[Research Report]
Join forces to protect people’s health in an all-round way
- A survey report based on community residents in 10 provinces and 20 cities
Wuhan University Population and Health Research Center Research Group
Editor’s Note
Recently, General Office of the State Council issued the "14th Five-Year Plan for National Health Plan" to make specific arrangements for comprehensively promoting the construction of a healthy China during the "14th Five-Year Plan" period. People's health is the most important indicator of modernization and the foundation for people's happy life. Since the 18th National Congress of the Communist Party of China, the Party Central Committee with Comrade Xi Jinping as the core has placed the protection of people's health in a more prominent position and issued a call to build a healthy China. People's health conditions and the fairness and accessibility of basic medical and health services have continued to improve. Looking back at the construction of a healthy China, what achievements have we made, what shortcomings do we still need to make up for, and how should we overcome difficulties and effectively advance it? This think tank report is presented to you.
Health is connected to the happiness of thousands of families and is related to the future of the country and the nation. In order to objectively present the current situation of building a healthy China and accurately understand the health demands of urban and rural residents, this research team conducted field surveys among community residents in 20 cities in 10 provinces, including Jilin, Zhejiang, Hubei, and Sichuan, from August to December 2021, and comprehensively analyzed 3231 A personal questionnaire and 55 community worker interviews were used to form this report, in order to provide practical reference and put forward countermeasures and suggestions for promoting the high-quality development of health care with Chinese characteristics.
On the occasion of China Student Nutrition Day on May 20, the chef of Hefei Feicui School explained the knowledge of food nutrition to the students. Xinhua News Agency issued a scan of the current situation
: The construction of a healthy China is advancing steadily, and grassroots health services still need to improve the quality and efficiency.
■ Healthy life: Residents’ health literacy has significantly improved, and the national fitness atmosphere is getting stronger.
Under the background of normalizing the prevention and control of the new coronavirus epidemic, Vietnam More and more residents are paying more attention to disease prevention and consciously practice a healthy lifestyle of reasonable diet , smoking and alcohol control, and regular physical examinations. In the survey, 82% of the respondents were able to basically achieve a combination of meat and vegetables in their daily diet, 78.5% of the respondents had not smoked in the past year, and nearly 40% of the respondents had a physical examination at least once a year. The national fitness atmosphere is getting stronger day by day. 58.7% of the residents surveyed regularly participate in physical exercise, among which 88.71% of those aged 60 and above regularly participate in physical exercise.
At present, the health literacy level of our country's residents has steadily improved, from 8.8% 10 years ago to 25.4% in 2021, completing the 2022 phased goals of the Healthy China Action ahead of schedule. The survey found that most residents are familiar with basic health knowledge such as "eating lightly will prevent high blood pressure" and "controlling blood lipids and lowering blood pressure can reduce the risk of stroke." However, they are not familiar with the typical symptoms of diabetes. High-level health knowledge such as "symptoms", "blood donation amount and blood donation interval" are still poorly understood.
■Health promotion: Community health activities are carried out unevenly, and there is a strong demand for grassroots social and medical linkage.
The survey found that there is an obvious disconnect between community health promotion activities in mid- to high-end communities and old communities. In urban communities such as Shaoxing in Zhejiang and Yichang in Hubei, health education, publicity, free clinics and other health-related activities are carried out more frequently, up to 12 to 30 times a year, covering various health contents, and community health bulletin boards are rich in content and location. Significantly, it can better meet the needs of residents. In old communities such as Jiaozuo, Henan, and Xiangxi, Hunan, communities carry out health activities only 2 to 6 times a year, and the formats and participants are relatively single.
Entering a new era, people have a more active awareness, more diversified means, and more comprehensive abilities in maintaining and promoting health, and are looking forward to getting more health knowledge that is "good to see, easy to listen to, easy to remember, and easy to use." Thanks to the development of mobile Internet and smart terminals, the people's needs for health knowledge are constantly being met. During the survey, many community workers said that joint activities with hospitals, clinics, enterprises, etc. can effectively enhance the diversity and richness of community health activities and increase residents' enthusiasm for participation. However, the current connection between grassroots communities and professional medical institutions and social organizations is not adequate, making it difficult to continue to provide residents with higher-quality health services.
