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On October 8, 2022, at Haidian Hospital in Beijing, medical staff received consultation from citizens. Photo/Xinhua News Agency
In the report of the 20th National Congress of the Communist Party of China, Xi Jinping proposed to promote the expansion of high-quality medical resources and regional balanced layout, adhere to prevention as the main focus, strengthen the health management of major chronic diseases, and improve the grassroots disease prevention, treatment and health management capabilities.
Comparing the report of the 19th National Congress of the Communist Party of China five years ago, this report transforms "prevention and control of major diseases" into "strengthening the health management of major chronic diseases", which shows that the harm of chronic diseases to the lives and health of our people urgently needs to be paid enough attention to; on the other hand, it also means that my country will further promote the construction of a policy system for chronic disease prevention and control and treatment.
At the same time, we can also foresee that the programmatic document related to the country's medium- and long-term strategy of the Twenty National Congress report highlights the health management of chronic diseases, which will surely deeply shape my country's special disease prevention and control system, especially the policy follow-up and improvement of medical, medical insurance and medical policies, and fully promote the construction of a healthy China and bring more sense of gain to the people.
cannot underestimate the social harm of chronic diseases
This year marks the 70th anniversary of the implementation of patriotic health campaign in my country. Since the founding of New China, it is under the patriotic health campaign that the living environment in urban and rural areas in my country has been greatly improved, and residents' health literacy has gradually improved. With the epidemics such as schistosomiasis, plague, malaria, , etc., basically extinct in China, my country's disease spectrum has shifted from acute infectious diseases to chronic non-communicable diseases.
In addition to social mobilization, the policy system plays an important role in strategic guidance and practical implementation in the prevention and control of various chronic diseases. my country has long supported chronic disease prevention and control work. As early as the planned economy period, our experience as "barefoot doctor" was praised by the World Health Assembly . After reform and opening up , with the popularization of "rich diseases" such as hypertension , hyperlipidemia, and hyperglycemia , my country has begun to lay out special policies for chronic diseases since the 1990s.
Especially since the 18th National Congress of the Communist Party of China, my country has introduced a series of policies in the prevention and control of chronic diseases. In 2016, the Central Committee of the Communist Party of China and the State Council issued the " "Healthy China 2030" Outline ", proposing that by 2030, the premature mortality rate of major chronic diseases will be reduced by 30% compared with 2015. To this end, we will implement the comprehensive prevention and control strategy of chronic diseases and strengthen the construction of national comprehensive prevention and control demonstration zones for chronic diseases.
In 2017, the General Office of the State Council issued the "China Medium- and Long-term Plan for the Prevention and Treatment of Chronic Diseases (2017-2025)", proposing that by 2025, we will strive to reduce the premature mortality rate of people aged 30-70 due to cardiovascular and cerebrovascular diseases, cancer, chronic respiratory diseases and diabetes by 20% compared with 2015.
In 2019, the State Council issued the "Healthy China Action (2019-2030)", proposing 15 special actions for major health influencing factors, key groups, and important disease areas. A detailed implementation plan has begun to exist for the prevention and control of chronic diseases such as cardiovascular and cerebrovascular diseases, cancer, chronic respiratory diseases, diabetes, etc. my country has begun to form a policy system for the prevention, control and treatment of chronic diseases.
On October 2, 2022, a doctor from Mingguang City Traditional Chinese Medicine Hospital in Anhui Province was in the ward. Photo/Xinhua News Agency
Nowadays, with the significant advancement of medical and medical technology, some diseases that were originally acute and severe or even "terminal illness", such as malignant tumors, rare disease , have turned into chronic diseases. As patients change from acute to chronic stage, if the grassroots medical systems such as communities and villages cannot be kept in the coverage, rehabilitation, follow-up and upward referral services cannot keep up, chronic diseases still have the risk of turning into acute or even "terminal illness".
Among chronic diseases, there are 270 million patients with hypertension in my country, more than 97 million patients with diabetes, nearly 100 million patients with chronic obstructive pulmonary disease, nearly 100 million patients with depression, and the base of patients with other chronic diseases such as stroke , coronary heart disease , chronic hepatitis B, rare diseases, etc. are also in the tens of millions. It can be said that the spread of chronic diseases has threatened the health and safety of our entire nation.
At the same time, the development and changes of chronic diseases have also had an impact on the payment security of all parties.Data from the National Health Insurance Administration shows that the four major chronic diseases account for more than 90% of the expenditure on medical insurance funds, and household expenses have accounted for more than 40% of their income, which is the biggest reason for the "disastrous medical expenditure" of families.
Therefore, we must never underestimate the social harm of chronic diseases. Although chronic diseases have not constituted a major public health incident like SARS and the new crown epidemic, they also seriously threaten national health. It is urgent to strengthen the health management of major chronic diseases.
