Decentralization of sixty-one items, attracting patients to return, the construction of Baoting County Medical Community was affirmed by the expert group of the National Health Commission
County medical breakthrough record
■ Hainan Daily reporter Ma Ke intern Wang Fei
Do you know what the most regrettable thing about a doctor is?
It is clear that patients can be treated, but they lose the opportunity because of insufficient medical conditions.
"When we notified the patient to come to do dialysis, the family told us that the person had left, because the dialysis could not be queued up to delay the treatment." In 2019, when Vientiane Xinxin arrived at the Baoting Li and Miao Autonomous County People's Hospital (hereinafter referred to as the Baoting County People's Hospital) as the person in charge, the medical regret of an old man with kidney disease became a thorn in his heart that could not be pulled out.
Such a thorn is also rooted in the hearts of the Rulers of Baoting and the common people.
In November 2020, on the basis of the Baoting County People's Hospital hosted by the Third Provincial People's Hospital (Sanya Central Hospital), Baoting established the County Medical Group to carry out the construction of the county medical community.
In July 2021, the achievements of the construction of the Baoting County Medical Community were affirmed by the Expert Guidance Group of the County Medical Community of the National Health commission, and the construction experience was regarded by the Provincial Health Commission as "a spark that can ignite the plains". How are these construction experiences different from the past? What benefits can the people enjoy?
Hospitals that once could not retain patients
"Who wouldn't want to see a doctor on their doorstep? But the equipment can't keep up! ”
Anyone who comes to Baoting to learn about the construction of the county medical community will be arranged to watch a promotional video first. The Baoting Pavilion in the short film has beautiful natural scenery and beautiful ethnic customs. "Seeing such a beautiful place, I feel that I can't let 'low medical care' become a lingering brand of this land." The relevant person in charge of the Institutional Reform Department of the Provincial Health commission who has visited Baoting many times to investigate and guide the reform work told the Hainan Daily reporter.
Yes, although Baoting once attracted nearly 100,000 "migratory bird" elderly people to come here for a holiday every year, it is difficult to retain patients - from tourists to local residents, they rarely choose to seek medical treatment locally.
"Sister, I tell you, we used to go to Sanya to see a doctor, there is no way, hey..." Huang Kaixing, a resident of Baoting Xiangshui Town, revealed his heart to the Hainan Daily reporter, and the words were full of helplessness.
Baoting also has its own county-level public hospital - founded in 1956 Baoting County People's Hospital, is a collection of medical, first aid, teaching, scientific research, prevention, rehabilitation, health care as one of the second-class general hospital, why Do Baoting people want to go to Sanya to see a doctor? The Hainan Daily reporter learned that because for a long time, this hospital has no special departments, no experts, and no equipment, it is difficult to meet the medical needs of the local people, not only the outflow of patients, but also the sense of existence in the Hainan medical circle.
Vientiane Xin was the head of the Imaging Department of the Third People's Hospital of Hainan Province. In 2019, while hosting the Baoting County People's Hospital by the Provincial Third Hospital, he was sent to the Baoting County People's Hospital as the president and found that there was a serious shortage of medical equipment in many departments of the hospital.
For example, the hemodialysis room of the hospital, at that time, there were only 9 dialysis equipment, which could not meet the needs of kidney disease patients in the prefecture. "Patients with severe kidney diseases such as uremia have to do hemodialysis every week, and if they don't do it for a month or two, it will be directly life-threatening." Vientiane new said.
The patient was treated in the hemodialysis room of baoting Li and Miao Autonomous County People's Hospital.
In the past 5 years, Wang Binli, the "migratory bird" of Harbin, has come to Baoting for vacation every winter. He is also a kidney disease patient, no matter where he is, he must find a hospital to do hemodialysis regularly, "A few years ago in Baoting, I went to the hospital in Sanya twice a week to do dialysis, very troublesome, who is not willing to see a doctor at the door of the house, but the equipment can not keep up, I am also very entangled." ”
If this is the case with the county people's hospital, it will be more difficult for other primary medical institutions in the county to retain patients.
Repeated modifications to the scenario
Is it painful or not, or is it drastic?
In order to fundamentally strengthen the construction of disciplines and promote the sinking of high-quality medical resources, from 2018 to 2020, Baoting County People's Hospital has undergone several medical reform adjustments: from accepting the trusteeship of the provincial three hospitals, to becoming a pilot unit for the construction of a close-knit county medical community nationwide, and then to forming a Baoting Medical Group with Baoting County People's Hospital as the leader, the provincial three hospitals as the support, and the township health centers and community health service stations under its jurisdiction.
These attempts are aimed at realizing the sharing of information, resources and talents among medical institutions at all levels and building a new order of medical treatment for hierarchical diagnosis and treatment. But how easy is it to share?
