Gwyf [2016] No. 45
The health and Family Planning Commission, the administration of traditional Chinese medicine and the Health Bureau of Xinjiang production and Construction Corps of all provinces, autonomous regions and municipalities directly under the Central Government:
In order to implement the relevant work requirements of the guiding opinions on promoting the construction of hierarchical diagnosis and treatment system (GBF [2015] No. 70, hereinafter referred to as the opinions), the notice of the general office of the State Council on printing and distributing the key work tasks of deepening the reform of the medical and health system in 2016 (GBF [2016] No. 26) and the 2016 government work report, on the basis of local declaration, The national health and Family Planning Commission and the State Administration of traditional Chinese medicine have identified four municipalities directly under the central government such as Beijing and 266 prefecture level cities such as Shijiazhuang in Hebei Province as pilot cities to carry out the pilot work of graded diagnosis and treatment. The following requirements are put forward for promoting the pilot work of graded diagnosis and treatment:
1、 Raise awareness and strengthen leadership
The health and family planning administrative departments of all provinces and pilot cities (including the administrative departments of traditional Chinese medicine, the same below) should fully understand the importance, difficulty and complexity of hierarchical diagnosis and treatment, give full play to the role of "vanguard" of pilot cities, strengthen the sense of responsibility and mission, and incorporate the construction of hierarchical diagnosis and treatment system into the overall arrangement of deepening medical reform in accordance with the relevant work requirements of the opinions, Effectively strengthen organizational leadership. On the basis of full investigation and demonstration, combined with the local medical reality, formulate a clear and feasible pilot work plan, clarify the objectives, tasks and time schedule, improve the management system and strictly implement it, and complete the pilot work tasks on time and with quality.
2、 Pilot first and highlight key points
The health and family planning administrative departments of the pilot cities shall, in accordance with the relevant work requirements of the opinions, formulate and implement various supporting policies and measures for the pilot around the pilot work plan, deploy and start the pilot work as soon as possible. On the basis of fully implementing the relevant requirements of the opinions, the following work will be done in 2016:
one
Further improve grass-roots service capacity
We will continue to strengthen the capacity-building of grass-roots medical and health institutions and county-level hospitals, strengthen the promotion of appropriate technologies around the diseases with high transfer out rate outside the county, and improve the disease diagnosis and treatment capacity of county-level hospitals. Through the establishment of medical consortia, counterpart support and multi-point practice of doctors, doctors in hospitals above the second level in cities are encouraged to practice in grass-roots medical and health institutions, or make regular visits and visits, so as to promote the flow of medical resources to grass-roots and rural areas and improve the service capacity of grass-roots. Improve the service capacity of traditional Chinese medicine and medical rehabilitation services of grass-roots medical and health institutions, strengthen the construction of characteristic diagnosis and treatment areas of traditional Chinese medicine, promote the comprehensive service mode of traditional Chinese medicine, and give full play to the role of traditional Chinese medicine in the prevention and treatment of common diseases, frequently occurring diseases and chronic diseases.
two
Promote family doctor signing services
Implement the relevant work requirements of the guiding opinions on promoting the contracted services of family doctors (Guo Yi Gai Ban Fa [2016] No. 1), summarize and promote the mature experience of local governments in promoting the contracted services of family doctors, formulate policy documents on improving the contracted services and management, and establish and improve the general practitioner system. Clarify the connotation and standards of signing services, standardize the charging of signing services, and improve the incentive and restraint mechanism of signing services. The contracted service fee shall be shared by the medical insurance fund, basic public health service funds and individual contracted residents.
three
Explore the establishment of medical Consortium
The health and family planning administrative departments at the provincial level and pilot cities should make overall planning, gradually form a regional collaborative service model with clear responsibilities, rights and interests through the establishment of a medical consortium, use information-based means such as telemedicine to promote the sharing and vertical flow of regional medical resources, and improve the hierarchical diagnosis and treatment service system. On the basis of the original work, encourage the formation of medical consortia in the region according to the principle of proximity and voluntariness, avoid the form of cross provincial formation, establish a responsibility sharing and benefit sharing mechanism within the medical consortia, and fully mobilize the enthusiasm of member units. In cities, areas with conditions are encouraged to establish asset integrated medical consortia based on ownership, or medical consortia focusing on resource sharing and technical cooperation. At the county level, we will focus on promoting the medical consortium led by county-level hospitals and integrated management of counties and townships.
four
Scientific implementation of urgent and slow treatment
Taking the Medical Union as the carrier and daytime surgery as the breakthrough, clarify the service process of acute and slow treatment in the medical union according to the functional positioning and medical service capacity of various medical institutions in the Medical Union.
