Lei Haichao: "Four aspects" continue to improve the public welfare of public hospitals

On September 12, the Information Office of the State Council held a series of press conferences on the theme of "Promoting High-quality Development". Lei Haichao, director of the National Health Commission, introduced the basic situation of the current health development and the progress and results of a number of key tasks at the meeting.

01 Residents' health quality and literacy have been significantly improved

The CPC Central Committee and the State Council attach great importance to the relevant plans for healthy development, and the National Health Commission has made significant progress in improving the health quality and literacy of residents through a series of health measures, such as the Healthy China Initiative, the Patriotic Health Campaign, and basic public health service projects.

First of all, there has been a significant increase in personal health awareness. The National Health Commission (NHC) has carried out a large number of high-frequency health knowledge dissemination actions with local health departments, disease control departments, and traditional Chinese medicine departments to support the promotion of personal health awareness. According to statistics, the health literacy level of Chinese residents has increased from 17.06% in 2018 to 29.70% in 2023.

Second, the health level of the masses has been markedly improved. In 2022, the overall myopia rate of children and adolescents in mainland China will be 51.9%, a decrease of 1.7 percentage points from 2018, and the deteriorating trend of myopia incidence among adolescents has been curbed and is being further consolidated. In 2023, the number of new cases of occupational diseases reported nationwide decreased by 48.6% compared to 2018. In 2023, the national mortality rate of children under 5 years old will be reduced to 6.2 per thousand, and the maternal mortality rate will be reduced to 15.1 per 100,000, reaching the best level in the history of the mainland and the advanced level of middle- and high-income countries in the world.

Third, the impact of environmental and major diseases on population health has been continuously improved and controlled. In recent years, the mainland's environmental indicators such as air, water and soil have been significantly improved, and the quality of public life has been improved. At the same time, the premature mortality rate of major chronic diseases in mainland China has dropped from 17.36% in 2018 to 15% in 2023.

At present, the mainland has established 1,052 national health cities, national health counties and districts, and 2,637 national health towns. In the process of construction, public finance has played a positive role in promoting and guaranteeing, and the national project to equalize basic public health services has increased from 15 yuan per capita in 2009 to 94 yuan per capita in 2024.

The Third Plenary Session of the 20th Central Committee of the Communist Party of China further put forward the "implementation of the strategy of giving priority to the development of health". In the next step, the National Health Commission will conscientiously implement the central government's decision-making and deployment, in-depth study of the strategic connotation, specific policies and implementation measures of health priority development, especially in development planning, government investment, social governance and other aspects, and study a more refined system of governance policies and regulations to achieve the strategic goal of health priority development.

02 The construction of a close-knit county-level medical community is expected to achieve the expected goals ahead of schedule

In recent years, the National Health Commission has continued to promote the pilot of a close-knit county-level medical community and unified action across the country. As of the end of August this year, the number of close-knit county-level medical communities in mainland China has grown to 2,171, which is in line with expectations and is expected to achieve the expected goals ahead of schedule.

The county-level medical and health institutions are also vigorously helping the urban and rural grassroots, forming a benign interactive situation of "the first level helping the first level, and the higher level helping the lower level". By the end of 2023, more than 80,000 rural order (directed) medical students have been trained free of charge in mainland China, providing a steady stream of high-quality professional and technical personnel to rural areas. At present, 90.9% of the counties have achieved full coverage of the personnel stationed in county-level hospitals to serve in township health centers, and the stationed personnel shall serve for no less than half a year in principle, and they should be rotated regularly to ensure that the township health centers have a sufficient number of professionals with sufficient capacity to provide services to the people.

In addition, methods such as roving medical care and remote diagnosis and treatment have been widely adopted at the county level. According to the monitoring, the method of "grassroots inspection and superior diagnosis" has covered two-thirds of the township health centers, and has formed an effective development path and promotion measures.

According to the plan, by the end of next year, more than 90% of the counties will establish a county-level medical community, and the degree of closeness should be newly improved, so as to achieve better coordination between the upper and lower institutions, more integrated information, and more frequent personnel exchanges, so that the grassroots service capacity and level will be continuously improved and improved.

03 "Four aspects" continue to improve the public welfare of public hospitals

The Third Plenary Session of the 20th Central Committee of the Communist Party of China has made clear arrangements for deepening the public welfare-oriented reform of public hospitals, which can be understood, studied and implemented from four aspects.

First, we must adhere to the guidance of public welfare and put public welfare in the first place. As the main force in providing medical services, public medical institutions should highlight public welfare in the specific management, development concept, macro planning and government investment of hospitals.