Doctor Tang Pushi (left) of the Second Affiliated Hospital of Nanjing Medical University conducts a physical examination for children with congenital heart disease in Dangxiong, Tibet. Xinhua News Agency issued
■Health services: The hierarchical diagnosis and treatment system is being promoted in an orderly manner, and the reasonable medical treatment pattern needs to be improved.
The survey found that residents at the grassroots level are more willing to accept first consultation, reaching 82.3%. However, among residents who have experienced medical treatment in the past year, the actual rate of grassroots medical treatment is only 66.1%. Factors such as grassroots equipment conditions and medical level have restricted the transformation of grassroots medical willingness into actual actions. There is a long way to go to strengthen the grassroots medical and health construction. Specifically, 22.8% of residents still go to tertiary hospitals for treatment due to minor illnesses such as colds. Residents' reasonable medical seeking behavior still needs to be actively guided. In addition, there are still blockages in the operation of two-way referral and , and the referral rate of secondary and above medical and health institutions is less than 10%. The survey found that the coverage rate of family doctor contract service is low, with the service awareness rate of 66.4% and the contract rate of only 24.0%. It has not yet played its due role in promoting hierarchical diagnosis and treatment. The
survey found that the accessibility of grassroots TCM services has increased. 42.4% of the respondents were recommended to use traditional Chinese medicine therapy when visiting the community health service center . Hospitals at all levels have extensively carried out smart construction, the appointment diagnosis and treatment system has become increasingly complete, and the construction of medical informatization has accelerated. Among patients visiting tertiary hospitals, 45.7% chose to make an appointment online, and the telephone appointment rate and the guide appointment rate were 3.8% and 3.5% respectively. However, due to limitations of relevant facilities and docking mechanisms, only 6.5% of respondents have received telemedicine services, and 27.9% of residents have not heard of this service.
■Health security: Residents’ willingness to participate in insurance continues to rise, and the construction of a multi-level medical security system needs to be strengthened.
The survey showed that the residents surveyed had a strong willingness to actively participate in medical insurance, with the insurance participation rate as high as 95.6%. The construction of a multi-level medical security system emphasizes supporting the development of supplementary security measures such as commercial health insurance and charitable assistance, so that the government, market, and charity can complement each other and cooperate with each other. It should be noted that although the multi-level universal medical insurance system is steadily advancing, the problem of uneven development has also become prominent, and the proportion of people insured by commercial medical insurance is relatively low. The survey shows that the direct settlement service for medical treatment in other places is recognized by most residents, and 72.7% of the respondents believe that the settlement of medical treatment in other places is relatively smooth. However, there are still obstacles in the actual medical treatment and settlement process. 44.3% of the respondents believe that "the reimbursement procedure is complicated and has a long cycle", and 34.6% said that "they are not familiar with the relevant policies." In recent years, long-term care insurance has received widespread attention as the “sixth insurance” of social security. The survey found that the willingness to participate in long-term care insurance is 70.4%. However, due to the limited number of pilot cities, the proportion of long-term care insurance participants among the survey respondents is extremely low, only 0.0614%. This shows that there is a supply and demand for long-term care insurance services. Large gap.
students from Binhu Road Primary School in Nanning City happily dribbled the ball during the break. Xinhua News Agency reported
■ Epidemic prevention and control: The national protection awareness has increased significantly, and urban and rural communities play an important role as a fortress.
Vaccination is an important means to establish active immunity barriers for the population and curb the spread of the epidemic. The survey shows that the vast majority of the residents surveyed (95.9%) can voluntarily participate in the COVID-19 vaccination campaign, and more than 90% of the residents surveyed reported that their communities have set up regular monitoring points for epidemic prevention and control. As an important line of defense for protecting urban and rural public health security, urban and rural communities have become an important bulwark in blocking the spread of the epidemic.
■ Moderate fertility: The willingness to have more children is not high, and the concept of "raising children to prevent old age" has changed.
In the survey, 13.9% of the people of childbearing age surveyed chose not to have children, 47% were only willing to have one child, 34.5% and 2% Respondents are willing to have a second and third child. 71.7% of residents believe that living costs such as education and medical care are high, and having multiple children will increase the family burden. 57.2% of residents believe that work affects their reproductive choices. 25.6% of people are subjectively unwilling to have children, and the concept of "raising children for old age" is changing.