"The whole country is exploring the construction of medical associations, but if we really want to achieve joint development, we must reach a community of interests, involving interests, and this road is doomed to be difficult." The relevant person in charge of the Institutional Reform Department of the Provincial Health and Health Commission frankly said that it is easy for Baoting Medical Group to hang a sign, but to truly break through the barriers between people, money and materials between medical institutions in the group, it is necessary to fundamentally decentralize power.
Decentralization is the most difficult link in reform.
"For example, if the management authority of people, property and materials in the township health center is not under the management of the county people's hospital, even if the Baoting Medical Group is formed, the county people's hospital as the leader of the group is not counted in other aspects except for the support of doctors, and it is difficult to carry out reform." The person in charge said, "In addition, the county hospital wants to recruit talents, according to the conventional practice, it is necessary to first report the demand to the county health commission and the county human resources and social security department, and then release the recruitment information after the approval, the process is as little as half a year, more than a year." ”
Is it painful or not, or is it drastic? Baoting chose the latter.
On June 17, 2020, the Baoting County Party Committee and the county government established the County Medical Group Management Committee (hereinafter referred to as the County Medical Management Committee), and the county party committee and the county government personally grasped and promoted the construction of the Baoting County Medical Community.
What impressed Vientiane Xin was that after returning from studying and studying in other provinces, the county medical management committee revised the "Relevant Implementation Plan for the Establishment of the County Medical Group in Baoting Li and Miao Autonomous County" many times, and finally delegated all the organizational and personnel powers and administrative powers to the medical group to control independently, and the Baoting Medical Group was able to free its hands and feet to reform.
The newly built Hemodialysis Room of the People's Hospital of Baoting Li and Miao Autonomous County.
The most powerful step "chess"
The list of boundaries of rights and responsibilities devolves 61 powers, and the medical group has greater autonomy in reform
1 county-level people's hospital, 9 township health centers, 2 community health service stations, 58 village clinics – in November 2020, Baoting Medical Group launched a new exploration on such a "test field".
Yan Yeli, deputy governor of Baoting County, introduced that Baoting Medical Group first implemented the unified management mode of party building, administration, personnel, business and drugs through the establishment of the only legal person system of the group president, and increased the overall management of grass-roots medical institutions by the general hospital.
However, the key to the effectiveness of this reform is a 9-page "List of Rights and Responsibilities of the Health Commission of Baoting Li and Miao Autonomous County and the Medical Group of Baoting Li and Miao Autonomous County", which clarifies the boundaries of the rights and responsibilities of the county health commission and the medical group in terms of organizational personnel management, planning and information construction, finance and auditing, medical administration and science and education, traditional Chinese medicine management, public health, pharmaceutical equipment management, and elderly health services.
This list has made the 61 items of management authority that were once at the level of the county health commission completely delegated to the hands of the medical group, becoming the most critical and powerful step in this reform.
"For example, the appointment and dismissal of personnel in medical institutions within the group is determined by the group according to development, and we only serve as a supervisor and guide. The group can recruit independently, only need to file with the county health commission and the county human resources and social security bureau. Li Pinghua, director of the Baoting Health Commission, said that the redefinition of the boundary of rights and responsibilities in the list has transformed the county health commission from a direct management party to a supervision, guidance and service provider of Baoting Medical Group.
"It's hard to do anywhere else!" The relevant person in charge of the Institutional Reform Department of the Provincial Health Commission told the Hainan Daily reporter that in addition, Li Pinghua, director of the Baoting Health Commission, and Wan Vientiane Xin, head of the Baoting Medical Group, have highly consistent work goals, mutual trust and support, and the "people" factor has also played an important role in promoting the reform of decentralization.
"The decentralization of power can also give the county health commission more energy to do planning and supervision." Li Pinghua said that during the new crown pneumonia epidemic, the deployment of epidemic prevention and control work has changed from the former county health commission to the hospital, to the county health commission only needs to keep an eye on the medical group, and the group carries out unified deployment among member units.
The Baoting Medical Group, which has more management authority, the first thing is to grasp the party building work.
"The group has established a party committee, and each member unit has established a party branch, and the general president responsibility system under the leadership of the group party committee has been implemented." Vientiane Xin believes that if the party building work is done smoothly, the reform will also be smooth.
A spark that can ignite the plains
The overall medical level has improved, and the number of patients visiting other places has dropped significantly
Greater space for reform autonomy has released more enthusiasm for officers: Since its establishment, Baoting Medical Group has independently introduced 9 senior medical experts, 10 deputy senior medical experts, and 9 master's degree students. This year, the Baoting County Party Committee and the county government added 88 new filing preparations, which were handed over to Baoting Medical Group for self-deployment and use, and the medical group introduced an ophthalmic medical team.
Liu Hongjun, director of the First Department of Foreign Affairs of Baoting County People's Hospital, is one of the experts who have been introduced. His addition has brought more surgical procedures and changed the situation that surgery in the outer department is difficult to carry out. In the first half of this year, the number of surgeries carried out in the department of foreign medicine was several times that of the same period last year.
