Recently, the Fujian Provincial Health Commission issued the "Fujian Province Deepening the Reform of the Medical and Health System in 2024 Key Task Plan" (hereinafter referred to as the "Plan"), the "Task" includes a total of 22 important measures in 5 aspects, among them, the emphasis is on continuing to promote the experience of Sanming medical reform, accelerate the expansion of high-quality medical resources, deepen the reform of the salary system of public hospitals, and promote the coordinated development and governance of medical insurance, medical treatment and medicine.
In terms of deepening the integrated reform of "medicine, price and insurance", the "Mission" clearly further strengthens the safety management of medical insurance funds. Standardize the use of medical insurance funds as an important part of the performance evaluation of medical institutions and medical personnel, and link it with salary distribution and evaluation.
Source: Fujian Provincial Health Commission
1. Promote the combination of medical reform and the construction of a healthy Fujian
The Plan proposes to deepen the promotion and management of health for all. Explore the training of exercise prescribers to promote the coordinated development of sports and health.
At the same time, we will promote the reform of the disease prevention and control system. Comprehensively complete the integration of municipal and county-level centers for disease control and prevention and health supervision institutions at the same level, establish and improve mechanisms for epidemic prevention and control and health administrative law enforcement, and standardize the provision of public health technical services to the public. Promote the coordinated development of county-level disease control institutions and county-level medical communities, and establish mechanisms for talent flow, service integration, and information sharing.
In terms of promoting the integrated development of medical care and health care, it is required to strengthen the cooperation and co-construction of medical institutions and elderly care institutions, and explore the expansion of services such as the integration of medical care and elderly care and palliative care. With the signing of family doctors as the starting point, we will carry out personalized services such as door-to-door diagnosis and treatment and assistance in referral for key groups such as the elderly. Implement family bed services in county-level public hospitals and qualified primary medical institutions.
2. Adhere to collaborative governance,
Deepen the integrated reform of "medicine, price and insurance".
The plan emphasizes the need to promote the centralized procurement of pharmaceutical consumables. Carry out centralized procurement of new batches of national, provincial (inter-provincial alliance) drugs and medical consumables, and add 80 drugs and 5 types of consumables in 2024 (a total of 600 drugs and more than 35 types of consumables), and each districted city and Pingtan Comprehensive Experimental Zone will carry out at least one batch of centralized procurement (including participation in municipal alliance procurement) for other varieties within the year. Strengthen the rigid constraints on the amount and implementation of centralized procurement by public medical institutions, and optimize the assessment and allocation procedures for the retention of medical insurance funds in centralized procurement.
Promote the dynamic adjustment of medical service prices. Each co-ordinating area shall complete the annual price adjustment assessment before the end of June, and adjust it within the year if it meets the requirements. Carry out the reform of medical service prices by category. Improve the price policy to support primary medical care, and gradually implement the same price for medical institutions at different levels in the same city for medical service projects with a high degree of homogenization and suitable for medical institutions at the second level and below. Implement a pharmacy service charging policy in the province's tertiary public hospitals.
Further strengthen the safety management of medical insurance funds. Promote the special rectification of medical institutions' illegal use of medical insurance funds, carry out cross-flight inspections on a regular basis, and establish mechanisms for information exchange between departments and mutual transfer of cases. Combined with the application of big data screening and analysis, explore the establishment of a whole-process intelligent monitoring mechanism of pre-event reminder, in-process review, and post-event punishment. Medical institutions shall do a good job of verifying the medical insurance identity of patients in accordance with regulations, identifying the application of the medical insurance catalog, recording and archiving inspection and inspection reports, and standardize the diagnosis and treatment, pricing, charging and other behaviors; Standardize the use of medical insurance funds as an important part of the performance evaluation of medical institutions and medical personnel, and link it with salary distribution and evaluation. Improve the management of medical service price projects, and respond to the reasonable demands of medical institutions in a timely manner by clarifying the connotation of price items, setting additional fee standards, and explaining policies in writing.
3. Adhere to the public welfare orientation,
Promote the reform and high-quality development of public hospitals
The Plan clearly and fully implements the government's responsibility to run medical institutions. Establish and improve a sustainable investment guarantee mechanism that is compatible with the level of economic development and coordinated with the financial situation, and explore the inclusion of financial investment in public hospitals in government performance evaluation. For subsidies for the reform and development of medical and health institutions that are in line with the regional health plan, the financial department at the same level shall bear the responsibility for expenditure according to the subordinate relationship, and implement the policy of tilting investment in hospitals such as traditional Chinese medicine, infectious diseases, and psychiatric diseases. In accordance with the requirements of "ensuring the basic and strengthening the grassroots", the new financial resources of local governments are tilted towards the rural medical and health field. On the basis of the overall planning of central funds, the provincial finance department shall provide subsidies to cities and counties to promote the comprehensive reform of public hospitals and the implementation of the basic drug system by primary medical and health institutions in accordance with regulations.