■Healthy elderly care: Home-based elderly care is still the mainstream, and the demand for public health care services is highlighted.
In the survey, 78% of the respondents expected to provide elderly care at home, and 11% and 6% of the respondents chose community and elderly care institutions respectively.More and more residents are willing to leave their homes and spend their remaining years in the community or in nursing homes. When asked about their long-term care needs, 52.1% of residents hope to receive care in public institutions such as nursing homes, nursing homes, and community day care centers, and 32.4% hope to receive home care services. Judging from the survey, less than 40% of communities have elderly care institutions and day care centers, and two-thirds of communities do not have integrated medical and nursing care institutions. It is urgent to increase the construction and development of related service systems.
In Jinjiang Community, Hongshan Town, Gulou District, Fuzhou City, the "Elderly Canteen" improves the level of elderly care services. Xinhua News Agency issued
policy recommendations: Concentrate efforts to promote collaboration, jointly build and share "big health"
Build a multi-subject collaborative governance pattern, and form a synergy for health promotion. Healthy China is a systematic project that requires the coordinated promotion and participation of the government, society, and individuals to strengthen the awareness that everyone is the first person responsible for their own health. Investment in community health resources and talent training should be increased, and communities should be encouraged to cooperate with surrounding hospitals and clinics; a platform for mutual assistance between social organizations and community staff should be established, and social organizations such as charities and foundations should be encouraged to actively participate in the community Health Promotion Activities. Explore the " Internet + " health promotion service model to achieve precise delivery of community health promotion services under the background of normalized epidemic prevention and control, and effectively solve problems such as "insufficient participating entities".
Build an integrated medical service system and strengthen digital technology support. adheres to the concept of combining prevention with treatment and medical care, integrates various medical, public health, and health care resources, establishes a collaborative mechanism of "prevention-treatment-rehabilitation-follow-up-long-term care", and provides integrated medical and health services. Continue to optimize the allocation of medical resources, promote the sinking of high-quality resources, increase the coverage of traditional Chinese medicine services at the grassroots level, and effectively enhance the ability to prevent and treat diseases at the grassroots level. Strengthen medical guidance and publicity, and cultivate the concept of medical treatment among urban and rural residents that "treat minor illnesses in the community, go to the hospital for serious illnesses, and return to the community for recovery". We will further promote the construction of a close medical alliance in counties and ensure the smooth operation of the two-way referral system. Strengthen digital empowerment and increase "Internet +" medical and health services to benefit the people.
Improve the multi-level medical security system and optimize the settlement path for medical treatment in other places. Since the implementation of the new round of medical reform, our country has built the world's largest basic medical security network covering the entire population. The next step should be to continue to adhere to the in-depth reform of the medical insurance level and complete the transformation from "laying the foundation" to "building momentum" change. Strengthen the basic, comprehensive and inclusive functions of the basic medical security system, and further increase the subsidy and reimbursement ratio for low-income groups. Encourage the orderly development of social capital, charitable donations and platform medical mutual assistance, and explore the urban pilot and promotion of new insurance types such as long-term care insurance. A multi-pronged approach will be taken to increase residents’ awareness of relevant policies, promote the exchange and sharing of inter-provincial medical insurance information, and improve the accessibility and convenience of insured persons’ settlement of medical treatment in other places.
Strengthen community governance resilience building and build a tight line of defense for community epidemic prevention and control. resilience focuses more on long-term capacity building, and it is recommended to focus on human defense, physical defense, and technical defense. It can encourage the development of volunteer teams and alleviate the shortage of human resources in the community. At the specific operational level, work rules can be formulated in a timely manner according to the current epidemic prevention and control characteristics that are in line with the actual conditions of various places. By increasing the allocation of community prevention and control facilities, a unified and interoperable Internet epidemic prevention and control information platform can be established to timely grasp population flow information and carry out effective track.
promotes full life cycle health management, so that the elderly and children "have support now and a secure future." has taken multiple measures to reduce the costs of childbearing, childcare, and education, explored flexible and diverse care models, and formed a medical care mechanism of "government support, social participation, and family support" to relieve people of childbearing age from worries. Do everything possible to increase the supply of basic elderly care services, such as creating a 15-minute home elderly care service circle. Relying on the community to develop diversified home-based elderly care services, accelerate the construction of a senior care service system and health support system that coordinates home and community institutions and combines medical care and health care to better meet the new aspirations of hundreds of millions of elderly people for a better life. expect.
