In order to promote the high-quality development of county medical and health undertakings, the General Office of the Henan Provincial People ’s Government has recently issued “Guiding Opinions on Accelerating the Construction of a Closer County Medical and Health Community” (hereinafter referred to as the “Opinions”), which aims to accelerate the promotion of graded diagnosis Achieve orderly medical treatment and comprehensively improve the county's medical and health services.

 

The "Opinions" make it clear that the construction of the medical community will be promoted in the province in 2020, and the pilot counties (cities) determined by the state and our province will achieve substantial results. Through the construction of the medical community, the county's medical and health service capacity has been significantly improved, the medical insurance fund has been effectively used, the residents' medical expenses have been reasonably controlled, and an orderly medical treatment pattern has basically been formed. Strive to achieve a 90% county medical consultation rate and a 65% primary medical consultation rate within the county %, The technology and projects that primary-level medical and health institutions are capable of carrying out continue to increase.

 

"Opinions" put forward four tasks:

 

One is to reshape the service system. According to the structure and layout of medical and health resources in the county, 1-3 medical communities will be established, led by county-level public medical institutions, with other county-level medical institutions, township health centers, and community health service centers as member units. The Medical Community provides medical and health services covering the whole life process, meeting the needs of healthy life, safe, effective, convenient and accessible for the residents in the jurisdiction. Strengthen the construction of county informatization and promote the interconnection of information systems of medical and health institutions. Develop telemedicine services and promote the development of "Internet + medical health".

 

The second is to innovate institutional mechanisms. Strengthen the Party's construction, improve the management system, and establish medical committee deliberations and coordination in accordance with the principles of optimization, coordination, and efficiency, led by county-level party committees and governments, with institutional preparation, development and reform, financial departments, and representatives of medical community member units. Mechanism, co-ordinating major issues such as the planning and layout of the construction of the medical community, investment guarantees, personnel arrangements, policy formulation and assessment supervision. According to the mode of group management, integrated operation, and continuous service, the medical community charter was formulated to gradually form a community of services, responsibilities, benefits, and management.

 

The third is to improve service efficiency. Strengthen the capacity building of county-level hospitals; stimulate the vitality of township health centers; consolidate the position of village clinics. The basic public health service tasks of not less than 45% will be entrusted to village clinics by 2020, and will be increased to 50% from 2021, and Corresponding subsidies will be given based on the assessment results. Strictly manage the quality of medical services; enhance the capacity of public health services; make sure that family doctors sign up for services; promote the formation of an orderly medical pattern; and promote the promotion of universal health literacy.

 

The fourth is to improve the support policy. Governments at all levels must strictly implement the investment policy for public hospitals and grass-roots medical and health institutions, and arrange all subsidies for medical community member units in full according to the original channels. The medical insurance department implements the budget management of the total medical insurance fund for the medical community, establishes an incentive and restraint mechanism for surplus retention and overexpenditure, deepens the reform of the personnel compensation system, and encourages the implementation of the annual salary system for the heads of the medical community and member units. Adjust the price of medical services, innovate the supervision model, and strengthen the accounting and auditing supervision of the economic operation and financial activities of the medical community.

 

The full text is attached below:

 

Guiding Opinions of the General Office of the People ’s Government of Henan Province on Accelerating the Construction of a Close County Medical and Health Community

 

April 9, 2020

 

The people's governments of the provinces, the management committee of the Jiyuan Demonstration Zone, the people's governments of the counties (cities) directly under the provinces, and the departments of the provincial people's government:

 

In order to promote the high-quality development of county-level medical and health services, accelerate the promotion of graded diagnosis and treatment, and achieve orderly medical treatment, with the consent of the provincial government, the following suggestions are made on accelerating the construction of a compact county-level medical and health community (hereinafter referred to as the medical community).

 

1. General requirements

 

(1) Guiding ideology. Guided by Xi Jinping ’s socialist ideology with Chinese characteristics in the new era, fully implement the spirit of the 19th National Congress of the Communist Party of China and the Second, Third, and Fourth Plenary Sessions of the 19th CPC Central Committee, adhere to the people ’s health as the center, and deepen the structure of the county ’s medical and health services Reform, accelerate the construction of the medical community, build a health care service system with clear positioning, clear rights and responsibilities, and division of labor, comprehensively improve the county health care service level, and provide people with fair, accessible and systematic health services.

