In the past ten years, Sichuan, as a national pilot province for comprehensive medical reform, has focused on solving the problems of "difficulty in seeing a doctor, expensive in seeing a doctor, and frequent illnesses" among the people, and coordinated the promotion of comprehen

"Welcome the Twenty Years of Sichuan Health and Health" Series Report 2

Comprehensive Medical Reform

Let the people go from "seeking good health" to "get sick less" Let the people go from "seeking good health" to "get sick less" html l2

personal health expenditures account for 27.68% of total health expenses; the health indicators of major residents of are better than the national average; the evaluation results of tiered diagnosis and treatment in the 13th Five-Year Plan rank first in the western region... In the past decade, Sichuan, as a national pilot province for comprehensive medical reform, has focused on solving the problems of "difficulty in seeing a doctor, expensive in seeing a doctor, and frequent illnesses" among the people, and coordinated the promotion of comprehensive reforms such as public health, medical services, medical security, drug supply, and regulatory system, and strived to embark on a medical reform path in which the people benefit, the health industry can develop, and medical staff are encouraged.

is difficult to see a doctor?

"Up to bottom linkage" to build a "new pattern" for medical treatment

Sichuan is a province with a large population and a wide area. The development of high-quality medical resources is unbalanced and inadequate, and the gap in medical service capabilities in urban and rural areas is relatively large. Focusing on achieving the goal of "severing serious illnesses and serious illnesses in the province, solving general diseases in cities and counties, and solving headaches and fevers in rural areas", Sichuan has issued the "Implementation Plan for Accelerating the Construction of a High-Quality and Efficient Graded Diagnosis and Treatment System", focusing on the supply-side reform of medical services and the construction of a close medical alliance as a carrier to promote the expansion and balanced layout of high-quality medical resources, and accelerate the formation of a tiered diagnosis and treatment model with first-level diagnosis and treatment at the grassroots level, two-way referral to , acute and chronic treatment, and upper and lower linkage. At present, 51,118 medical alliances of various types have been built in the province, including 71 urban medical groups, 5,270 county medical communities, 490 specialty alliances, and 287 telemedicine collaboration networks.

"Doctor Wang, my blood pressure fluctuates a lot recently, please help me check..." Every Monday morning, at the Xinjin District Traditional Chinese Medicine Hospital of Chengdu, you can always see doctoral experts from the Department of Cardiovascular Internal Medicine of Sichuan University West China Hospital to treat local patients common diseases and critical and severe diseases such as coronary heart disease, hypertension, heart failure, arrhythmia, , and other common diseases and critical diseases in cardiovascular internal medicine.

According to Chen Qi, Party Secretary and Director of Xinjin District Health Bureau, the people can enjoy high-quality and convenient medical services in large-scale urban Grade A hospitals, thanks to the district's continuous strengthening of medical alliance cooperation relationships established with Sichuan University West China Hospital, Sichuan Provincial People's Hospital, Chengdu Women and Children's Central Hospital , etc. over the years, and "sink" the high-quality medical resources of the province and city to Xinjin , improving the management level and medical service capabilities of local hospitals. "Remaining normalized 40 provincial and municipal experts in Xinjin to attend consultations."

, and in Jiang'an County located on the southern edge of Sichuan, the shore of the Yangtze River , through the construction of county-level medical communities, the medical and health service system "centered with people's health", allowing the people of Jiang'an to enjoy the dividends of medical reform.

In 2019, after Jiang'an County was identified as a "Pilot County for the Construction of a National Close-up County Medical and Health Community", it was led by Jiang'an County People's Hospital and County Traditional Chinese Medicine Hospital to integrate the county rehabilitation hospital, county maternal and child health hospital, 19 town health centers and 509 village health stations (rooms) within its jurisdiction. In accordance with the "1+10+N" and "1+11+N" models, two county medical communities, namely Jiang'an County People's Medical and Health Group Hospital and Jiang'an County Traditional Chinese Medicine Medical and Health Group Hospital, were established to implement integrated management. This year, Jiang'an County continues to deepen the construction of county medical communities, integrates two medical and health group hospitals into Jiang'an County General Hospital, establishes a general hospital party committee, promotes the in-depth integration of county medical and health resources, and achieves the upgrading of county medical communities.

expensive to treat?

"Three Medical Linkage " releases the "new dividend" of medical reform

Sichuan unswervingly promotes the experience of Sanming's medical reform, and holds a provincial video conference on the reform of the "three medical" linkage, and promotes the real connection and real reform of the "three medical" ones.The pilot project of "three medical" linkage and system integration reform in Chengdu, Zigong , Yibin and other places has been carried out, and the pilot project of medical and health integration innovation reform in 11 counties (cities, districts) has been promoted, and significant results have been achieved in "making space, adjusting structure, ensuring connection, strengthening supervision, and increasing vitality".

Medical insurance is the basis of the basic medical and health system and the fundamental solution to solve the problem of "expensive medical treatment". Focusing on accelerating the relief of the problem of expensive medical treatment, Sichuan Province has vigorously promoted the centralized procurement and use of drug consumables in accordance with the basic principles of "guaranteeing basics, improving mechanisms, adapting to local conditions, and promoting in a coordinated manner", established and improved a dynamic adjustment mechanism for medical service prices, and deepened the reform of diversified and compound medical insurance payment methods. The momentum of unreasonable growth of medical expenses has been effectively controlled, medical service behavior has been more standardized, and the burden of medical treatment for the masses has been effectively reduced.

