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Interpretation of the 13th Five-Year Plan Policy for Deepening the Reform of Medicine and Health System in Jilin Province
Recently, the relevant person in charge of the Jilin Provincial Health and Family Planning Commission interpreted the policy of the 13th Five-Year Plan for deepening the reform of the medical and health system in Jilin Province.
During the "Thirteenth Five-Year Plan" period, deepening the medical reform work will fully implement the spirit of the National Health and Wellness Conference, focusing on the establishment of a basic medical and health system in line with the provincial conditions, in the classification and treatment, modern hospital management, universal health insurance, drug supply security, and comprehensive New breakthroughs were made in the construction of five systems including supervision. At the same time, the overall promotion of reforms in related fields mainly includes: improving and perfecting the personnel training and incentive evaluation mechanism, accelerating the formation of a multi-disciplinary medical model, and promoting the construction of a public health service system.
Keywords: grading diagnosis and treatment
By 2020, the graded diagnosis and treatment model will gradually form
Improve and improve the medical and health service system, enhance the capacity of primary health care services, and promote the construction of multi-level medical complexes led by the government. Under the leadership of the government, we will further improve the construction of the five provincial medical associations at the provincial level, and simultaneously promote the capacity building of four levels of medical complexes at the municipal, county and specialist levels. In 2017, the coverage rate of medical associations reached 95%, the proportion of medical treatment in primary health care institutions accounted for more than 65% of the total number of medical treatments, and the rate of medical treatment in the county reached about 90%. On the basis of hypertension and diabetes, tumors and cardiovascular diseases were increased. Chronic diseases such as tuberculosis are the key diseases for graded diagnosis and treatment. By 2020, the medical union coverage rate will reach 100%.
Scientifically and reasonably guide the masses to seek medical treatment. Establish and improve family doctors' contracting services to encourage urban and rural residents to sign contracts with grassroots doctors or family doctors by improving grassroots service capabilities, medical insurance payments, price control, and convenience for the people. Improve the two-way referral procedure, establish a sound referral guidance catalogue, focus on smooth referral channels, and gradually achieve orderly referrals between different levels and different types of medical institutions. The deductible line is continuously calculated for the eligible referral hospitalized patients. By 2017, the grading diagnosis and treatment policy system will be gradually improved, and more than 85% of the cities will carry out pilot projects. By 2020, the grading diagnosis and treatment model will be gradually formed, and a grading diagnosis and treatment system in line with national conditions will be basically established.
Promote the construction of medical remote consultation network. Improve the capability of telemedicine services, cross-link the medical remote consultation network between the five major medical unions and upper-level hospitals, realize the sharing of excellent expert resources, and vertically link the medical remote consultation system between superior hospitals and 9 prefectures and 43 county-level hospitals. Improve the operational mechanism of medical remote consultation, improve the accessibility of quality medical resources and the overall efficiency of medical services. Explore county-level hospitals to establish medical remote consultation systems with borders and poor villages. In 2017, medical remote consultation covers more than 90% of counties (cities, districts). In 2020, medical remote consultation covers more than 100% of counties (cities, districts).
Keywords: modern hospital management system construction
By 2017, all types of public hospitals will comprehensively push forward comprehensive reforms.
During the "Thirteenth Five-Year Plan" period, the comprehensive reform of county-level public hospitals will be further deepened, and the comprehensive reform of urban public hospitals will be accelerated. By 2017, all types of public hospitals at all levels will comprehensively push forward comprehensive reforms, and initially establish management systems and governance mechanisms for decision-making, implementation, and supervision of mutual coordination, mutual checks and balances, and mutual promotion. By 2020, we will basically establish a modern hospital management system with clear Chinese characteristics, scientific management, perfect governance, efficient operation, and strong supervision, and establish a new mechanism for maintaining public welfare, mobilizing enthusiasm, ensuring sustainable operation, and scientific and rational. Compensation Mechanism.
