On December 29, 2023, the National Health Commission and 9 ministries and commissions issued the "Guiding Opinions on Comprehensively Promoting the Construction of a Close-knit County-level Medical and Health Community", which officially kicked off the prelude to comprehensively promoting the "county-level medical community" in all provinces and counties across the country, and also shows that the work of the pilot provinces and pilot counties that began in 2019 has achieved certain phased results and officially entered the stage of comprehensive promotion.
1. The national policy release on the close-knit county-level medical and health community:
1) In 2017, the General Office of the People's Republic of China issued the "Guiding Opinions on Promoting the Construction and Development of Medical Consortiums", clarifying that medical communities should be established at the county level;
2) In May 2019, the Notice on Promoting the Construction of a Close-knit County Medical and Health Community was issued;
3) In June 2019, a meeting was held to promote the construction of a close-knit county-level medical and health community;
4) List of pilot provinces and pilot counties for the construction of a compact county-level medical and health community in August 2019, Shanxi and Zhejiang pilot provinces, and 567 counties across the country are pilot counties;
5) Notice on the list of personnel and job responsibilities of the expert group for the construction of a close-knit county-level medical and health community in December 2019;
6) In August 2020, the evaluation criteria and monitoring index system for the construction of a close-knit county-level medical and health community were released;
7) From 2021 to 2023, organize and carry out monitoring of the progress of the construction of a close-knit county-level medical and health community for three consecutive years;
8) On December 29, 2023, the National Health Commission, together with 9 ministries and commissions, issued the "Guiding Opinions on Comprehensively Promoting the Construction of a Close-knit County-level Medical and Health Community".
2. Specific measures and management systems for close-knit county-level medical and health communities:
1) Goal: Adhere to the public welfare of basic medical and health undertakings, deepen the linkage reform of the "three medicines", and focus on the goal of "strong at the county level, active at the township level, stable at the village level, upper and lower linkages, and information communication", promote the integration of urban and rural areas, townships and villages, and the integration of counties and townships, and accelerate the construction of a close-knit county-level medical community.
2) Planning: By the end of June 2024, all provinces will comprehensively promote the construction of a close-knit county-level medical community. By the end of 2025, significant progress will be made in the construction of a compact county-level medical community, and more than 90% of the counties in the country (county-level cities, qualified municipal districts can be referred to) will be basically built into county-level medical communities. By the end of 2027, the close-knit county-level medical community will basically achieve full coverage.
3) Layout: 1-3 county-level medical communities composed of non-profit general hospitals or traditional Chinese medicine hospitals at level 2 or above as the leading hospitals, and other county-level medical and health institutions, township health centers, and community health service centers.
4) Upper and lower linkage: Strengthen the cooperation between county-level medical communities and urban hospitals, and form various forms of medical alliances, and send at least 3 or more experts to provide guidance all year round; Qualified public village clinics will be gradually converted into village-level medical service points extended by township health centers, so as to achieve unified management of personnel, property and property.
5) Data integration: unify the information system within the county-level medical community, strengthen data exchange and sharing and business collaboration, promote the extension of telemedicine to rural areas, and promote grassroots examinations, superior diagnosis, and mutual recognition of results.
6) Unified management: Adhere to the positioning of the main body of the county-level medical community, gradually realize the comprehensive and unified management of people, property and property, strengthen the management of drug consumables, implement a unified drug catalog, unified procurement and distribution, and free flow of prescriptions, and realize five major management centers such as human resources, financial management, medical quality control, medical insurance management, and information data.
7) Health expenditures: local governments should fully arrange the development and construction expenditures such as capital construction and equipment purchase of primary medical and health institutions according to the plan; Operating costs such as personnel expenses and operating expenses are compensated through service charges and subsidies; **The government supports rural medical and health institutions through subsidy funds for basic public health services and basic drug systems.
8) Personnel salary: The county-level medical community has more autonomy to carry out personnel establishment and salary management, implement the "two allows", and encourage the implementation of the annual salary system.
9) Medical insurance payment: Implement the total payment of medical insurance for the compact county-level medical community, strengthen the assessment of the growth rate of medical expenses, the proportion of medical insurance reimbursement, the rate of primary medical treatment, the proportion of expenditure in the county, and the proportion of medical insurance in the county, improve the surplus retention mechanism, and use the surplus funds as the business income of the county-level medical community, and improve the reasonable over-expenditure sharing mechanism.
3. Pharmaceutical companies should attach great importance to the 7 considerations of the emerging market of "county-level medical community":
1) Although the "county-level medical community" is not an emerging terminal, it is an emerging market that integrates county-level medical care, township primary medical care, and private outpatient medical care.
1. Procurement and distribution system.
1. Under the premise of unified pharmaceutical settlement, in fact, 2,843 county-level regions across the country have formed an emerging terminal market of nearly 3,000 terminals, and some enterprises may need to consider establishing a "county-level" team.
2) The drugs of the county-level medical community are also a collection of various drug catalogs such as the basic drug catalog, the medical insurance drug catalog, the centralized procurement and joint procurement catalog, the chronic disease drug catalog, and the maternal and child drug catalog.
3) Each province will recommend or formulate the corresponding drug or procurement catalogue of the county-level medical community in the province based on local regional differences, and pharmaceutical companies need to actively grasp the policy dynamics of various places, especially the pilot experience of Jiangxi, Zhejiang and Shandong provinces and the way the catalogue is determined, actively lay out regional access affairs, and look for regional partners who are familiar with the policies and resources of the medical community.
4) Pharmaceutical companies need to strengthen or integrate the evidence-based data or basis for the pharmacoeconomic or clinical value and economics of their own products, and grasp the clinical pathways, formularies and DRGS DIP rules in the corresponding disease areas, and have the corresponding basis and promotion materials when entering the county-level medical community catalog or procurement.
5) With the unified procurement, distribution and settlement of the medical community, in addition to the distribution cooperation with the State Control, China Resources, etc., some pilot areas also use the state-owned funds in the region to establish a unified pharmaceutical distribution enterprise, which brings new challenges to the management of the business distribution channels of pharmaceutical enterprises, either to establish their own business teams, or to find a large number of county distribution business cooperation.
6) Pharmaceutical companies need to consider how to build a promotion and service team for the "county-level medical community", that is, to have the clinical value and economic explanation ability for the top-level product access of the medical community, but also to have a promotion service team for the doctor group in the county and countryside, but also to meet the county-wide drug distribution work, it is unrealistic for pharmaceutical companies to build such a team in the country, and a large number of original clinical promotion or third terminal promotion of the first business team can quickly cut into this market. And with many pharmaceutical companies to establish promotion partnerships.
7) In view of the "county-level medical community" market, it is necessary to coordinate the distribution of drugs and benefits, including the network, commercial distribution costs, payment collection period costs, front-line promotion costs, regional partner interests, etc., in the reality of continuous decline in drug prices, it is impossible to have a large space and high costs, and the benefit distribution of efficient and low-cost compliance is bound to be planned.