(Written by: Wang Peigang, Yao Xiaohua, Chen Zongshun, Ma Xiaoqian; This report is part of the National Social Science Fund major project "Research on the strategic direction and dynamic mechanism for comprehensively promoting the construction of a healthy China" [21ZDA104] to study and interpret the spirit of the Fifth Plenary Session of the 19th CPC Central Committee Sexual results)
[Research Record]
Looking forward to more accessible health services
■ Speaking of progress, steady improvement -
Mr. Xu, a resident of Dongguan Community in Qinyang City: After the renovation of community, the environment of our community is much better. Everyone has There is no place to exercise, and to live a healthy life, you must move!
Ms. Wang, a resident of Huiminxi Community, Wujiang District, Shaoguan City: In the past, we people hoped to get good medical treatment and good treatment. Now, medical treatment is more comfortable and the service is more considerate. What’s particularly rare is that the state helped us negotiate with pharmaceutical companies, and drug prices have also dropped, which is a great benefit.
Mr. Zhou, a resident of Bayi Bridge, Furong District, Changsha City: It is really convenient to see a doctor now. Open "Xiang Medical Insurance" on your mobile phone and scan it, and you can register, pay and pick up medicines by yourself.
Wen Qiufen, Vice President of Wuhan Jinyin Lake Community Health Service Center: When we carried out COVID-19 vaccination, residents were particularly active, and some even took the initiative to help maintain order, which saved us a lot of time and energy.
■Not enough, but challenges still exist -
Mr. Sun, a resident of Qiluo Village, Yancheng District, Luohe City: I still believe in big hospitals when seeing a doctor. Now more and more people in rural areas have cars, and it is more convenient to go to big hospitals. There are too many people in large hospitals, and sometimes there is no queue, so we have to make several trips.
Song Yi, director of the Hui'an Traditional Chinese Medicine Clinic in Wuhan City: At present, our traditional Chinese medicine services are relatively limited to the elderly, who are basically the elderly. Young people live a fast-paced life and are not willing to come to see traditional Chinese medicine doctors whose treatment courses are long-term and have slow effects. They find it troublesome just to take medicine and decoct it.
Yingzhuang community worker in Jishou City, Xiangxi Tujia and Miao Autonomous Prefecture: Our community also wants to do more health activities. However, many people do not understand and are not active, and their awareness of participating in activities is relatively weak.
Cai Xueliang, a doctor at Hongguang Township Health Center, Jiayin County, Yichun City: Many young doctors go to big hospitals to develop their careers after passing the certification exam. Unfortunately, grassroots doctors are not paid well and it is difficult to retain talents.
■ Talking about the appeal, the future is promising -
Ms. Ma, a resident of Chaoyang Community, Dongchang District, Tonghua City: hopes to reduce the cost of having children and help young people reduce more of their burdens.
Ms. Zhang, a resident of Tuanshan Community, Hi-tech Zone, Xiangyang City: It would be great if we could provide door-to-door service whenever we want to see a doctor. My wife and I are both old. He has had a stroke and has been lying in bed for three years. Sometimes he feels uncomfortable. Take him with you. Going to the doctor is very inconvenient.
Guo Gang, a doctor at the Central Health Center of Goubangzi Town, Jinzhou City: The level of primary hospitals is still different from that of large hospitals. Sometimes when patients come back from a big hospital, they come to us with a copy of their medical records and copies: Oh, there are so many advanced things. I hope that I can go out more, study further, make up for my lessons, and serve everyone better when I come back.
Zhu Miaoyin, Party Committee Secretary and Director of Yuedu Community, Yuecheng District, Shaoxing City: I feel that people are paying more attention to adolescent mental health issues, but they are not professional enough. We hope that schools, society, and families can work together so that every child can grow healthy.
"Guangming Daily" (Page 7, June 23, 2022)
Source: Guangming.com - "Guangming Daily"
