Enable grassroots people to enjoy high-quality medical services nearby
2024-06-14
Tight county medical community refers to the establishment of a certain management and operation mechanism for county-level hospitals and township health centers within the county, forming a community of responsibility, management, service, and interests. In 2019, the National Health Commission launched a pilot project for the construction of a tightly knit county-level medical and health community, identifying 828 pilot counties with an average visit rate of over 90%. Currently, the construction of a tightly knit county-level medical community has shifted towards a comprehensive promotion stage. In December 2023, the National Health Commission, the Central Compilation Office and other 10 departments jointly issued the Guiding Opinions on Comprehensively Promoting the Construction of Tight County Medical and Health Communities, proposing that by the end of 2027, the Tight County Medical Communities will basically achieve full coverage. At present, various regions are actively promoting the construction of a closely knit county-level medical community and have made many beneficial explorations. The reporter recently conducted research and interviews on this in Guizhou, Jiangsu and other places. Jianqiang led the hospital to achieve the goal of preventing serious illnesses from leaving the county. "My body has recovered well and my mood is much better." Chen Meiqiong, a villager from Jingkou Village, Dawujiang Town, Yuqing County, Zunyi City, Guizhou Province, completed a follow-up examination at the county people's hospital. When she heard the doctor say that all indicators were normal, she breathed a sigh of relief. A year ago, Chen Meiqiong, who was over sixty years old, underwent rectal cancer surgery at Yuqing County People's Hospital. "I didn't expect the county hospital to perform such a big surgery at that time," said Chen Meiqiong. If it were two years earlier, cancer patients like Chen Meiqiong could only be referred to the city or province for treatment. Nowadays, we can independently carry out some major disease surgeries, and the postoperative results are good Tian Jingfu, Director of the General Surgery Department of Yuqing County People's Hospital, introduced that with the promotion of the construction of a closely knit county-level medical community, the hospital's ability to diagnose and treat major diseases has rapidly improved, and the General Surgery Department also has the ability to perform surgical treatment for rectal cancer. Yuqing County is located in the hinterland of central Guizhou, with mountainous and hilly terrain as the main feature. In order to enhance the ability to diagnose and treat serious diseases, in 2023, Yuqing County will integrate two county-level medical communities led by the County People's Hospital and the County Traditional Chinese Medicine Hospital, forming a tight county-level medical community with 4 county-level medical and health institutions as the backbone, 10 township health centers as members, and village clinics as the network base. Taking this as an opportunity, Yuqing County People's Hospital has strengthened the construction of key specialties and established two provincial-level key specialties, namely gastroenterology and orthopedics, as well as five municipal key specialties, including general surgery and cardiovascular medicine. "As the leading hospital, with strong financial support, we have invested tens of millions of yuan to upgrade our software and hardware, effectively improving our ability to diagnose and treat serious illnesses," said Zhu Xuesong, Vice President of Yuqing County People's Hospital. Dongtai is a county-level city in central Jiangsu Province. In the past, if people fell seriously ill, they usually chose to go to large hospitals in Shanghai and Nanjing, which was time-consuming and laborious, and also increased medical expenses. To address this issue, Dongtai City has placed greater emphasis on strengthening the specialized capabilities of leading hospitals in the process of building a closely knit county-level medical community. Nowadays, Dongtai People's Hospital and Dongtai Traditional Chinese Medicine Hospital, two leading hospitals, have established 44 provincial and municipal key specialties (disciplines) and 59 provincial and municipal grassroots characteristic departments. Every year, experts from major hospitals such as Shanghai and Nanjing are invited to the hospital to open studios, and 120 experts are flexibly introduced. A total of 76 new technologies and 158 new projects have been carried out. We provide annual financial support of 180000 to 200000 yuan to each expert studio of the leading hospital, and have formulated assessment tasks. In addition to attending consultations, experts also need to provide surgical demonstrations, guidance, and training to enhance local doctors' clinical skills Cui Hai, Director of the Health Commission of Dongtai City, introduced that currently, the consultation rate within the county of Dongtai City is stable at over 90%. "One of the strategic goals of the national healthcare reform is to achieve the goal of 'preventing serious illnesses from leaving the county'. This requires expanding the service