The second aspect is to establish a dynamic adjustment mechanism for the establishment of public hospitals. The state should formulate corresponding dynamic adjustment standards, and all localities should implement the relevant work of dynamic adjustment of the establishment of public hospitals, so that qualified, capable, and good medical ethics and medical professional and technical personnel can be guaranteed to be established and safely engaged in medical work that serves the people.

Third, it is necessary to establish a charging mechanism dominated by medical services. At present, the main task of price reform is to incorporate the service items and technologies that have been proven clinically effective and professionally recognized into the scope of price management and medical insurance payment in a timely manner according to the changes in the financing level of the medical insurance fund, the cost space saved by the centralized procurement of drugs and medical consumables, and the new development trend of medical technology. In addition, for some long-term low medical service price items, necessary adjustments will be made within the limits that the medical insurance fund and the people can pay. At the same time, it is necessary to establish and improve the medical insurance payment system with multiple payments as the main body, support technological development, and control the unreasonable growth of costs.

Fourth, improve the salary system of public hospitals. The reform of the salary system should ensure the implementation of the "two allows" policy and "do a good job in the three structural adjustments". The "two permits" mean that when the relevant departments approve the performance salary of personnel in public medical institutions, they should approve the total amount and adjust it dynamically, so that the performance salary of medical personnel is synchronized with the changes in the economy, society and price level, reflecting the labor value of doctors, and encouraging excellent work and more work. The "three structural adjustments" include: the first structural adjustment, public medical institutions should adhere to the public welfare as the basic starting point and foothold, and gradually narrow the gap between the performance salary level of public first, second and third level medical institutions; The second structural adjustment is to adhere to the requirements of public welfare, and gradually narrow the salary gap between different specialties and different departments within medical institutions, so that the income and treatment of professional medical personnel with relatively weak shortcomings such as pediatrics, pathology, mental health, anesthesia, general medicine, and obstetrics have been improved; Finally, in structural adjustment, it is necessary to gradually increase the proportion of fixed income in the performance salary of medical personnel in accordance with the requirements of public welfare, appropriately regulate and control the proportion of flexible income bonuses, make it more in line with the positioning of public welfare, and encourage medical and health professionals to study more technology and provide more good services.

In the next step, the National Health Commission will implement and improve the above work ideas and preliminary considerations, continue to improve the public welfare of public hospitals, mobilize and maintain the enthusiasm of medical staff, strengthen comprehensive supervision, and form a virtuous circle and interaction between the development of public hospitals and economic and social development.

04 Accelerate the balanced distribution of regions and the homogeneity of medical services

The shortage and uneven distribution of high-quality medical resources is a common problem in the world. The mainland attaches great importance to this issue and has adopted a series of effective measures.

First, expand the scale and capacity of high-quality medical resources. In recent years, the mainland has promoted the expansion of high-quality medical resources from the three levels of national medical centers, national regional medical centers and provincial regional medical centers, and has successively set up 13 professional national medical centers, 125 national regional medical centers and 114 provincial regional medical centers. Through multi-level construction, the mainland's medical resources and service capacity have made a significant leap, and the distribution between the eastern, central and western regions has become more balanced.

Second, focus on sinking high-quality medical resources. In recent years, the National Health Commission has successively promoted the counterpart of tertiary hospitals to help county-level hospitals and the "10,000 Physicians to Support Rural Health Project", so that high-quality medical services can be delivered to the grassroots people. The 44 commission-managed hospitals that were launched a few days ago have achieved full coverage of state-appointed hospitals for the first time in the annual roving medical tours. In addition, according to statistics, 40% of the new construction projects of key clinical specialties are located in cities other than provincial capitals, reflecting the policy arrangements made for the balanced provision of medical services.

Third, we should give full play to the supporting role of informatization. At present, the number of Internet hospitals in China has reached 3,340, and the number of Internet diagnosis and treatment services provided by more than 100 million people every year has provided a strong supplement to the form of medical services.

A few days ago, the National Health Commission announced that it will pilot the establishment of foreign-funded hospitals in 9 cities in China to provide more support for the business environment and residents' medical treatment options in these 9 cities. In the next step, the National Health Commission will highlight the reform of the system and mechanism, and further promote the diversification of the content and form of medical services and the clearer service level in accordance with the decision-making and deployment of the Third Plenary Session of the 20th Central Committee of the Communist Party of China.

Source: Chinese Journal of Health

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