Moreover, the prevention and control of acute infectious diseases highlights the advantages of the national system and reflects the public health emergency response capabilities. In comparison, behind the pathogenic factors of chronic diseases are complex economic, social and cultural factors, which require the joint efforts of the government, society and individuals to prevent and treat them, and rely more on the continuous efforts of the policy system and work hard for a long time.
Chronic disease prevention and control also requires " Three Medical Linkage "
According to World Health Organization , among the main factors affecting health, medical conditions only account for 8%, while lifestyle accounts for as high as 60%. Therefore, for incubation periods and mild chronic diseases, health interventions in home and community scenarios are usually more suitable. This also requires us to become the first responsible person for our own health and to keep a good "first level" of health management.
For chronic disease management, the community needs to shift from indoctrination of education to equal dialogue, and from rigid constraints to "soft laws" guidance such as township rules and regulations, and community culture. We can also explore the "health gatekeeper" family member mutual assistance mechanism, explore the "health planner" community health services, integrate healthy diet, work and rest, exercise and other lifestyles into thousands of households, and keep a good start to "get sick less, get sick late, and try not to get seriously ill."
In terms of medical care, if hospitals and doctors focus on the diagnosis and treatment services of "treatment of existing diseases" and "treatment of major diseases", intervention of health factors of the disease (zero-level prevention), intervention of pathogenic factors ( primary prevention ), and early screening (secondary prevention), it is very likely that pathogenic factors will spread and minor diseases will be delayed into major diseases. In the end, the whole society and patients will have to pay for higher medical costs.
On January 14, 2022, at the convenience clinic window of Shaxian District General Hospital of Sanming City, Fujian Province, the public consulted about medical reimbursement. Photo/Xinhua News Agency
It is also true that the World Health Organization recommends that doctors become engineers who change human behavior. This urgently requires vigorously promoting the "Health Promotion Hospital" and "Health Management Physician Team" model.
On the one hand, the government's assessment of public hospitals should downplay economic performance, strengthen health performance, and link it with the "medical hat" and "money bag" of hospital management and medical workers to prevent medical institutions at all levels and types from "focusing on medical care over health"; on the other hand, in addition to medical courses, more health management, health education and patient-centered special courses should be offered to school medical students, so that chronic disease prevention and control can be implanted into the "gene" of the medical community, and strengthen the health promotion responsibility of the medical system.
In addition, it is also necessary to promote the "three medical linkage" incentive policy for chronic disease prevention and control. In terms of medical policies, if the superior and lower-level medical and health institutions have a smooth channel for the acute period of upward referral and the chronic period and the recovery period, the health and health departments should build a close-knit county medical community and urban medical groups so that the three-level institutions of counties (districts), townships (streets), and villages (communities) can achieve "one family, one heart, one account".
If you want to avoid "whipping fast bulls" and "the better you are preventing, the less you earn", you can learn from the medical reform experience of Sanming . The medical insurance department has shifted from distributing the "cake" of medical insurance according to the hospital level or medical costs to distributing the "cake" of medical insurance according to medical quality and health effects, and returns a considerable proportion of the saved chronic disease treatment costs to the surplus institutions, and allows the latter to freely distribute, including for the implementation of performance rewards to relevant medical personnel.
is suitable for chronic disease diagnosis and treatment scenarios such as day treatment, community treatment, and home treatment. The drug supervision department should encourage enterprises to develop new dosage forms in terms of medical policies. Do not inject subcutaneously if it can be taken orally, and do not intravenously if it can be injected subcutaneously if it can be injected.
As an encouragement, the medical insurance fund should also include the diseases of this type of "chronic disease-friendly" innovative drug into the outpatient chronic disease and special disease catalog, and open up the "dual channels" of equal medical insurance reimbursement benefits for designated retail pharmacies outside the hospital, and allow the attending doctor to prescribe a "long prescription" of up to 2 months, thereby minimizing the cost of medication for chronic disease patients and improving accessibility.
my country has a thousand-year medical culture tradition of "preventing diseases" and also has the advantages of grassroots governance of urban and rural grid layout. I believe that with the strategic guidance of the Twenty Major Reports, the urban and rural medical and health service system and multi-level guarantee system are becoming increasingly perfect. The prevention and control of chronic diseases will form three major defense lines, including personal and family self-health care, village (community) organization health management, and specialized services for large and medium-sized hospitals.
Under the construction of this policy system, my country will also promote a significant decline in the incidence and premature mortality rate of common chronic diseases, gradually improve the public's health level, and blaze a new way to prevent and control chronic diseases in a big country. This is the meaning of building a healthy China, and it is also directly related to our yearning for a better life.
Written by / Liang Jialin (Secretary-General of the Expert Committee of Value Medical Consulting)
Editing / He Rui
Proofreading / Wang Xin