Sichuan Province actively explores and improves the comprehensive supervision system, innovates the information supervision of medical institutions, medical personnel, and medical behavior (hereinafter referred to as the "three supervisions" of medical care), and basically achieves full coverage of public medical institutions and private hospitals. In January 2017, the "three supervisions" platform connected more than 7,000 medical institutions at all levels and types, and connected to diagnosis and treatment services, medical record homepage information and statistical direct reports and other data to achieve real-time, dynamic and full-process precise supervision of medical service behavior. At present, 21 cities (prefectures) in the province have completed the construction of the municipal platform for medical "three supervisions" and included all key monitoring drugs in the scope of medical "three supervisions".

As a national demonstration city for comprehensive reform of public hospitals, Zigong has issued the "Implementation Plan for the Comprehensive Reform of Public Hospitals in Zigong City's "Three Medical" Collaborative Construction of Public Hospitals", promoting the transformation of medical reform from single breakthroughs to system integration, promoting the transformation of public hospital development mode from scale expansion to quality and efficiency improvement, the operating model shifts from extensive management to refined management, and resource allocation shifts from focusing on material elements to paying more attention to talent and technical elements. Zigong City implements centralized procurement of pharmaceutical and equipment, and has implemented nearly 400 drugs and 6 batches of 7 medical consumables in 11 batches. The average decline in drugs and medical consumables has reached 60% and 85% respectively, and a total of 485 million yuan of procurement funds have been saved. Accelerate the streamlining of medical service prices, continuously optimize hospital structural income, and adjust the prices of 616 medical service projects in recent years, and announce the addition and continued implementation of 87 new technical medical service projects. Actively promote the provincial pilot program of DRG point method, and the fund expenditure on DRG paid for hospitalized medical expenses accounted for 72%. Strengthen the coordinated supervision of the "three medical care" and establish a mechanism for screening suspected problems, self-inspection of institutions, and supervision and verification. At the same time, the reform of the personnel compensation system is deepened, and public hospitals are allowed to set up senior positions according to the maximum limit, and the total salary of public hospitals is dynamically verified. The proportion of senior positions in public hospitals reaches up to 40%, and personnel funds account for 41.35% of the total expenditure, which is at the leading level in the province.

multiple diseases?

"Combination of all specialties" helps health "new services"

With the economic and social development and the improvement of people's living standards, health has become the most direct and realistic issue of people's livelihood and well-being. This also requires that in the process of deepening and practical medical reform, we must not only pay attention to the problem of "difficulty and expensive medical treatment", but also promote the transformation from treating diseases as the center to health-centered, and from focusing on "treating existing diseases" to focusing on "preventing diseases". Focusing on making the people less sick and late, Sichuan innovates the "full-university-integrated" contract service model, promotes the equalization of basic public health services for and universalization of . The free basic public health service projects have been expanded from 9 categories to 14 categories. The filing rate of electronic health records for urban and rural residents in the province has reached 95.08%, and the standardized management rates of patients with hypertension and patients with diabetes respectively reached 79.25% and 77.74% respectively.

"Indicators are just 'standards', and management is 'central'." Chen Qi, as the head of the Xinjin District Health Bureau, has been engaged in medical reform for many years. He has his own thoughts on how to make grassroots health management services more sound.In recent years, Xinjin District has relied on the construction of a close county medical community to explore the "1+2+3+N" health management system centered on the masses and chronic disease management as the entry point, and strives to provide the masses with all-round, multi-level, full-cycle health services that integrate prevention, treatment, health, care and care.

Chen Qi introduced that the district has established a "management center" of the district health management work leading group with the main person in charge as the group leader, the person in charge as the deputy group leader, and the leading unit of Medical Community and the main person in charge as the members of each business department; established the district health management guidance center and the district medical community health management center as two "organizational tools"; built three "health support" for technology, performance, and majors; 58 teams of improvement family doctors in public hospitals, general practitioners, nurses, rural doctors, etc. in public hospitals ( Community Health Service Center ) general practitioners, nurses, rural doctors, etc. to consolidate the "N service units".

"By allowing district-level public hospitals to participate in health management, and the 'leading hospitals' to create a service package, the people have higher trust and enthusiasm for basic public health services, and the 'full-university-combined' family doctor contract service model has significantly improved residents' sense of gain." Chen Qi said that last year, the district's family doctor contract rate was 42.44%, and the key groups signed a rate of 92.06%. The performance appraisal of basic public health services and family doctor services ranked first in the city, and successfully passed the re-examination of the third batch of national comprehensive chronic disease prevention and control demonstration zones.

After ten years of hard work and exploration, the health level of urban and rural residents in Sichuan Province has continued to improve, health equity has been significantly improved, basic medical insurance for urban and rural residents has eliminated the dual differences between urban and rural areas, and the accessibility of medical services has been significantly enhanced. More than 90% of residents can reach the nearest medical point within 15 minutes, the burden of medical treatment for the masses has been effectively reduced, and the satisfaction of medical services has reached more than 90%.

Source: Health Sichuan Official Micro