. Promote the expansion and balanced distribution of high-quality medical resources
The first is to promote the establishment of national medical centers and the construction of regional medical centers.
Yulin Hospital of the First Affiliated Hospital of Xi'an Jiaotong University was approved as the fifth batch of national regional medical centers, and completed the construction of three national regional medical centers for endocrine and metabolic diseases, intensive care medicine, and hematology. Four provincial-level regional medical center projects have been implemented steadily.
The second is to promote the construction of medical groups and medical communities.
Yan'an, Baoji and Tongchuan have been identified as pilot cities of national compact urban medical groups. The number of counties (cities and districts) in the province has increased from 49 to 83, and the number of counties (cities and districts) has been fully covered according to the statistics of county-level economic development. 11 counties were selected to start the implementation of the medical community department co-construction project, enriching the connotation of the construction of a close-knit county-level medical community. Promote the connection between the "Thousand County Project" group assistance and the construction of the medical community, and extend the three central functions of 54 county-level hospitals, such as chest pain, stroke and trauma, to the town health center, so as to strive for more effective time for emergency patients.
The third is to improve the capacity of grassroots services.
Provincial 6246% of township health centers (community health service centers) have met the service capacity standards of township health centers and community health service centers issued by the National Health Commission. Give full play to the role of Jiangsu and Shaanxi cooperation, counterpart support and "group" assistance mechanism, 46 ** hospitals in the province help 105 county-level hospitals, and 66 ** hospitals in Jiangsu help 56 county-level hospitals in poverty alleviation counties. A total of 19 new clinical departments have been established in 11 key county hospitals for rural revitalization, and 273 new technologies and new businesses have been launched.
The fourth is to promote the inheritance and development of traditional Chinese medicine.
The National Traditional Chinese Medicine Inheritance and Innovation Demonstration City Project landed in Tongchuan City. 9 units were included in the national "14th Five-Year Plan" major projects in the field of traditional Chinese medicine, and were approved to invest 4 in the budget500 million yuan. 16 demonstration center construction projects of traditional Chinese medicine characteristics in hospitals have been implemented. 10 provincial-level traditional Chinese medicine school inheritance studios have been built. 533 in-hospital preparations are included in the scope of payment of basic medical insurance and maternity insurance**, and the management of Class B drugs is implemented.
Fifth, develop and strengthen the medical and health team.
Implement the "Health Talent Cultivation Action" and strengthen the three-year action plan (2023-2025) for the construction of primary medical and health talents, and 244 medical majors in colleges and universities in the province will be distributed. 1,536 medical undergraduates were recruited for medical and health institutions at and below the county level, 3,236 new residents were recruited for standardized training (including 325 in general practice, 839 in transfer training, and 201 in rural orders), 430 backbone doctors and 2,331 rural doctors were trained, and the proportion of rural doctors who obtained the qualification of practicing (assistant) physicians increased to 362%。The distribution of medical resources in various regions has been further optimized, and hierarchical diagnosis and treatment and orderly medical treatment have been continuously promoted.
3. Promote the coordinated development and governance of medical insurance, medical care, and medicine
The first is to improve the multi-level medical security system.
The general outpatient clinic was coordinated and implemented smoothly. The province has opened outpatient co-ordination and designated medical institutions150,000 families, with a cumulative settlement of 2350320,000 person-times, with a total settlement amount of 44$1.9 billion. The total number of people who activated the medical insurance electronic voucher reached 3,126910,000 people, with an activation rate of 8459%。*100% access rate of medical insurance electronic vouchers for medical institutions, 99% access rate for secondary medical institutions, and 97% access rate for designated retail pharmacies. Adjust and determine the fixed subsidy standard for medical assistance, and the sum of financial subsidies at all levels shall not be less than 50% of the individual payment standards for basic medical insurance for urban and rural residents announced by the state in the current year, and cities (districts) higher than 50% shall not reduce the current subsidy standards and arrange provincial medical assistance subsidy funds 167.3 billion yuan.
The second is to deepen the reform of payment methods.
All 12 cities (districts) in the province have introduced DRG DIP payment reform plans, 5 cities have implemented DRG payment, 7 cities have implemented DIP payment, and the coverage rate of medical institutions paid according to DRG DIP in the actual payment co-ordination area has reached 59%, and the number of cases paid according to DRG DIP accounts for 922%, and 656%。
The third is to promote the reform of the pharmaceutical field.
The number of national and provincial centralized procurement drugs has reached 512, and the three major fields of chemical drugs, biological drugs, and Chinese patent medicines have been fully coveredCarry out 17 categories of centralized procurement of medical consumables, the average price of the selected varieties has decreased by more than 50%, and the cumulative saving of procurement funds is 528.5 billion yuan. A special fund of 60.08 million yuan was issued for the development of key industrial chains to support 34 projects and products in the medical device industry chain. The "Guiding Opinions on the Remote Prescription Review Service of Licensed Pharmacists for Pharmaceutical Retail Chain Enterprises in Shaanxi Province" and the "Standards for the New Establishment of Pharmaceutical Retail Enterprises" were issued to support and standardize the development of new business formats in the pharmaceutical field.
In addition, Yan'an City has implemented the "Pilot Implementation Plan for the Construction of Yan'an Compact Urban Medical Groups", promoted the transformation and development of the three major urban medical groups and 31 county-level medical communities to a compact type, and achieved the goal of not leaving the city for serious illnesses, not leaving the county for general diseases, and solving headaches and brain fever in the countryside, and gradually building a hierarchical diagnosis and treatment pattern.
