Four Highlights of "Deepening the Reform of Medical and Health System Key Tasks in 2017"

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Graded diagnosis and treatment pilot and family doctor contracted services expanded to more than 85% of cities, urban and rural residents medical insurance financial subsidies per person per year to increase 30 yuan ...... Recently, the General Office of the State Council issued the "Deepening the Reform of the Medical and Health System 2017 Key Tasks" proposed that in 2017 to basically establish a hierarchical diagnosis and treatment, modern hospital management, universal health care, drug supply security, comprehensive supervision and other five basic medical and health system framework, to deepen the medical reform "implementation year" to build "four beams and eight pillars".

In 2017, what are the "small goals" of deepening medical reform and how to promote the "construction drawing"? How to break the chronic disease of reform and how to achieve "stepping on the stone and leaving a mark on the iron"? Experts believe that the "work task" reflects the general idea and requirements for further improving the medical reform policy, and reflects the development trend of raising the reform to the construction of the system.

Point 1: Breaking the "Pain" of Difficult Medical Treatment at the Grass-roots Level Expanded to More than 85% of Cities in 2017

The total amount is insufficient, the structure is unreasonable, and the distribution is uneven. The "medium obstruction" of my country's medical resources makes it difficult for the grassroots people to seek medical treatment for a long time. How can the supply-side structural reform of medical and health services improve the "gold content"? Wang Hesheng, director of the State Council's Medical Reform Office and deputy director of the National Health and Family Planning Commission, said that as one of the primary tasks of the 13th Five-Year Plan to deepen the medical reform plan, graded diagnosis and treatment is a key part of optimizing the order of medical treatment, which is of strategic significance for building a new pattern of medical reform.

Data show that as of the end of 2016, 4 municipalities and 266 cities have carried out hierarchical diagnosis and treatment pilot. The "work task" emphasizes that the scope of the pilot project will be further expanded this year, and the pilot project of graded diagnosis and treatment will be expanded to more than 85% of the prefectures and cities.

"Tong" is not "pain", amplifying the effect of superior medical resources requires the institutional innovation of the medical consortium, and doing a good job of graded diagnosis and treatment "booster" at the mechanism level ". The "Work Task" proposes to fully launch various forms of medical consortium construction pilots, and tertiary public hospitals must all participate and play a leading role. Wang Hesheng said that the construction of a "hospital at the door of the people's home" is conducive to the connection of high-quality medical resources, and is an important starting point for gradually realizing the goal of providing all-round and full-cycle health services for the people. Zhao Kun, a researcher at the Health Development Research Center of the National Health and Family Planning Commission, believes that in the future, we should accelerate the removal of institutional barriers, encourage social medical institutions to join the construction of medical consortia, improve supporting measures, and pool medical resources.

How can we ensure that grass-roots services are "receptive" when large hospitals are "willing to let go" and patients "come down"? In terms of "hematopoiesis" for grass-roots medical services, the Task Force emphasizes the training of more than 25000 general practitioners, the addition of about 70000 new physicians to participate in standardized resident training, the acceleration of the development of the health industry related personnel training, while optimizing the proportion of senior positions in grass-roots medical institutions to enhance job attractiveness.

Point 2: The average increase in medical expenses in public hospitals should be controlled below 10% within a year to break the "medicine supplement"

"The reform of public hospitals is the most difficult 'hard bone' in the new round of deepening medical reform '." Some experts said that my country urgently needs to establish a modern hospital management system as a "hub" for the transformation of the new operating mechanism ". With heavy burdens, heavy responsibilities, and a lot of attention, how can public hospitals straighten out the structure of medical expenses, save "real money" for people's medical treatment, and at the same time enhance people's satisfaction and mobilize the enthusiasm of medical staff?

In order to reduce the "virtual fire" of drug prices, the "work task" is clear that the comprehensive reform of public hospitals will be comprehensively launched by the end of September, and all public hospitals will cancel the drug addition (except for Chinese herbal pieces). To adjust the structure and make room, the "work task" clearly allows medical and health institutions to break through the current wage regulation and control level of public institutions, and separately formulate measures for determining the total amount of performance wages for medical and health institutions, and gradually increase the proportion of medical service income such as diagnosis and treatment fees, nursing fees and operation fees in the total income of the hospital. "The" Work Task "puts forward higher requirements for the refined development of public hospitals, which will promote connotative development." Wang Hufeng, director of the Medical Reform Research Center of Renmin University of China, said.

Experts said that public welfare should be written on the banner of public hospital reform to avoid "talking about heroes based on economic benefits". At the same time, we should truly realize the "coordinated promotion of the reform of management system, medical price, personnel salary and medical insurance payment method" proposed in the "work task", accelerate the transformation of public hospital functions, and improve the quality and efficiency of medical services.

Point three: medical insurance management "six unified" to do a good job of "leverage" "engine"

For a long time, under the old system, drug procurement in some places was centralized to the health care department, and the medical insurance department was responsible for "paying the bill" but could not "order food". How to implement the external constraints of the health insurance fund?

The "Work Task" emphasizes that it is necessary to pilot the establishment of a medical insurance fund management center to undertake functions such as drug procurement and cost settlement, and medical insurance payment standard negotiation. "This will help to realize the overall management of the basic medical insurance fund, to give full play to the centralized payment function of medical insurance for the purchase of drugs, to strengthen the supervision and control of hospitals and doctors, and to standardize service behavior." Fujian medical insurance office director Zhan Jifu said.

Relevant experts from the Social Security Research Institute of the Ministry of Human Resources and Social Security also said that medical insurance payment should not only focus on the balance of medical insurance funds and the treatment of insured persons, but also pay attention to the accessibility of drugs by patients and the smooth operation of the pharmaceutical market in the future.

Point 4: In 2017, comprehensive medical reform pilot provinces and 200 public hospital comprehensive reform pilot cities will fully implement the "two-vote system"

In response to problems such as inflated drug prices and frequent chaos in circulation, the "Work Tasks" follow the relevant requirements of the "Several Opinions of the General Office of the State Council on Further Reforming and Improving Drug Production, Circulation and Use Policies" in the field of drug reform. Make efforts to reform and improve the circulation system. In 2017, all public medical institutions in the pilot provinces of comprehensive medical reform and the first four batches of 200 public hospital comprehensive reform pilot cities will fully implement the "two-invoice system". At the same time, adhere to the principle of centralized procurement with volume, so that drug prices "formed in the sun".

In order to allow the common people to use cheap and high-quality medicines, the "Work Task" emphasizes further expanding the scope of designated production of shortage drugs, and establishing and improving the monitoring and early warning and hierarchical response system for shortage drugs. Ding Jinxi, a professor at China Pharmaceutical University, said that the "work task" reflects the reform direction of precise policy implementation, and "really covers the bottom line" for the urgent needs of health and people's livelihood ".

Ding Jinxi pointed out that in accordance with the relevant arrangements of the "Work Tasks", my country should also strengthen the role of pharmacists as the "gatekeeper" of drug safety in the next step to promote the rational use of drugs in medical institutions. (Xinhua News Agency reporters Wang Bin and Li Song)