(1) Implement the functional orientation of medical institutions. Urban tertiary hospitals mainly provide diagnosis and treatment services for acute, critical and complex diseases; Urban secondary hospitals mainly receive patients in the recovery stage of acute diseases, patients in the recovery stage after operation and patients in the stable stage of critical diseases referred by tertiary hospitals; Level III TCM hospitals mainly make full use of TCM technology and methods and modern science and technology to provide TCM diagnosis and treatment services for acute, critical, difficult and complex diseases and TCM outpatient diagnosis and treatment services for dominant diseases of TCM; The secondary traditional Chinese medicine hospital mainly makes full use of traditional Chinese medicine technology and modern science and technology to provide traditional Chinese medicine diagnosis and treatment of common, frequently occurring and chronic diseases in the region, rescue of critically ill patients, and upward referral services for difficult and complex diseases; Provide medical treatment and rehabilitation services for elderly patients with chronic diseases.
(2) Establish a division of labor and cooperation mechanism for medical institutions within the Medical Federation. Patients beyond the diagnosis and treatment capacity of medical institutions shall be transferred to the nearest higher-level hospital within the Medical Union; For patients with chronic diseases and convalescent patients with clear diagnosis and stable condition, they shall be transferred to subordinate medical institutions to provide continuous diagnosis and treatment services for patients. Where conditions permit, a patient referral center shall be established within the Medical Federation to coordinate and arrange two-way referral services for patients. For areas with imperfect grass-roots TCM service system and weak ability, we should treat TCM hospitals differently, include TCM outpatient diagnosis and treatment services in TCM hospitals into the scope of the first diagnosis, give full play to the service capacity of TCM hospitals, and meet the needs of the people for the first diagnosis and treatment of TCM.
(3) Gradually promote daytime surgery. Taking the medical consortium as the starting point, gradually promote the daytime operation mode of division of labor and cooperation between tertiary hospitals and their cooperative secondary hospitals and grass-roots medical and health institutions. Level III hospitals gradually implement daytime surgery, optimize the diagnosis and treatment service process, improve the efficiency of medical services, provide efficient daytime surgery services for patients on the premise of ensuring medical quality and safety, transfer patients with stable postoperative rehabilitation to level II hospitals and grass-roots medical and health institutions, establish a postoperative patient follow-up system, and guide lower level medical institutions to do a good job in patients' postoperative rehabilitation, And open a green channel for day surgery for grass-roots medical and health institutions.
five
Accelerate the construction of medical and health information and promote regional resource sharing
Accelerate the construction of regional medical and health information platform, and gradually realize the continuous recording of electronic health archives and electronic medical records, as well as the information sharing among different levels and different types of medical institutions. Using information-based means such as telemedicine to promote the vertical flow of medical resources and improve the accessibility of high-quality medical resources and the overall efficiency of medical services. Develop Internet-based medical and health services, and give full play to the role of Internet, big data and other information technology means in hierarchical diagnosis and treatment. Explore the establishment of independent medical institutions such as medical image diagnosis center and medical laboratory to realize regional resource sharing.
six
Strengthen departmental coordination and improve supporting policies
Health and family planning administrative departments at the provincial level and pilot cities should strengthen communication and cooperation with relevant departments such as development and Reform (price), finance, human resources and social security, innovate systems and mechanisms, improve supporting policies, make overall and coordinated progress, and create conditions for promoting the construction of hierarchical diagnosis and treatment system. Further improve the pharmaceutical price policy and implement graded pricing measures. Improve the medical insurance payment policy, promote the reform of medical insurance payment mode, and improve the performance-based salary distribution mechanism. Implement the financial subsidy policy. Through the pilot of graded diagnosis and treatment, more useful experiences that can be copied and popularized will be formed.