scope of county-level hospitals, improving service capabilities, and allowing grassroots residents to enjoy high-quality medical services nearby." Wang Hufeng, Director of the Medical Reform Research Center at Renmin University of China, believes that county hospitals play a leading role in the county-level medical service system and a bridging role in the urban-rural medical service system. Suggest strengthening the specialized capacity construction of county-level hospitals, focusing on the weak links in the improvement of county-level medical service capabilities, and focusing on filling the disciplinary gaps in oncology, cardiovascular, respiratory, pediatrics, and mental health; With a long-term perspective, large hospitals should provide targeted assistance and support, and increase efforts in talent cultivation. Breaking down barriers and promoting collaborative medical services between counties and rural areas. "Suspected thickening of the appendix, please combine with clinical physical examination; mild dilation and gas accumulation in some intestines..." 71 year old Zhang Dashan completed abdominal CT imaging at Fudong Health Center in Fu'an Town, Dongtai City. Shortly after, Deng Yijun, deputy chief physician of the imaging department at Dongtai People's Hospital, received his diagnostic opinion. The reporter walked into the Dongtai City Imaging Cloud Diagnosis Center, where several imaging experts from Dongtai People's Hospital were nervously diagnosing real-time patient images uploaded from various regions online. Zhang Dashan was able to quickly obtain a diagnostic opinion thanks to this. The Imaging Cloud Diagnosis Center is located at Dongtai People's Hospital, connecting 28 grassroots medical institutions and 5 private hospitals in the city into a "network". The imaging data of each medical institution is uploaded to the center in real time. Leveraging the strong imaging specialty of Dongtai People's Hospital, medical imaging diagnosis services are provided to various medical institutions in the region, solving the problem of insufficient imaging diagnosis capabilities in grassroots medical institutions. At present, the average annual consultation volume of the center reaches 15000, which basically meets the imaging diagnosis needs in the jurisdiction. To address the shortage of grassroots pharmacy personnel and the low quality of prescriptions, Dongtai has established a regional prescription review center at the Municipal People's Hospital, organizing more than 10 professional pharmacists to conduct centralized prescription reviews. For outpatient prescriptions issued by all medical institutions within the city, each party must review and each party must check. In addition to the Imaging Cloud Diagnosis Center and the Regional Audit Center, Dongtai has also established a Regional Inspection Center, Network ECG Center, Smart Emergency Center, Remote Consultation Center, Drug Distribution Center, Health Follow up Center, Medical Dispatch Center, and Disinfection Supply Center at the Municipal People's Hospital, covering the inspection and testing, treatment and diagnosis, and out of hospital services within the scope of a closely knit county-level medical community. "The construction of 10 centers has opened up data barriers within the county, united counties, towns, and villages, centralized and unified management, and achieved the sharing of high-quality medical resources. Since its operation, it has served 250000 people annually, driving the synchronous improvement of grassroots medical quality, and saving more than 100 million yuan in medical expenses for the public." Cui Hai said. In Zunyi City, the municipal government has invested 59.39 million yuan to launch the construction of a closely knit county-level medical community information platform, empowering efficient management and operation of medical communities through information technology, and promoting information interconnection within the county. With the continuous improvement of health information technology, the medical community in Yuqing County has achieved full coverage of electrocardiogram, imaging, ultrasound, consultation, testing, and remote diagnosis and treatment, which can provide timely and efficient diagnostic opinions for township health centers. "At present, we are actively promoting the access and sharing of health information, striving to make county-level public hospitals and township health centers more smoothly access the city's electronic health records, electronic medical records, examination and testing systems, and achieve regional medical and health information interconnection and data fusion and sharing." said Wu Youhai, a fourth level researcher at the Yuqing County Health Bureau. "Digitization is an inevitable trend for the high-quality development of closely knit county-level medical communities. However, there are still some difficulties in breaking through data barriers in county-level medical communities, such as inconsistent construction standards and data formats. At the same time, due to the lack of supervision, various departments and regions are concerned about potential risks such as data leakage and technology abuse." Miao Yanqing, Deputy Director and Researcher of the Health Strategy and Service