Improve the management system of public hospitals. Establish a standardized and efficient operating mechanism. Cancel the drug addition (excluding Chinese medicine decoction pieces), and establish a scientific and reasonable compensation mechanism by adjusting the price of medical services, increasing government investment, reforming payment methods, and reducing hospital operating costs. Strengthen the classification guidance and rationalize the price relationship between medical institutions and medical service projects at different levels. The price of medical services that liberalize special needs medical services and other markets with relatively full competition and strong individualized needs shall be independently formulated by medical institutions. Establish a personnel and compensation system that meets the characteristics of the health care industry. Innovate the management methods of public hospitals, and carry out compilation management reforms and pilot personnel management in some third-class public hospitals in some large and medium-sized cities. Establish a hospital evaluation mechanism with quality as the core and public welfare as the orientation. Control the unreasonable growth of medical expenses in public hospitals. Set the medical cost increase control target. Information on the price, medical service efficiency, and average medical expenses of each hospital in the jurisdiction shall be disclosed to the public in the district-based city.
Keywords: universal medical insurance system construction
Continue to lower the deductible line and increase the proportion of reimbursement
The construction of the universal medical insurance system during the 13th Five-Year Plan period will focus on the three key links of diversification of funding sources, standardization of safeguard systems, and socialization of management services in accordance with the principles of basic protection, bottom line and sustainability. Establish a national health insurance system that operates efficiently. By 2017, the basic realization of the hospitalization expenses for medical treatment in the same place that meets the referral regulations will be directly settled. By 2020, the basic medical insurance participation rate will be stable at over 98%.
Improve the stable and sustainable financing and reimbursement ratio adjustment mechanism for basic medical insurance. Deepen the reform of medical insurance payment methods. Improve the medical insurance payment mechanism and interest control mechanism, implement refined management, and stimulate the medical institutions to regulate behavior, control costs, and rationally treat and refer patients for endogenous motivation. A comprehensive payment method based on case-based payment, combined with multiple payment methods such as head-to-head, bed-to-bed, and total prepayment, is encouraged to implement a payment method based on disease diagnosis.
Promote the integration of the basic medical insurance system. Unified basic medical insurance management, unified basic medical insurance management, piloting the establishment of medical insurance fund management center in 1-3 cities, undertaking fund payment and management, drug procurement and fee settlement, medical insurance payment standard negotiation, agreement of designated agencies Management and settlement functions. Improve the mechanism of serious and serious disease protection. On the basis of comprehensive implementation of the major illness insurance for urban and rural residents, in accordance with the requirements of the “Implementation Opinions on Further Improving the Basic Medical Insurance System for Urban and Rural Residents” of the General Office of the Provincial Government, continue to reduce the deductible line, increase the proportion of reimbursement, and reasonably determine the scope of compliance medical expenses. Measures to improve the accuracy of the payment of major illness insurance to the needy. We will comprehensively carry out medical assistance for major and serious diseases, and include low-income families such as the elderly, minors, severely disabled people, and seriously ill patients in low-income families, as well as seriously ill patients in poverty-stricken families. Promote the development of commercial health insurance.
Keywords: drug supply security system construction
Solve the problem of low-cost drugs, "life-saving drugs", and the supply of children's drugs
During the "Thirteenth Five-Year Plan" period, the whole process of drug production, circulation, and use will be reformed, medicines will be broken, and a national drug policy system in line with national conditions will be established to rationalize drug prices, promote the restructuring of the pharmaceutical industry, and transform and upgrade the drugs. Safe and effective, reasonable price and adequate supply.
Deepen the reform of the pharmaceutical supply sector. Establish a more scientific and efficient drug review and approval system. Strengthen medical device innovation and strict medical device approval. Closely monitor the shortage of drugs and take effective measures to solve the problem of low-cost drugs, "life-saving drugs", "orphan drugs" and the supply of children's drugs.
Deepen the reform of the drug circulation system. Consolidate and improve the basic drug system. Consolidate the results of the implementation of the basic drug system by the government-run grassroots medical and health institutions and village clinics, and promote the implementation of unified policies on the basic drugs in terms of catalogue, labeling, price, distribution, and use, and promote the fairness and accessibility of essential drugs. Strengthen the basic drug use for special populations such as children, the elderly, chronic patients, tuberculosis patients, severe mental patients and severely disabled people. Improve the national drug policy system. Promote the separation of medicines and take comprehensive measures to cut off the chain of interests between hospitals and medical personnel and medicines and consumables. Exploring the multi-channel drug purchasing mode of hospital outpatients, medical institutions must not restrict prescription outflows, and patients can purchase drugs from retail pharmacies by prescription. Improve the centralized procurement system for pharmaceuticals and high-value medical consumables.