3、 Strengthen assessment and summarize in time
The health and family planning administrative departments at the provincial level and pilot cities shall establish a pilot effect evaluation mechanism and performance evaluation methods, and earnestly implement the responsibility system and accountability system. Establish a tracking and supervision system for key work, set annual quantitative indicators for pilot work tasks, strengthen policy guidance, and regularly supervise and inspect the implementation of pilot work within the jurisdiction. Carefully organize and carry out baseline survey to provide baseline data for pilot evaluation in the future. Establish a regular reporting system for data and information of graded diagnosis and treatment pilot work, strengthen the monitoring of the pilot situation, collect relevant data, and carry out data analysis by means of informatization. Timely grasp the progress of the pilot work and summarize the useful experience of promotion.
We should strengthen exchanges and learning, fully learn from the mature experience of other pilot areas, innovate ideas and constantly promote. When the health and family planning administrative departments of the pilot cities formulate the pilot work plan, they can refer to Shanghai. On the basis of residents' voluntary choice of family doctors in the community health service center, they can choose a district level medical institution and a municipal level medical institution to sign the contract, forming a "1 + 1 + 1" combination of signed medical institutions, with the elderly over 60 as the main body, Based on the principle of voluntary contract signing and high-quality service, we will gradually promote the establishment of a hierarchical diagnosis and treatment system. With hypertension and diabetes as the breakthrough point, Xiamen has set up a team composed of specialists, general practitioners and health administrators, to link up the large hospitals and the community hospitals with the "three teachers co management" as the link. Jiangsu Province has established a medical consortium to implement resource sharing, information interconnection, personnel allocation and homogeneous services within it. Hangzhou focuses on signing contracts with family doctors to promote graded diagnosis and treatment.
4、 Strengthen publicity and guide public opinion
The health and family planning administrative departments at the provincial level and pilot cities should strengthen publicity and education, carry out relevant training for administrative personnel and medical personnel, take the establishment of hierarchical diagnosis and treatment system as an inevitable requirement for fulfilling social responsibilities and promoting career development, enhance initiative and enthusiasm. Give full play to the role of the media, strengthen the promotion of the service capacity of grass-roots medical and health institutions and the promotion of graded diagnosis and treatment, and strive for the recognition and support of all sectors of society and the broad masses of the people for the graded diagnosis and treatment system. Widely publicize disease prevention and control knowledge, promote patients to establish a scientific concept of medical treatment, and give priority to grass-roots medical and health institutions.
The health and family planning administrative departments of the pilot cities are requested to print and distribute the pilot work plan and start the pilot work before September 15, 2016. The provincial health and family planning administrative departments are requested to collect and summarize the pilot work plans officially issued by the pilot cities within their jurisdiction, and submit them to the national health and Family Planning Commission and the State Administration of traditional Chinese medicine for the record before September 30, 2016.
The provincial health and family planning administrative departments shall summarize the pilot work within their jurisdiction on a monthly basis and submit the monthly work progress to the medical administration and medical administration of the national health and Family Planning Commission before January 15. The national health and Family Planning Commission will timely organize the supervision and inspection of the implementation of the pilot work of graded diagnosis and treatment in various regions, and conduct the assessment item by item according to the assessment and evaluation criteria for the pilot work of graded diagnosis and treatment attached to the opinions.
