Recently, the Shanghai Municipal Health Commission has issued two documents on social medical services, indicating that social medical services are still encouraged by policies.
Author: Xu Yucai
来源｜看医界（ID：vistamed）
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In recent years, there have been rumors that social medical services have been "neglected" or even "discriminated against", and recently, the Shanghai Municipal Health Commission has issued two documents on social medical services, indicating that social medical services are still encouraged by policies.
These two documents are the "Guiding Opinions on the Establishment of Socially-run Medical Institutions in Shanghai" (hereinafter referred to as the "Guiding Opinions on the Establishment"), and the other is the "Administrative Measures for the Examination and Approval of the Practice of Socially-run Medical Institutions in Shanghai" (hereinafter referred to as the "Measures for the Examination and Approval of Practice").
It is reported that both documents will come into force on June 8, 2024 and will be valid for 5 years until June 7, 2029.
After inquiry, it was learned that in fact, the reason why these two documents were issued was because the two same documents (the Opinions on Optimizing the Establishment and Management of Social Medical Institutions in Shanghai issued in January 2019 and the Administrative Measures for the Examination and Approval of Practice in Social Medical Institutions in Shanghai, which came into force on March 1, 2019 and are valid until February 29, 2024) are valid for the "renewal" documents after the expiration date.
You must know that in 2018, Shanghai issued the "50 Articles of the Medical and Health Industry" that shook the industry, and Professor Cai Jiangnan, a well-known medical reform expert at that time, once interpreted that Shanghai's 50 articles are leading the country in horizontal comparison, and they are also the most open and reformed in the history of Shanghai's medical and health policies. Even though five years have passed, it still seems that the opinions on the management of the establishment of social medical institutions and the examination and approval measures for the practice of social medical institutions have not changed, and this just shows that in the past five years, the policy of regulating social medical services has not changed, and social medical institutions are still encouraged by the policy.
Here, only some of the contents worthy of attention in the document are sorted out for the reference of social capital investment.
1. In terms of the positioning of social medical institutions, special independent medical institutions emphasize sharing and serving the grassroots
For the establishment of social medical institutions, the "Guiding Opinions on the Establishment" emphasizes that it is necessary to follow the principle of ensuring health and diversified development; planning and guidance, orderly development; Openness and transparency, quality first; Focus on efficiency and dynamically adjust the four basic principles to maximize the efficiency of medical resources.
In terms of functional positioning, the "Guiding Opinions on the Establishment" clearly stipulates that the third-level, second-level, first-level and other medical institutions are required to develop specialized characteristics and improve the comprehensive ability of medical teaching and research for specialized diseases. Focusing on the diagnosis and treatment of difficult and miscellaneous diseases and patients, clinical teaching, training, scientific research and the promotion and teaching of new technologies and achievements are carried out; It plays an exemplary role in hospital management and standardized diagnosis and treatment.
Secondary medical institutions should carry out medical services for the social population within the region, and carry out diagnosis and treatment services for common and frequently occurring diseases.
First-level and other medical institutions are mainly oriented to communities and families, carrying out preventive health care, diagnosis, treatment, rehabilitation, and nursing services for common and frequently occurring diseases, and have functions such as health care for women and children, health care and rehabilitation for the elderly, and health education.
It is particularly noteworthy that for special independent medical institutions such as medical testing laboratories, medical imaging diagnosis centers, pathological diagnosis centers, hemodialysis centers, and medical disinfection supply centers, the "Guiding Opinions on the Establishment" requires that they should promote hierarchical diagnosis and treatment, effectively share and utilize medical resources such as testing, imaging, pathology, hemodialysis, and disinfection supply, improve the service capacity of primary medical institutions, and meet the diversified and multi-level medical service needs of the people.
2. In terms of beds, it continues to be proposed to reserve space for social medical institutions at a rate of not less than 30% of the total number of beds (including treatment and long-term care beds) in accordance with the relevant national planning requirements. The treatment beds of newly established social medical institutions with international influence shall be coordinated by the municipal health administrative department.
3. Classified management is the characteristic of Shanghai's management of social medical institutions
Classified management includes sub-regional, sub-specialty, and sub-level, which provides an open and transparent reference for where social capital is located and what kind of medical institutions are set up.
The so-called sub-regional, that is, according to the current situation of medical resource allocation, according to the sub-regional management of rich medical resources, relatively insufficient medical resources, weak medical resources, and encouraging the development of health care service industry clusters, guide social capital to invest in medical institutions in areas with relatively insufficient medical resources and weak medical resources. Encourage the development of areas where the health care service industry gathers, and remove restrictions on the number, grade, size of beds, and location distance of institutions run by social capital other than tertiary medical institutions and special independent medical institutions. Encourage the introduction of high-quality, high-level social medical institutions with good reputation and advanced management.
The so-called sub-specialization, that is, for weak specialized medical institutions with large social needs such as geriatric medical care, rehabilitation, and pediatrics, in principle, there are no restrictions on the number, grade, size of beds, and site selection distance.