 

(2) Basic principles.

 

1. Adhere to government leadership. Fully implement the government's responsibility for running medicine, coordinate the development of urban and rural integration, optimize and integrate the medical and health resources in the county, rationally form a medical community, innovate the management system and operating mechanism, and improve the security policy.

 

2. Stick to separate management. Deepen the reform of "delegating services", clarify the responsibilities of the management office, implement the autonomy of the management and management of the medical community, and promote the coordinated development within the medical community and the orderly competition between the medical communities.

 

3. Persist in sinking resources. Promote the downward shift of the focus of medical and health work, sinking of medical and health resources, give full play to the role of the link between the county hospitals and the lower link, and lead more high-quality medical and health resources to the grassroots and invest in the grassroots.

 

4. Adhere to the combination of prevention and control. Carry out the prevention-oriented sanitation and health work policy, give full play to the unique role of traditional Chinese medicine in maintaining and promoting people's health, and promote the transformation from "treating disease-centered" to "people-centered health".

 

5. Adhere to the public welfare orientation. Focusing on the improvement of basic medical and health services, we will coordinately promote the reform of medical, medical insurance, and medical linkages, and enhance the people's sense of gain.

 

(3) Main objectives. In 2020, the construction of the medical community will be promoted in the whole province, and the pilot counties (cities) identified by the state and our province will achieve substantial results. Through the construction of the medical community, the county's medical and health service capacity has been significantly improved, the medical insurance fund has been effectively used, the residents' medical expenses have been reasonably controlled, and an orderly medical treatment pattern has basically been formed. %, The technology and projects that primary-level medical and health institutions are capable of carrying out continue to increase.

 

Second, the task

 

(1) Reshape the service system.

 

1. Optimize resource layout. According to the structure and layout of medical and health resources in the county, 1-3 medical communities will be established, led by county-level public medical institutions, with other county-level medical institutions, township health centers, and community health service centers as member units. The medical institutions leading medical institutions are in principle second-class and above medical institutions. Encourage social forces to run medical institutions, rehabilitation centers, and nursing homes to join the medical community. The legal personality of the medical community member unit remains unchanged, and its legal representative may be (part-time) served by the person in charge of the lead medical institution.

 

2. Clear function positioning. The Medical Community provides medical and health services covering the whole life process, meeting the needs of healthy life, safe, effective, convenient and accessible for the residents in the jurisdiction. The medical community-led medical institution focuses on the treatment of acute and critically ill patients and upward referral services for patients with difficult and complex diseases, as well as overall management of medical services, public health services, and integration of medical and nursing services in the medical community. Primary-level medical and health institutions provide diagnosis and treatment services for common diseases and frequently-occurring diseases, provide continuous medical and health services for patients with well-diagnosed and stable chronic diseases, and patients during rehabilitation, and do basic public health services and health poverty alleviation work. Other medical and health institutions conduct business in accordance with their functional positioning and the division of responsibilities of the medical community.

 

3. Promote joint construction and sharing. Strengthen the construction of county informatization and promote the interconnection of information systems of medical and health institutions. Establish centers for remote consultation, remote electrocardiography, remote imaging, examination and inspection, pathological diagnosis, and disinfection supply, promote grass-roots examination, superior diagnosis, and promote mutual recognition of examination and examination results within counties. To develop telemedicine services, take county-level medical institutions as a link, connect up with the city's third-level hospitals, and radiate down to township hospitals and village clinics, and promote the development of "Internet + medical health".

 

(2) Innovative institutional mechanisms.

 

1. Strengthen party building. Earnestly implement the Provincial Party Committee's plan to strengthen the party's construction of public hospitals in the province, establish the Medical Communist Party Committee, give full play to the leadership role of the Medical Communist Party Committee, implement the president's responsibility system under the leadership of the Party Committee, and fully implement the strict governance of the Party Guidelines and requirements to strengthen the construction of party style and clean government and medical ethics.