Liu Hongjun, director of the first department of the people's hospital of Baoting Li and Miao Autonomous County, is discussing the patient's condition with colleagues.
Recently, Huang Kaixing went to the baoting County People's Hospital for treatment, and after receiving transurethral prostate electroresection surgery performed by Liu Hongjun, he finally bid farewell to the prostatic hyperplasia that had plagued him for a long time. "In the county hospital to do surgery medical insurance can be reimbursed 75%, the technology is better than the original, no longer need to run to Sanya to see a doctor!" Huang said happily.
"The primary goal of the construction of the medical community is to promote the sinking of high-quality medical resources, so that the people can enjoy the medical services of large hospitals at their doorstep." The relevant person in charge of the Institutional Reform Department of the Provincial Health Commission said.
In order to improve the service capacity of rural grassroots medical personnel, Baoting Medical Group has also formulated relevant systems and support plans for people, money and materials to sink to the grassroots level: 10 medical experts at or above the deputy senior level of internal medicine and surgery have been selected to set up mobile medical teams to sit in township health centers for consultation, rounds, and clinical teaching; experts have been sent to township health centers for long-term help; and business guidance for township health centers and village clinics has been strengthened.
Huang Qingxiang, a 71-year-old grandfather of Kamo Town, is one of the beneficiaries of the support program. "I have been suffering from low back pain for many years, and I have gone to a big hospital to treat it, far from home, and the cost is large." When he heard that Rong Xueqin, director of the Pain and Spine Minimally Invasive Center of the Provincial Third Hospital, came to the Kamao Town Center Health Center every Wednesday for consultation, Huang Agong lit up hope. When the Hainan Daily reporter met Huang Agong, he had already received Rong Xueqin's small needle knife surgery at the Jiamao Town Health Center, "I didn't expect to be able to let the experts see a doctor so close to home, and I felt much more relaxed after the operation." ”
After the establishment of the medical group, the hardware support of Baoting County People's Hospital has also been updated - for example, dialysis equipment has been increased to 17 units. "I don't need to go to Sanya dialysis this year, there is equipment here in Baoting, which is much more convenient." Wang Binli said.
Up to now, Baoting County People's Hospital has carried out more than 40 new technologies and new projects, set up 3 new departments, expanded 4 departments, added large-scale medical equipment such as CT and MRI, added 80 beds, and built a 5G remote surgery guidance system networked with the top three hospitals.
The improvement of the overall medical service capacity has allowed Baoting to retain more patients. Since the beginning of this year, the number of operating tables carried out by Baoting County People's Hospital has increased by 38.1% year-on-year. The number of patients visiting other places has dropped significantly, and in 2020, 241 people were referred outside Baoting County, down 50% from 2018. Since the establishment of Baoting Medical Group in 2020, the business volume of each member unit has increased to varying degrees.
The construction of the medical group has also reduced the price of pharmaceutical consumables.
"Baoting Medical Group implements unified procurement and supply of drugs and medical and health consumables of member units, and the bidding work for consumables has been completed, and the unit price of the transaction has been reduced by 52% year-on-year." Vientiane said that the price reduction of drugs and consumables makes him deeply feel the necessity of this reform, "After reducing procurement costs, member units can free up more resources to upgrade medical technology and allow patients to enjoy better medical services." ”
"Baoting's health care reform broke free from the biggest shackles of reform: the issue of power ownership. With the deepening of reform, the 'Baoting model' will play a role in the construction of the Hainan Medical Community as 'the spark of a spark can ignite the plains'. The relevant person in charge of the Institutional Reform Department of the Provincial Health Commission said.
In June this year, the Office of the Provincial Leading Group for Deepening the Reform of the Medical and Health System issued the "Implementation Plan for Hainan Province to Comprehensively Promote the Construction of Urban Medical Groups and County-level Medical Communities", proposing to establish urban medical groups in Haikou, Sanya, Danzhou and other prefecture-level cities, and 1 to 2 county-level medical communities in county-level cities. By 2023, the province's urban medical federation and the county medical community will basically form a regional coordination model with clear responsibilities, rights and benefits.
When I left the Baoting County People's Hospital, it was Wednesday afternoon, and the Hainan Daily reporter saw that the registration and payment windows during this period were crowded. The return of patients highlights the steaming vitality of the construction of the Baoting County Medical Community.
(Hainan Daily Baocheng, October 26)
Medical Association
It is based on the principle of government-led overall planning, and the consortium of medical institutions with different functions, positioning and levels can promote the integration of high-quality medical resources up and down, and realize the hierarchical diagnosis and treatment pattern of primary diagnosis, two-way referral, acute and slow treatment, and upper and lower linkage.
There are 4 joint forms of the medical association
◆ City Medical Group
◆ County Medical Community
◆ Cross-regional specialist alliances
◆ Telemedicine collaboration network