Ankang CityThe health system has thoroughly implemented the "one activity and two plans", that is, the theme activities of improving the feeling of medical treatment and enhancing the patient experience, the action plan for comprehensively improving the quality of medical care, and the action plan for further improving nursing services, so as to further optimize the medical environment for the masses and improve the medical experience and service experience in the whole process.
Fourth, accelerate the establishment and improvement of a new mechanism for the operation of public hospitals
The first is to deepen the reform of the salary system.
Among the 107 counties (cities and districts) in the province, 59 have implemented the policies of "first-class guarantee, second-class management" and "two permits", accounting for 55%. Launched the pilot project of independent evaluation of health series professional titles, and granted Xi'an Hospital of Traditional Chinese Medicine and Xianyang Central Hospital the right to review some professional senior professional titles. Explore the implementation of the dean's appointment system, annual salary system, and tenure target responsibility system, and establish and improve evaluation and supervision and restraint mechanisms. Eight city-level hospitals in four cities and 20 county-level public hospitals in seven counties (cities and districts) implement the annual salary system for directors.
The second is to promote the high-quality development of public hospitals.
Yan'an was selected as a national demonstration project for the reform and high-quality development of public hospitals, and 10 individual programs were launched. All public hospitals above the second level implement the president responsibility system under the leadership of the party committee. Organize 54 pilot hospitals for the modern hospital management system, carry out a competition to establish and improve the pilot hospital of the modern hospital management system, and select 10 model hospitals and 10 excellent hospitals.
The third is to promote the dynamic adjustment of medical services.
There were 129 new and revised medical service items, of which 40 were newly added, 83 were revised, and 6 were repealed. At the same time, 2 categories of revised material libraries have been added, involving a total of 24 coded materials. Baoji City was selected to carry out the pilot reform of provincial medical services. At present, Baoji City has issued the "Implementation Plan" and "Operation Rules", and has entered the substantive pilot stage.
In addition, Yan'an City and Ankang City have also achieved new results in deepening the reform of the personnel and salary system and promoting the reform of the linkage of the three medical institutions
Yan'an City: Jointly promote the reform of the linkage of the three medical institutions, and activate the new efficiency of high-quality development of public hospitals
The first is to promote the coordinated governance of the three medical institutions. Establish and improve the dynamic adjustment mechanism of medical services, and fully reflect the value of medical personnel's labor technology. Strictly implement the centralized procurement of drugs and medical consumables and the return mechanism of medical insurance surplus funds, accelerate the reform of multiple and composite medical insurance payment methods, and continue to expand the scope on the basis of the implementation of 117 payment according to disease types and 3 psychiatric and 17 ** diseases on the basis of daily payment by bed, and effectively reduce the burden of medical treatment for the masses.
The second is to deepen the reform of the personnel and salary system. Take the lead in launching municipal public hospitalsReform of the preparation of the filing systemFurther improve the performance appraisal and evaluation system of public hospitals, strictly implement the fulfillment of performance rewards and punishments, fully implement the "two permits" policy, and achieve the goal of "first-class guarantee and second-class management" of primary medical and health institutions.
The third is to continue to establish and improve the modern hospital management system. Explore the overall budget management and refined management systems of public hospitals, comprehensively strengthen the party building of public hospitals, promote the separation of party and government in secondary and above medical institutions, fully implement the president responsibility system under the leadership of the party committee, and give full play to the leading role of the party organization of public hospitals in setting the direction, managing the overall situation, making decisions, promoting reform, and ensuring implementation.
Ankang City: Implement the "three reforms" and optimize the health system and mechanism
The first is to further promote the reform of the hospital management system. Strengthen the promotion of party and government organizations, multi-department linkage and cooperation, clarify responsibilities and authority, and earnestly perform the duties of running a medical service. Since 2022, the municipal medical reform leading group has studied and implemented key reforms such as personnel salary, increased investment, performance appraisal, and medical insurance payment in public hospitals for 6 times, and the county level has done a good job in implementing them simultaneously, and the public welfare-oriented public hospital reform has continued to deepen.
The second is to further promote the reform of the personnel and remuneration system. The total number of employees in the four municipal public hospitals was adjusted to 8,250, an increase of 2,850 compared with 2016, and the staff and non-staff were treated equally and paid for equal work. Within the total amount, public hospitals have been given autonomy in employing personnel, and city and county public hospitals have independently recruited 1,673 medical and health talents in three years, including 156 with a master's degree or above. At the municipal level and in five counties and districts, the annual salary system for the main person in charge of public hospitals is implemented, and the performance distribution is inclined to the backbone and front-line personnelThe average annual income of hospital employees increased by 1 compared with 201960,000 yuan. All township health centers have implemented first-class public welfare guarantee and second-class performance management, and the average annual income of employees has increased by 1 compared with 201940,000 yuan.
The third is to further promote the reform of the linkage of the three medical services. Implement centralized procurement of more than 450 kinds of drugs and 12 categories of medical consumables, and reduce the procurement cost of drug consumables by more than 100 million yuan every year. Establish a dynamic adjustment mechanism for medical services, and adjust more than 4,000 medical services three times since 2017. The pilot implementation of the reform of medical insurance payment methods, the launch of disease diagnosis-related group payment pilot 7, in 2 counties established the total amount of medical insurance prepayment, balance retention, reasonable overspending sharing mechanism, the use of medical insurance is increasingly efficient, medical institutions more standardized services, the burden of patients to seek medical treatment has been reduced.
In the next step, the province's medical reform work will continue to strengthen the people's health as the center, promote the coordinated development and governance of the "three medicines", deepen the public welfare-oriented public hospital reform, continue to improve the health and well-being of the people, and promote the high-quality development of medicine and health.
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