On January 3, the reporter learned from the District Health and Family Planning Commissionthat the Comprehensive Reform Program to Deepen Medical and Health System in Binhai New Area(hereinafter referred to as the Program) has been formally introduced. According to theProgram, Binhai New Area will deepen the comprehensive reform of public hospitals, speed up the construction of grading medical treatment system, improve the universal medical insurance system, strive to achieve substantial progress in key areas and key reforms by 2020, and establish a basic medical and health system, a medical insurance system and a high quality and efficient medical and health service system that match the comprehensive and high-quality moderately prosperous society.
According to the Program, after its formulation, between December 2017 and March 2018, it will improve the supporting documents. Between April 2018 and December 2018, it will bethe promotion and organization phase. Between January 2019 and December 2019, it will be thedeepen promotion phase. Between January 2020 and December 2020, it will be the consolidationand improvement stage.
Gradually cancelation of hospital administrative levels
According to the Program, Binhai New Area will comprehensively deepen the reform of public hospitals.
Binhai New Area will get rid of the medicine supplementing mechanism. It will cancel the addition of medicines and consumables, reduce the revenue from the reduction of charges for large-scale medical examination equipment by canceling the addition of medicines and consumables, and take such measures as raising examination fees, nursing fees, surgery fees and Chinese medicine treatment fees, which can manifest the value of services by medical and technical personnel.
Binhai New Area will improve the financial compensation mechanism. It will implement theaccountablility of government investment, reform the mode of financial subsidy, perfect the government purchasing service mechanism, establish a comprehensive appraisal and evaluation mechanism guided by public welfare, and achieve the linkage among financial subsidies,performance appraisal and reform effects.
Binhai New Area will improve the public hospital operating mechanism. It will implement the autonomy of operation and management in public hospitals and promote the professional management of chief deans and chief accountants. It will gradually cancel the administrative level of public hospitals and take the lead to set up pilot in the Fifth Central Hospital of Tianjin and Tianjin Medical University Sino-Singapore Tianjin Eco-city Hospital.
Binhai New Area will reform the personnel and appointment system. It will fullyimplement the job management system, in which posts will not be assigned to fixed personneland job management will replace identity management.
Binhai New Area will reform the remuneration distribution system and establish a scientific and rational remuneration distribution system. It will allow the practice of using medical income after deducting costs and the withdrawal of funds, according to the provisions, to reward the main personnel. It is strictly forbidden to set income-generating targets for medical staffs. Their remuneration may not be linked to the business receipts of hospital medicines, consumables and medical examinations. It will implement day surgery and daytime chemotherapy, and in level two hospitals and above, outpatient intravenous infusion of antimicrobial drugs will be stopped.
Binhai New Area will not control growth in management and control of medical expenses. It will improve the level of hospital fine management, shorten the average length ofinpatient stay, and expand the coverage of clinical pathways. It will gradually establish a standard prescription system and implement the prescription list management. It will encourage medical institutions to use drugs in large packaging and simple packaging, andencourage patients to purchase drugs at retail pharmacies, to prohibit hospitals to limit the outflow of prescriptions.
Binhai New Area will vigorously improve medical services. It will focus on making appointments, daytime surgery, information push, pharmacy services, quality care and other work. By the end of 2018, Class A hospitals will fully implement appointment clinics to enhance the level of medical services.
Binhai New Area will explore the innovation of TCM diagnosis and treatment mode. All community health service centers, community health service stations and village clinics willpromote and training of 2 grassroots TCM appropriate techniques annually.
Binhai New Area will accelerate the development of social medicine. It will adhere to the combination of social work with public hospital reform and encourage social forces to invest in the field of health care. Nonprofit and high-end non-basic medical service agencies are organized to expand the total amount of medical and health resources to meet the diverse needs of the masses. If social forces hold clinics, the clinics are not subject to restrictions of planning and layout.
Improvement of primary health care service system
The Program clearly indicates that Binhai New Area will speed up the construction of grading medical system and improve the quality of primary health care service system.
Newly-built or remodeled residential community health service facilities and residential buildings are planned and constructed synchronously, and the public buildings are synchronized and put into use simultaneously. We will comprehensively enhance the capacity of primary medical and health institutions, formulate and implement a three-year plan of action for the construction of general practitioners and enrich the strength of general practitioners. By 2020, there will be more than three general practitioners per 10,000 residents.
Binhai New Area will establish a new model of primary health care services. It will promote the transformation of primary health care service to health management service mode during the whole life cycle. By 2020, it will strive to achieve full coverage of family doctor service contract.
Binhai New Area will vigorously promote the construction of Medical Association and improve the classification of treatment system. It will encourage the medical joint body to form a community of responsibility and community interests, develop telemedicine services,as well as mutual recognition of the results of the joint medical examination. It will actively promote the pilot registration of regional physicians and encourage physicians inlarge hospitals to practice of in multi-points in primary health care institutions. It will take diabetes and hypertension as the pilot diseases, and actively promote the grading diagnosis and treatment mode of "grass-roots first diagnosis, two-way referral, division of acute and chronic diseases, and upper-lower linkage".
Binhai New Area will adopt the differentiated medical care reimbursement policy. The amount of medical insurance fund is inclined to the grass-roots level. The scope of reimbursement for drugs of primary medical institutions is expanded to the full range ofcatalogs of food and drug products. Long-term prescriptions issued by physicians in primary medical institutions are included in the reimbursement of medical insurance.
Binhai New Area will promote combination of medical care and health care. The overall medical and pension service resources will be coordinated, to form a safe and convenient medical service network with appropriate size and complementary functions.
Improvement of universal health insurance and comprehensive regulatory system
According to the Program, Binhai New Area will further improve the universal health care system.
Binhai New Area will improve the universal health insurance system. It will implementcredit card delay settlement in advance medical expenses network. It will focus on the relocation of retirees in different places and steadily promote medical settlement in different places across provinces.
Binhai New Area will reform medical care payment method. It will comprehensively push forward the reform of the composite payment system that combines total management,individual payment and payment according to different kinds of diseases, to enhance the incentive and restraint effect of medical insurance on medical service behaviors. In combination with outpatient services, payment on a first-come-first-served basis is given priority to special medical outpatient diseases such as diabetes, kidney dialysis and hemophilia which are heavily burdened with medical care. Pilot projects on chronic diseases are carried out to gradually expand the coverage of diseases and medical institutions.
In addition, Binhai New Area will also improve the comprehensive supervision system, establish and improve a joint multi-sectoral law enforcement mechanism, strengthen theongoing and afterwards supervision of events and eliminate excessive medical practices. It will strengthen personnel support and disciplinary construction, formulate supportive policies that meet the development needs of various kinds of scarce talents, and focus on strengthening the training and supplementing of the shortage of pediatric and pre-hospital emergency personnel.