Will hospitals with strong surgical strength have more advantages in the future?
The high-quality development of public hospitals, how to do it? Now, the answer is announced.
On February 9, the "Evaluation Indicators for Promoting the High-quality Development of Public Hospitals in Provinces (Autonomous Regions and Municipalities) (Trial Implementation)" (hereinafter referred to as the "Indicators") was made public by the Secretariat of the State Council Medical Reform Leading Group, and every June thereafter, the Secretariat of the State Council Medical Reform Leading Group will notify the results of its evaluation of each province (autonomous region, municipality) to the provincial medical reform leading groups.
The 27 clear, quantifiable secondary indicators depict the overall blueprint of the future mainland public health care system. "It can be summed up as internal medicine surgery, traditional Chinese medicine characteristics, management refinement, and hospital informatization." Dr. Zhuang Yiqiang, director of GAHA of Guangzhou Elippi Hospital Management Center, said.
Truncated from the official website of the National Health Commission
Hospitals with strong surgery are more dominant,
Higher requirements have been put forward for tertiary hospitals
The ratio of the number of outpatients to the number of discharged patients in tertiary public hospitals is the fourth secondary indicator, which is commonly known in the industry as the "door-to-door ratio". The calculation method is to divide the number of outpatients after the removal of emergency departments and health examinations by the number of discharged patients.
The "Indicators" make it clear that the purpose of setting this article is to control the scale of ordinary outpatient clinics in tertiary hospitals.
"The level of the 'door-to-door ratio' reflects the proportion of patients who need to be hospitalized in the outpatient treatment of the hospital, and can also be understood as the proportion of patients admitted to the hospital outpatient clinics that belong to the proportion of difficult and complicated diseases."
Zhuang Yiqiang told the "medical think tank": "The number of beds in tertiary public hospitals is fixed, so the number of discharged patients is limited. The high 'door-to-door ratio' often means that the hospital outpatient clinic has admitted a large number of mild patients who do not need to be hospitalized, in other words, the tertiary hospital siphons a large number of mild patients who should have gone to the primary medical treatment. ”
The fifth secondary indicator, which follows, says that the proportion of hospitalizations in the county should be gradually increased. Article 6 states that the proportion of diagnosis and treatment in primary medical and health institutions to the total amount of diagnosis and treatment should reach a reasonable level. The three indicators are connected together, and the purpose of promoting the realization of the hierarchical diagnosis and treatment system is clearly visible.
The Guiding Opinions of the General Office of the State Council on Promoting the Construction of a Graded Diagnosis and Treatment System (Guo Ban Fa [2015] No. 70) clearly pointed out: "Urban tertiary hospitals mainly provide diagnosis and treatment services for acute and critical diseases and difficult and complex diseases. "The "Indicators" also put forward requirements for the case combination index of tertiary public hospitals, that is, the CMI value, without exception.
"The higher the CMI value, the higher the proportion of patients admitted to the hospital for incurable diseases. Combined with the requirements of the 'door-to-door ratio', the basic stuck hospital vainly tries to 'make it bigger' by admitting a large number of patients with mild diseases to the possibility of 'bigger' denominator, and the tertiary hospital can only develop in the direction of admitting and treating difficult and complicated diseases in the future. Zhuang Yiqiang analyzed the "think tank in the medical field".
The "Indicators" also pointed out that it is necessary to gradually increase the amount of scientific and technological achievements per 100 health technicians in tertiary public hospitals. "This actually puts forward higher requirements for the scientific research level of tertiary hospitals, breaking the evaluation system of only papers and papers published in the past, and now, scientific research results must be able to land and be transformed." He said.
In addition, in view of the "Indicators" to gradually increase the proportion of tertiary public hospital discharge patients with four-level surgery, and gradually increase the requirements of medical service income other than drugs and consumables, Zhuang Yiqiang pointed out that hospitals with strong surgical strength will have more advantages in the future.