The so-called hierarchical, that is, for social medical institutions with 100 beds or more, there are no restrictions on the number, grade, location distance, etc. In accordance with the "Interim Measures for the Administration of Clinics for the Record" and the "Interim Measures for the Administration of the Filing of Traditional Chinese Medicine Clinics", there are no specific restrictions on clinics, traditional Chinese medicine clinics and other medical institutions.
At the same time, the "Guiding Opinions on the Establishment" encourages the formation of chain and collectivization of social medical institutions, and the establishment of standardized and standardized management and service models. Priority may be given to applicants who intend to set up collectivized or chained social medical institutions.
4. There is a clear division of setting permissions
The "Guiding Opinions on the Establishment" stipulates that general hospitals of the second level and above, traditional Chinese medicine hospitals, hospitals integrating traditional Chinese and Western medicine, specialized hospitals (including specialized hospitals of traditional Chinese medicine), rehabilitation hospitals; Sanatorium; Medical Testing Laboratory, Pathological Diagnosis Center, Medical Imaging Diagnosis Center, Hemodialysis Center, Medical Disinfection Supply Center, Health Examination Center; Sino-foreign joint venture and cooperative medical institutions, medical institutions organized by Hong Kong, Macao and Taiwan service providers shall be set up by the municipal health administrative department, and the district health administrative department shall be responsible for the preliminary examination.
First-class general hospitals, traditional Chinese medicine hospitals, integrated traditional Chinese and Western medicine hospitals; outpatient departments, clinics (health centers, health rooms, infirmaries), rehabilitation medical centers, palliative care centers; Nursing homes, nursing stations, nursing centers, etc., shall be set up by the district health administrative department.
5. Reiterate the three systems of social offices
The Measures for the Examination and Approval of Practice once again reiterate the three systems of social medical services.
The first is the licensing system. The Measures for the Examination and Approval of Practice stipulate that social medical institutions shall implement the system of Practice License for Medical Institutions, and no unit or individual shall engage in medical practice activities without the permission of the administrative department of health. When registering for practice, those who apply for practice registration in tertiary hospitals, tertiary maternal and child health care hospitals, Sino-foreign joint venture cooperative medical institutions, and medical institutions wholly owned by Hong Kong, Macao and Taiwan shall also obtain the "Approval Letter for the Establishment of Medical Institutions". This is consistent with the requirements of the notice issued by the national health administrative department in November 2018 on optimizing the access services of medical institutions and medical staff, "improving the 'two certificates in one' for the approval and practice registration of secondary and below medical institutions".
The second is the social publicity system. The Measures for the Examination and Approval of Practice stipulate that the practice registration of socially-run medical institutions shall be subject to a public announcement system. The administrative department of health shall publicize the social medical institutions to be registered for a period of 5 working days. The content of the publicity includes the type of social medical institution to be established, the practice address, the diagnosis and treatment subjects, the bed (dental chair, observation bed), as well as the name of the person who set it up and the name of the applicant. If a real-name report or objection is received during the publicity period, the administrative department of health shall promptly organize an investigation, and if it is verified that it does not meet the requirements for practice, the announcement will not be passed, and the administrative department of health shall not approve the practice registration.
The third is the on-site audit system. The Measures for the Examination and Approval of Practice require the establishment of an on-site review system for the practice registration of social medical institutions. After the administrative department of health accepts the application for practice registration of a social medical institution, it shall, in accordance with the provisions, conduct an on-site review of the social medical institution to be registered, focusing on the department setting, instruments and equipment, basic facilities, and qualifications, basic knowledge and skills of the social medical institution to be registered, and form a written opinion. If the on-site examination is unqualified, the "Medical Institution Practice License" shall not be issued.
6. There is a doorway for the registration of diagnosis and treatment subjects
The "Practice Examination and Approval Measures" put forward six requirements for the registration of diagnosis and treatment subjects, and three points are particularly emphasized here:
First, if a social medical institution does not divide the second-level disciplines (professional groups) under the first-level diagnosis and treatment subjects, it only needs to approve and register the first-level diagnosis and treatment subjects; According to the requirements of the "List of Diagnosis and Treatment Subjects of Medical Institutions", if the second-level disciplines (professional groups) are divided under the first-level diagnosis and treatment subjects, the second-level diagnosis and treatment subjects shall be approved and registered, and the corresponding equipment and facilities, technical level and professional ability shall be met; It is forbidden for socially-run medical institutions that only register first-level diagnosis and treatment subjects to carry out medical service projects that are technically complex, risky, difficult, and require high requirements for supporting equipment and facilities;
Second, a diagnosis and treatment subject must have at least one physician with more than five years of work experience in the specialty, registered in the medical institution in the main practice institution, and equipped with health technicians in accordance with the basic standards of medical institutions and the corresponding specialty standards;
Third, for medical examination, medical imaging, pathology and other diagnosis and treatment subjects, the cooperation agreement between the social medical institution and the municipal medical center, the regional medical center, the medical testing laboratory, the medical imaging diagnosis center, the pathological diagnosis center, and the cooperation agreement with other social medical institutions operating in the same brand chain can be used as the basis for the registration of diagnosis and treatment subjects, and it is indicated on the copy of the "Medical Institution Practice License". (This article is published by "Seeing the Medical World", and reprinting must be authorized, and the author and source should be indicated at the beginning of the article.) ）