 

2. Improve the management system. In accordance with the principles of optimization, coordination, and efficiency, establish the medical community deliberations led by county-level party committees and governments, with institutional establishment, development and reform, finance, human resources, social security, health and medical insurance, and representatives of medical community member units. Coordination mechanism to coordinate the planning, layout, investment guarantee, personnel arrangement, policy formulation, assessment and supervision of the construction of medical community. The office of the coordination mechanism is located at the county-level health committee, the director of the office is also served by the director of the health committee, and the members are composed of the relevant personnel of each member unit.

 

3. Improve the operating mechanism. According to the mode of group management, integrated operation and continuous service, formulate the charter of the medical community, clarify the relationship between the leading medical institution and the member unit of the medical community, and improve the participation of the leading medical institution and each member unit in regular consultations The decision-making system promotes unified management of administration, personnel, business, medicine, finance, performance, and information, and gradually forms a community of services, responsibilities, interests, and management. Explore the establishment of the chief accountant system and the chief pharmacist system.

 

(3) Improve service efficiency.

 

1. Strengthen the capacity building of county-level hospitals. Accelerate the construction of key specialties such as respiration, intensive care, infection, tumor, cardio-cerebrovascular, hemodialysis, pathology, occupational disease prevention, mental health and geriatrics in county-level hospitals, and promote diagnosis and treatment of traditional Chinese medicine, chest pain, stroke, trauma, and critically ill pregnant women Construction of centers for treatment, treatment of critically ill children and newborns, and management of chronic diseases. Strengthen the construction of county-level medical centers. County (city) people's hospitals have all reached the second-class level A, and some have reached the third-level general hospital medical service capacity. Give full play to the helping and leading role of urban tertiary hospitals, and improve the service capacity and management level of the medical community leading medical institutions.

 

2. Stimulate the vitality of township health centers. Strictly implement the public welfare first-class financial security policy, allowing township health centers to break through the current wage adjustment level of public institutions and independently determine the internal performance wage ratio; more than 60% of the balance of medical service income after deduction of costs and withdrawal of various funds in that year For the issuance of incentive performance wages, subprojects such as general practitioner post allowance, overtime night shift subsidies, subsidies to the countryside, toxic and harmful subsidies can be set up in the incentive performance wages; in principle, the family doctor's contracted service income is not less than 70 % Is used for internal distribution of the contracting team. The family doctor contracting service fee and general practitioner post allowance for internal distribution of the contracting team are included in the total performance salary management and are listed separately in the performance salary. For general practitioners working in township health centers, certain job allowances will be issued based on factors such as working conditions, work tasks and length of service, and financial subsidies will be granted. In principle, the income level of general practitioners in primary-level medical and health institutions should not be lower than the average income level of clinicians with the same conditions in local county-level general hospitals. Within 3 years, all township health centers have reached the basic standard or recommended standard of service capacity.

 

3. Consolidate the village clinic position. In 2020, no less than 45% of the basic public health service tasks will be entrusted to the village clinic, which will be increased to 50% from 2021, and corresponding subsidies will be granted based on the assessment results. According to the regulations, special subsidies for village clinics' general medical expenses and basic medicine system shall be implemented. Actively promote the construction of public health village clinics. Gradual implementation of tight rural integrated management, rural village doctors with qualified (assistant) doctor qualifications should be employed by villages and villages, be included in the unified management of township health centers, participate in basic pension insurance for enterprise employees according to law, and the payment of township health centers should be included in their normal The scope of expenditure is subsidized by the county finance. Rural doctors are encouraged to voluntarily participate in basic pension insurance for enterprise employees or pension insurance for urban and rural residents as flexible social employees.

 

4. Strict medical service quality management. The member units of the Medical Community implement unified standards in systems, technical specifications, service processes, personnel training, quality control, etc., and implement unified management in the procurement and distribution of pharmaceutical consumables and pharmaceutical services. Use clinical path management, disease diagnosis related grouping (DRGs) performance evaluation and other management tools to strengthen medical service quality supervision.