"Medical service income can be roughly divided into 2 types, one is dependent income, such as prescribing drugs and prescribing examination orders. Doctors also need to think about this process, but their remuneration is tied to the income from medicines and examinations. "The other is purely technical income, like surgery fees." In the context of the price of medical services set by the government, the more technical income, the higher the proportion of medical service revenue, which is why internal medicine is becoming more and more surgical, and physicians will also carry out technical treatment such as interventional surgery. ”
Put forward quality requirements for traditional Chinese medicine hospitals,
The evaluation indicators are overall off-site and quantifiable
In the past year, relevant departments have issued many favorable documents to promote the development of traditional Chinese medicine hospitals and traditional Chinese medicine diagnosis and treatment. Among them, the most likely to be "eye-catching" is the "Guiding Opinions on Medical Insurance Supporting the Inheritance and Innovative Development of Traditional Chinese Medicine" jointly issued by the National Medical Insurance Bureau and the State Administration of Traditional Chinese Medicine on December 30, 2021.
Among them, it is clear that "TCM medical institutions can temporarily not implement payment according to disease diagnosis related groupings (DRG)", which seems to have left a "safe haven" for TCM in the storm of medical insurance payment method reform. But there are no Traditional Chinese medicine hospitals that do not carry out Western medical treatment at all. So how to keep the original intention of the favorable policies of traditional Chinese medicine?
The "Indicators" gives an answer: In addition to the quantitative requirements for county-run TCM medical institutions to gradually achieve full coverage and the number of practicing (assistant) physicians in the TCM category to increase reasonably, in terms of quality, it also requires the use rate of Chinese medicine tablets in outpatient and discharged patients in TCM hospitals, and the proportion of discharged patients treated mainly by TCM, to reach a reasonable level.
The "Indicators" also lists some evaluation indicators for improving the quality and efficiency of public hospitals, such as reasonably reducing the average hospital stay, controlling the increase in the average cost of outpatient and inpatient visits, reasonably determining personnel costs, and reducing management costs.
Zhang Lihua, director of the operation and management department of Zhongnan Hospital of Wuhan University, told the "medical think tank": "Personnel cost control is an important part of the operation and management of public hospitals, because the proportion of personnel costs is too low will affect the enthusiasm of medical work, and too high a proportion will affect the rational allocation of resources of other elements." ”
"Therefore, it is necessary to combine the overall development strategy of the hospital, the current situation of the discipline development of each department, and the budget of personnel costs at both levels of the hospital to reasonably determine the proportion of personnel costs in each year to the total cost." The hospital management cost is the cost of ensuring the normal operation of the hospital, and in the context of the current public hospital's 'open source is limited and throttling is the mainstay', it must also be reasonably spent, so as not to cause a burden on the operation of the hospital. ”
The "Indicators" also mention the remuneration reform, but the requirement to "play the role of the remuneration system guarantee" is slightly vague. In this regard, zhong Chongming, a medical policy researcher, believes that from the perspective of local practice, the risks and challenges of the reform of the remuneration system are not small, and it is still necessary to be cautious.
"Overall, the operability of the Indicators is still quite strong, because many evaluation indicators coincide with the performance appraisal indicators of tertiary public hospitals," Zhuang Yiqiang said, "The latter has been running for 3 years, whether it is the official or the hospital has a certain experience, but this time it is to push this set of standards to all public hospitals in the country." ”
It is worth pointing out that the Secretariat of the State Council Medical Reform Leading Group clarified in this document: "The relevant data of the evaluation indicators are directly taken from the existing information systems such as the medical reform monitoring system, the health statistical yearbook, the health and health financial annual report, the performance appraisal of public hospitals, and the satisfaction survey, and must not increase the burden on the grass-roots level, and must not increase the workload of hospitals to fill in forms and report the number of reports." ”
Zhuang Yiqiang believes that this reflects the off-site nature of the evaluation index assessment (no need for relevant experts to go to the hospital to score the assessment) and quantifiable, "compared with the qualitative evaluation and on-site evaluation, off-site and quantitative data can play a role in improving efficiency, reducing human interference and subjective factors, and the evaluation is more objective and more scientific."
Source: Medical Community Think Tank
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
Plate making: Xue Jiao