System Research Department of the Health Development Research Center of the National Health Commission, believes that top-level design should be strengthened, a digital medical community standard system should be established, medical community digital technology application evaluation should be carried out, network security system construction should be strengthened, and data security and personal privacy should be guaranteed. Reforming the payment mechanism and effectively managing and utilizing the medical insurance fund is also a test for the medical community on how to make the use of the medical insurance fund more efficient. The proportion of the population aged 60 and above in Dongtai City exceeds 37%, with a severe aging population and a high demand for medical care. Before the launch of the reform of the tightly knit county-level medical community in Dongtai City, there were many people who went out for medical treatment. The proportion of medical insurance fund expenditure for medical treatment in other places exceeded 30% of total expenditure for several consecutive years. The medical insurance for employees in the city has been continuously insufficient for more than ten years, and the medical insurance for residents has been continuously insufficient for six years. Therefore, the reform of medical insurance payment methods is imperative. After the reform, Dongtai City implemented a payment system for the total amount of medical insurance funds for the medical community. Based on the approved distribution base and expected annual increase, the fund for remote medical treatment and the settlement fund for medical community member units were included in the total budget management. The funds were prepaid at the beginning of the year, settled monthly, and settled at the end of the year. The remaining funds were used as business income for the medical community, for personnel performance rewards, medical prevention integration, health management, and service capacity improvement. Through refined assessment within the medical community, member units are guided to conduct precise diagnosis and treatment, orderly competition, and prevent excessive medical treatment. "In 2023, the medical insurance fund achieved a balance of income and expenditure, with a slight surplus. The average cost of medication per hospitalization for patients decreased from 2212.12 yuan in 2022 to 1801.34 yuan in 2023, a decrease of 18.6%," said Cui Hai. As one of the three pilot counties in Zunyi City for the payment of the total amount of medical insurance for closely knit county-level medical communities, Fenggang County has approved the total amount of medical insurance funds for urban and rural residents and employees in the county to the leading hospital of the medical community, implementing "total amount contracting, surplus retention, and reasonable overspending sharing". "The total amount of medical insurance paid by the tightly knit county-level medical community guides medical institutions and staff to establish awareness of cost control and conservation, correctly distinguish between 'sick' and 'not sick', as well as the difference between hospitalization and outpatient services, reduce the burden of patients' medical treatment, and effectively achieve the effect of opening up sources and reducing costs." said Zhou Xiuping, Deputy Director of Fenggang County Medical Insurance Bureau. "The bundled payment of medical insurance funds is a key link in establishing an incentive compatibility mechanism for closely knit county-level medical communities. It is conducive to incentivizing internal medical communities to improve fund utilization efficiency, reduce unreasonable cost growth, and guide medical institutions to pay more attention to patients' health rather than diseases." Miao Yanqing believes that medical insurance packaging payment cannot be done in one package, and precise calculation is needed. How to determine the total amount of medical insurance packaging is crucial. At the same time, medical insurance package payment and cost control responsibility should also be packaged in order to promote the transformation towards a health-centered service approach. "We need to strengthen the supervision and assessment of medical insurance funds to ensure that they are used in a standardized manner within the tightly knit county medical community." Huang Xinyu, Director of the Medical Management Department of the National Medical Insurance Administration, stated that medical insurance departments at all levels should effectively fulfill their regulatory responsibilities for the medical insurance fund. The assessment of the medical community should not only include routine aspects such as the quality of medical services, medical expenses, and satisfaction of insured personnel, but also highlight indicators and effectiveness that reflect hierarchical diagnosis and treatment, such as the county-level consultation rate and grassroots consultation rate. In addition, it is necessary to refine the indicators and evaluation standards for assessment and evaluation, link the assessment results with the year-end medical insurance expense settlement, and effectively manage and make good use of the medical insurance fund. (Lai Xin She)