 

5. Improve public health service capacity. Improve the public health service system, optimize the input structure of medical and health resources, and strengthen the building of grassroots prevention and control capabilities. Strengthen the construction of the public health team, and improve the training, access, use, treatment guarantee, assessment and evaluation and incentive mechanisms for practitioners. Promote the efficient coordination and seamless connection of public health services and medical services, improve the mechanism of prevention and control, joint prevention and joint control, and group prevention and treatment, and improve the capacity for major epidemic prevention and control and emergency treatment of public health emergencies. Professional public health institutions, such as disease control and maternal and child health care, may send part-time deputy deans and technical backbones to the medical community to carry out technical guidance and professional training.

 

6. Realize family doctor contract service. Make full use of the medical community's technical resources, incorporate specialists from county-level medical institutions as a technical support force into the family doctor team, establish a service model with general practitioners at the core, effective linkage of general specialists, and organic integration of medical and defense, to improve the quality of contracted services .

 

7. Promote the formation of an orderly medical treatment pattern. Provide diagnosis and treatment services in accordance with the three-level disease diagnosis and treatment catalogues of counties, townships and villages, improve the management methods for referrals within and between medical communities and outside the county, and gradually form the "basic primary consultation, two-way referral, rapid division, "Up and down linkage" graded diagnosis and treatment, orderly medical treatment pattern.

 

8. Promote national health literacy promotion actions. Improve the "three-entry, two-construction, one-help" health promotion work model (promote health education into rural areas, families, and schools, and strengthen the construction of health education positions and health education teams; by a third-level hospital, a county level Medical institutions and a provincial expert correspond to a county to help guide the grassroots to carry out health education work), and raise the people's self-health management awareness and health literacy level.

 

(4) Improve support policies.

 

1. Implement the financial security policy. Governments at all levels must strictly implement the investment policy for public hospitals and grass-roots medical and health institutions, and arrange all subsidies for medical community member units in full according to the original channels. The county-level government should implement the investment responsibility for the county-level public hospitals in accordance with the regulations.

 

2. Reform medical insurance payment methods. The medical insurance department implements budget management of the total amount of medical insurance funds for the medical community, establishes an incentive and restraint mechanism for the retention of surplus and overpayment, and reserves a certain percentage of risk adjustment funds, quality guarantee funds and total funds for the basic medical insurance of urban and rural residents in the county within the year. After the major illness insurance fund, according to the number of insured residents covered by the medical community, combined with the provision of medical services in the past 1-3 years and the payment of the medical insurance fund, the annual pre-division quota of the medical community is determined, and the medical insurance agency will prepay the medical community on a monthly basis. The leading medical institution implements the budget at the beginning of the year, monthly advance payment, quarterly assessment, and year-end liquidation. The medical community takes the lead in the medical institutions to do the medical insurance fund settlement with other medical communities and medical institutions in the county and the referral review outside the county. The medical insurance expenses incurred for out-of-country medical treatment are paid from the medical community's annual pre-division quota. The municipal medical insurance department organizes and supervises the management of the medical insurance fund of the medical community, and the assessment results are linked to the return of quality guarantee funds, the annual liquidation of medical insurance expenses, and the determination of the pre-annual quota for the next year, to ensure that the medical service level and quality of the medical community are not reduced. .

 

3. Deepen the reform of the personnel compensation system. The establishment of county-level medical institutions and primary-level medical and health institutions within the Medical Communities is separately verified and explored for use by the Medical Community as a whole. Implement the autonomy of the Medical Community in personnel recruitment, job setting, appointment of middle-level cadres, internal performance evaluation, income distribution, and appointment of professional titles. Explore the establishment of a mechanism for the introduction, use, and management of talents recruited by the county, employed by the village, employed by the village, and stationed in rotation. Establish an incentive and restriction mechanism to promote the sinking of talents, and it is strictly forbidden to siphon grassroots professional and technical personnel. Encourage the implementation of the annual salary system for the heads of medical communities and heads of member units.

 

4. Adjust the price of medical services. According to the total amount control,