Primary medical care bears the job responsibilities of national public health, is the executor of the construction of a hierarchical diagnosis and treatment system, and is the "gatekeeper" of the people's health, so it is also the focus of attention of the annual committee members.
At the two sessions in 2024,Liu Meilin, member of the National Committee of the Chinese People's Political Consultative Conference and chief physician of the Department of Geriatric Internal Medicine of Peking University First HospitalSuggestion: The elderly with disabilities, dementia and stable chronic diseases should be sent to the grassroots level, and standardized management should be carried out by the grassroots hospitals and family doctor teams.
She has been practicing medicine for many years, and has found that whether it is a patient with chronic diseases or an elderly person with dementia and disability, relying on large hospitals alone cannot provide the best basic medical care. In the past few years, the state has given a lot of resources and policy guidance to primary diagnosis and treatmentAttracting critically ill patients to seek medical treatment at the grassroots level has achieved some results. However, it is not enough to improve the management level of chronic diseases in the elderly at the grassroots level.
Deputy to the National People's Congress, cardiovascular physician Wang Daowen of Wuhan Tongji HospitalIt is believed that higher-level teaching hospitals should provide technical guidance to grassroots medical institutions and provide assistance at designated points and responsibilities. In this regard, he suggested: through the form of legislation, the medical technical work and the best work combined, with political performance as the assessment, with the past poverty alleviation model, to complete the construction of primary medical care, which is a long-lasting work that requires the strength of the whole society.
Improving the level of services for patients with chronic diseases and the disabled and demented elderly in primary medical institutions is not only the wish of the deputies and committee members, but also the expectation of many ordinary people. This year, some deputies and committee members saidExplore the "county to hire townships (villages)" for primary medical talents, so that grassroots doctors can "recruit and retain".It is hoped that the problem of health care for the elderly can be solved by strengthening the strength of grassroots talents.
The inability of primary health care providers to retain people is a big problem. Cai Xiujun, member of the Standing Committee of the National Committee of the Chinese People's Political Consultative Conference (CPPCC) and President of Sir Run Run Shaw Hospital affiliated to Zhejiang University School of MedicineA survey was conducted: 50% to 60% of the medical tasks in many third- and fourth-tier cities are undertaken by village doctors, and there are also 85-year-old village doctors who are still consulting and practicing medicine for the majority of patients.
Zhang Boli, President of Tianjin University of Traditional Chinese Medicine and President of China Academy of Chinese Medical SciencesIt is believed that with the continuous deepening of China's medical reform, the medical level of township and rural health centers has been significantly improved, but the talent force is still weak. Zhang Boli suggested that it is necessary to establish and improve financial inputEnsure funding and increase the motivation of expatriate medical personnelIn the promotion of professional titles, evaluation and other aspects to give a certain tilt.
Those who hold the same view as Zhang Boli areXu Xiaochan, deputy chief physician of the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, deputy to the National People's Congress. Xu Xiaochan said: It is necessary to clarify the scope of responsibilities of grassroots medical institutions, clearly delineate the medical talents that need to be cultivated at the grassroots level, and formulate a special training plan.
Cai Xiujun pointed out that it is the solution to support the "county to hire township (village) use" talents, break the management system of medical personnel at different levels, and promote the circulation of talents. "Graduates are recruited in the countyHe received regular training in the county hospital, and then took turns to work in the rural primary medical institutions. ”
Now the most prominent contradiction is the elderly in rural areas, and the total amount is close to 1300 million people. Although the typical experience of large hospitals is good, it cannot be generalized to grassroots hospitals. How to make doctors willing to go to the grassroots has always been one of the most difficult problems in China's medical service security.
Cai Xiujun said that in the context of the current construction of a close-knit medical community, it can be explored and implemented"Compile and manage the idle preparation, re-accounting and preparation, and overall use".The new establishment management model.
How to expand the chronic disease management team of the elderly at the grassroots level? Liu Meilin suggested: through the incentive mechanism, attract more medical talents to transform, and engage in the management of chronic diseases of the elderly after standardized training.
After the fresh blood of the medical force sinks, it will bring new technologies and concepts, which can not only raise the capacity of primary medical services to a higher level, but also connect more grassroots islands to the overall medical security network. Wu Xiangjun, deputy to the National People's Congress and chairman of Yiling PharmaceuticalIt is believed that the construction of informatization is a link between all parties, and it is necessary to strengthen the construction of grassroots information platforms and application systems, take the leading medical institutions as the hub, connect with the telemedicine system of urban hospitals, and radiate to the medical institutions at the township and village levels.
After retaining outstanding talents, how to let them play a role in grassroots positions is also an important part of effectively improving the level of primary diagnosis and treatment services.
The progress and development of medical technology in China in recent years is obvious to all, but the equipment allocation rate of primary medical institutions is not high, and the business level and diagnosis and treatment technology are updated slowlyThe medical capacity of grassroots clinics cannot meet the medical needs of the masses at their doorstep.
Geng Funeng, deputy to the National People's Congress and chairman of the Good Doctor GroupIt was found that doctors in grassroots clinics still rely on stethoscopes, blood pressure monitors, and thermometers. Therefore, he suggested that it is necessary to strengthen the construction of grassroots medical skillsThrough the establishment of special departments such as imaging and examination, we assist doctors in treating diseasesLet the people enjoy the diagnosis and treatment services of the ** hospital at their doorstep.
Li Dongsheng, the representative of the national adults and the chairman of TCLIt is mentioned that at present, the standard of the starting line for outpatient reimbursement is differentIt is recommended to completely abolish the reimbursement threshold for primary medical outpatient clinics such as township hospitals and community health service centers.
In February 2020, the "Opinions on Deepening the Reform of the Medical Security System" was promulgated, which clearly clarified that outpatient medical expenses will be gradually included in the scope of basic medical insurance co-ordination** payment, reform the personal accounts of employees' basic medical insurance, and establish and improve the outpatient mutual aid security mechanism.
Li Dongsheng's suggestion is: I hope to further improve the outpatient treatmentExpand the scope of payment of medical insurance co-ordination in outpatient clinics, so that the masses can go to primary medical institutions to get diagnosis and treatment services as soon as possible, and avoid minor illnesses from becoming major illnesses.
Written by丨Xiaomi.
Editor丨Jiang Yun Jia Ting.
Operated by Twenty-Three.
Illustration by Visual China.
Disclaimer: Original content of the Health Knowledge Bureau, please do not do it without permission**