State health and Family Planning Commission and State Administration of traditional Chinese Medicine
August 19, 2016
Gwyf [2016] No. 45
The health and Family Planning Commission, the administration of traditional Chinese medicine and the Health Bureau of Xinjiang production and Construction Corps of all provinces, autonomous regions and municipalities directly under the Central Government:
In order to implement the relevant work requirements of the guiding opinions on promoting the construction of hierarchical diagnosis and treatment system (GBF [2015] No. 70, hereinafter referred to as the opinions), the notice of the general office of the State Council on printing and distributing the key work tasks of deepening the reform of the medical and health system in 2016 (GBF [2016] No. 26) and the 2016 government work report, on the basis of local declaration, The national health and Family Planning Commission and the State Administration of traditional Chinese medicine have identified four municipalities directly under the central government such as Beijing and 266 prefecture level cities such as Shijiazhuang in Hebei Province as pilot cities to carry out the pilot work of graded diagnosis and treatment. The following requirements are put forward for promoting the pilot work of graded diagnosis and treatment:
1、 Raise awareness and strengthen leadership
The health and family planning administrative departments of all provinces and pilot cities (including the administrative departments of traditional Chinese medicine, the same below) should fully understand the importance, difficulty and complexity of hierarchical diagnosis and treatment, give full play to the role of "vanguard" of pilot cities, strengthen the sense of responsibility and mission, and incorporate the construction of hierarchical diagnosis and treatment system into the overall arrangement of deepening medical reform in accordance with the relevant work requirements of the opinions, Effectively strengthen organizational leadership. On the basis of full investigation and demonstration, combined with the local medical reality, formulate a clear and feasible pilot work plan, clarify the objectives, tasks and time schedule, improve the management system and strictly implement it, and complete the pilot work tasks on time and with quality.
2、 Pilot first and highlight key points
The health and family planning administrative departments of the pilot cities shall, in accordance with the relevant work requirements of the opinions, formulate and implement various supporting policies and measures for the pilot around the pilot work plan, deploy and start the pilot work as soon as possible. On the basis of fully implementing the relevant requirements of the opinions, the following work will be done in 2016:
one
Further improve grass-roots service capacity
We will continue to strengthen the capacity-building of grass-roots medical and health institutions and county-level hospitals, strengthen the promotion of appropriate technologies around the diseases with high transfer out rate outside the county, and improve the disease diagnosis and treatment capacity of county-level hospitals. Through the establishment of medical consortia, counterpart support and multi-point practice of doctors, doctors in hospitals above the second level in cities are encouraged to practice in grass-roots medical and health institutions, or make regular visits and visits, so as to promote the flow of medical resources to grass-roots and rural areas and improve the service capacity of grass-roots. Improve the service capacity of traditional Chinese medicine and medical rehabilitation services of grass-roots medical and health institutions, strengthen the construction of characteristic diagnosis and treatment areas of traditional Chinese medicine, promote the comprehensive service mode of traditional Chinese medicine, and give full play to the role of traditional Chinese medicine in the prevention and treatment of common diseases, frequently occurring diseases and chronic diseases.
two
Promote family doctor signing services
Implement the relevant work requirements of the guiding opinions on promoting the contracted services of family doctors (Guo Yi Gai Ban Fa [2016] No. 1), summarize and promote the mature experience of local governments in promoting the contracted services of family doctors, formulate policy documents on improving the contracted services and management, and establish and improve the general practitioner system. Clarify the connotation and standards of signing services, standardize the charging of signing services, and improve the incentive and restraint mechanism of signing services. The contracted service fee shall be shared by the medical insurance fund, basic public health service funds and individual contracted residents.
three
Explore the establishment of medical Consortium
The health and family planning administrative departments at the provincial level and pilot cities should make overall planning, gradually form a regional collaborative service model with clear responsibilities, rights and interests through the establishment of a medical consortium, use information-based means such as telemedicine to promote the sharing and vertical flow of regional medical resources, and improve the hierarchical diagnosis and treatment service system. On the basis of the original work, encourage the formation of medical consortia in the region according to the principle of proximity and voluntariness, avoid the form of cross provincial formation, establish a responsibility sharing and benefit sharing mechanism within the medical consortia, and fully mobilize the enthusiasm of member units. In cities, areas with conditions are encouraged to establish asset integrated medical consortia based on ownership, or medical consortia focusing on resource sharing and technical cooperation. At the county level, we will focus on promoting the medical consortium led by county-level hospitals and integrated management of counties and townships.
four
Scientific implementation of urgent and slow treatment
Taking the Medical Union as the carrier and daytime surgery as the breakthrough, clarify the service process of acute and slow treatment in the medical union according to the functional positioning and medical service capacity of various medical institutions in the Medical Union.