Deepen the reform of the operating mechanism of public hospitals. Improve the management of the total salary of public hospitals, and explore the establishment of a health performance-oriented distribution mechanism. Carry out in-depth activities for the year of economic management of public medical institutions, and promote the full implementation of the chief accountant system in tertiary public hospitals and county-level medical communities. Guide and urge Sanming City to complete the national public hospital reform and high-quality development demonstration project, and promote 25 provincial demonstration hospitals to play a leading role.
Establish and improve a long-term mechanism for rational diagnosis and treatment. Organize and carry out a new round of hospital inspections, and take the promotion of centralized rectification of corruption in the pharmaceutical field and the strengthening of medical ethics and medical style education as an important part of the high-quality management of public hospitals. Strengthen spot checks on the implementation of the core system of medical quality and safety by medical institutions, improve the mutual recognition of inspection results and the mechanism for accessing and sharing medical imaging data, and explore the establishment of a chief pharmacist system in tertiary public hospitals. Medical institutions at all levels shall report or give feedback to the health and medical insurance departments at the same level on a quarterly basis or feedback on the difficulties, problems and suggestions encountered in the implementation of policies such as medical services, project prices, medical insurance payments, and drug supply guarantees, and the relevant departments shall provide guidance or solutions in a timely manner according to their duties.
The "Plan" emphasizes that the transformation of ward conditions should be promoted to improve the level of ageing, comfort and convenience. The pilot scope of "unaccompanied" wards will be expanded to all tertiary hospitals in the province, and gradually extended to secondary public hospitals. Focusing on the construction of a high-quality and efficient medical and health service system, pilot work has been carried out in Sanming, Quanzhou, and Nanping, and the service model of multi-disease co-prevention and co-management at the grassroots level and the integration of medical treatment and prevention of chronic diseases has been explored.
Fourth, adhere to the center of gravity downward,
Accelerate the construction of a new pattern of orderly medical treatment and treatment
Make up for the shortcomings of primary medical services. Every year, 100 township health centers will be selected for key support and construction, and 214 weak township health centers will be implemented from 2024 to 2025 to improve the service capacity of 214 weak township health centers, so as to meet the corresponding national service capacity standards as soon as possible. By the end of 2024, the proportion of primary diagnosis and treatment in each county will reach 65% or an increase of about 1 percentage point year-on-year.
Promote the construction of medical complexes by category. Promote the national pilot work of Sanming and Nanping compact urban medical groups and provincial pilot projects in Fuzhou, Xiamen, Quanzhou, etc., and establish a reasonable division of labor, complementary advantages, and benefit sharing mechanism for the whole chain of disease diagnosis and treatment. Comprehensively promote the construction of a close-knit county-level medical community, improve the operational mechanisms for the establishment and use of medical communities, personnel management, etc., and make overall arrangements for one person with the title of attending physician or above to serve in townships and towns all year round. Promote all kinds of medical alliances to promote the sharing of medical resources and the seamless connection of two-way referral through the joint construction of joint wards and convenient outpatient clinics.
5. Adhere to integrity and innovation, and make overall plans to promote reforms in relevant fields
Improve the mechanism for the training and use of medical personnel. Deepen the coordination of medical education, support the province's medical colleges and universities to hold "3+3" higher vocational undergraduate clinical medicine majors, and increase the enrollment of about 350 people. Accelerate the completion of the shortcomings of the county-level physician team, and train about 400 new medical orientation students for county-level hospitals and township health centers in the province; Implement a special plan for college students and rural doctors, and incorporate it into the establishment and management of township health centers in accordance with relevant policies; Gradually include the practicing (assistant) physicians of village clinics that have achieved integrated management into the evaluation of professional titles in township health centers. Strictly implement the policy of health technicians applying for deputy senior professional titles before going down to the grassroots level. Strengthen the construction of the nursing team and gradually increase the number of registered nurses per 1,000 population. Deepen the coordinated development of military and local medical institutions, and explore the establishment of a training mechanism for grassroots military doctors to practice in local emergency institutions.
Strive to create a demonstration area for the comprehensive reform of traditional Chinese medicine. Promote the implementation of projects such as key hospitals with traditional Chinese medicine characteristics and "flagship" hospitals of national synergy of traditional Chinese and Western medicine, and improve the service connotation of county-level shared traditional Chinese medicine pharmacies and grassroots Chinese medicine halls.
Strengthen the coordination and linkage of medical and health supervision. Establish and complete mechanisms for joint consultation on law enforcement by multiple departments, standardizing comprehensive supervision and supervision, joint handling of problem leads, and coordinated application of law enforcement results. Carry out in-depth special governance of large-scale equipment inspection prices and online drug prices, and severely crack down on illegal medical practice and illegal advertising. Strengthen supervision and guidance of lawful practice, and promote the standardized development of private hospitals and retail pharmacies.
All relevant departments in all localities give full play to the role of Sanming City as a national medical reform experience promotion base, pay attention to learning from Sanming's reform spirit of "people first, dare to be the first", adhere to the problem-oriented and goal-oriented, focus on the urgency and sorrow of the masses to seek medical treatment, and explore small-incision, differentiation and leading innovative measures according to local conditions.