Medical reforms have entered a dense period: How can public hospitals develop a comprehensive breakthrough?

The 21st Century Business Herald reporter Chen Hongxia's intern reported that Wuhan reported that the new crown pneumonia's epidemic broke out, and put forward new requirements and challenges to the development of domestic medical institutions.

At the High -quality Development Forum of Public Hospital of the World Health Industry Expo in the 2022 World Health Industry Expo in 2022, a number of experts said to the 21st Century Business Herald that during the "14th Five -Year Plan" period, a large number of public health systems in my country supplemented the shortcomings infrastructure projects Go up, and the implementation of a new round of construction such as the National Medical Center and the Regional Medical Center may change the total amount of medical resources from a short board to a long board. Market competition is becoming increasingly fierce. Therefore, in the context of medical insurance-medical-medical-medical linkage reform, public hospitals are conducting high-quality development reforms from large-scale development from scale expansion to quality and efficiency, shift from extensive management to refined management, and shift from paying attention to material elements to more attention to talent technical elements.

Public hospitals accelerate high -quality development

Since 2021, a series of policies have been introduced around the "Opinions on Promoting High -quality Development of Public Hospitals" in my country, and public hospitals have moved from a stage of large -scale development to a new stage of high -quality development. On August 1, 2022, the "Public Hospital's High -quality Development Evaluation Index (Trial)", "Public Traditional Chinese Medicine Hospital High -quality Development Evaluation Index (Trial)" was released to establish an index system from 5 dimensions.

Professor Li Ling, director of the Health Development Research Center of Peking University, said at the forum, "After the epidemic improves the public health and health service system, it is urgent to accelerate the reform of public hospitals." She believes that the development of public hospitals first requires high -quality health output to reduce diseases , Improve people's health level. Secondly, high -quality medical services include not only high -quality treatment, but also high -quality public health, prevention of health care, process management, and social work and mass work for national health protection. At the same time, public hospital resources across the country have changed from overall resource insufficient resources to existing and inadequate coexistence. The key to achieving high -quality development is to achieve high -quality supply and demand matching.

In fact, at present, the implementation of high -quality development in my country's public hospitals has faced many problems.

From the perspective of the overall industry, in 2022, the operation of my country's public hospitals still showed a "three drops and two liters" trend, that is, the willingness to seek medical treatment, the reduction of medical services, the reduction of medical business income, the increase in epidemic prevention costs, and the increase in operating costs.

Wei Li, Secretary of the Party Committee of Wuhan First Hospital, pointed out at the meeting that "the above problems objectively require the hospital to further strengthen cost control, improve efficiency, and reduce consumption."

However, many domestic hospitals have accelerated the high -quality development of hospital operations. Together with Tongji Hospital (hereinafter referred to as "Wuhan Tongji Hospital") in Tongji Medical College of Huazhong University of Science and Technology in Wuhan, the hospital has integrated high -quality development into the "ten Among the Fourth Five "planning, we will focus on improving the three capabilities, that is, the ability of scientific and technological innovation, the ability of discipline talents to develop, and modern hospital management capabilities; do a good job of building three international talents, strengthen discipline construction, strengthen scientific research and innovation capabilities Essence

One of the positioning of Wuhan Tongji Hospital in a new system of high -quality development is to build a national medical center to achieve regional leadership. The goal established by the hospital shows that by 2025, the CMI value will reach 1.5, level 4 surgery accounts for 45%, technical service income accounts for 40%of the medical income, personnel expenditure accounts for 45%, and fixed in personnel compensation will be fixed. Partially accounted for 50%. By 2030, the CMI value reached 2, and the remaining four indicators reached 60%.

Liao Jiazhi, deputy secretary of the party committee of Wuhan Tongji Hospital, pointed out, "Through the construction of the National Medical Center, the scale of Tongji Hospital will expand and even expand to a large scale. The layout of the three districts of the hospital. However, in order to complete the above goals, Tongji Hospital also needs to further "do" to promote the high -quality development of the hospital.

In the current reform of public hospitals, relatively special traditional Chinese medicine hospitals are also facing some difficulties, and all sectors are accelerating the problem.

"At present, the business development of the Chinese Medicine Hospital is facing unprecedented challenges." He Shaobin, Dean of Hubei Provincial Hospital of Traditional Chinese Medicine Hospital, also said at the meeting that from the external environment, new medical reforms such as cancellation of drugs and consumables, controlling the total medical insurance, and reform payment methods such as reform and payment methods are canceled Measures such as continuously promoting and increasing the cost of controlling medical expenses are becoming stricter. Unlike comprehensive hospitals, the Hospital of Traditional Chinese Medicine has its own characteristics, including low CMI values, fewer charges for traditional Chinese medicine, low standards, etc. Secondly, the medical pattern of "small illness does not go out of the village, the common illness does not leave the countryside, and the serious illness does not go out of the county" makes the referral sources more limited. There are many superior medical resources in various provinces, and the demand for medical services has basically become saturated. In addition, the state encourages high -quality resources to expand capacity and regional balanced development, which has exacerbated competition in the medical market. The masses' cognition of traditional Chinese medicine needs to be improved, and there is also a deviation in cognition.

In terms of internal conditions, the types of critical illness such as tumors and cardiovascular and cerebrovascular incidence are exactly the shortcomings of traditional Chinese medicine. Rehabilitation and gastric disease treatment are still the characteristics of traditional Chinese medicine. Compared with traditional Chinese medicine, the construction of the entire Chinese medicine system is relatively backward. Traditional Chinese and Western medicine needs to be coordinated, and the internal medicine is strong and the surgical is weak. In addition, there are partial disciplines. Traditional Chinese medicine is also relatively conservative, and the death of famous doctors may cause some unique technologies to lose.

However, He Shaobin believes that the development of the Chinese Medicine Hospital also contains new opportunities. At present, the climax of the construction of a new round of public health system is coming. In addition, in recent years, the state has more support for industries and various policies for traditional Chinese medicine, and the project investment has been inclined. "For the development of traditional Chinese medicine, we must clarify the concept of development, clarify the goals of development, grasp the principles of development, and refine development measures. First of all, the traditional Chinese medicine hospital has traditional Chinese medicine technology and fulfills the mission of inheritance and innovation of Chinese medicine. Institutions cannot follow the operating mode of the TCM Hall in the past. At the same time, the development goals of the Chinese Medicine Hospital should be moderate scale, strong strength, distinctive characteristics, and scientific management. "The reform of medical insurance policy has entered a dense period.

In the next 8-10 years, medical insurance policies that are closely related to the quality of hospital operations have also entered a period of densely advanced reform. "Turn on the settlement" will not change within a period of time. In addition, judging from the current medical insurance policies such as benefits, payment, fundraising, supervision, medicine, and price, the "basic and construction mechanism" is still a key task of medical insurance reform.

Mao Zongfu, director of the Global Health Center of Wuhan University, pointed out that the overall requirements of my country's medical insurance policy planning is to comprehensively build a multi -level medical security system covering the entire population, urban and rural coordination, clear power and responsibility, moderate protection, and sustainable. At present, the reform of pharmaceutical consumables and the reform of medical insurance payment has played a leading role in deepening the reform of the supply side of pharmaceutical services, promoting the formation of pharmaceutical collaborative development into a established path, thereby promoting the implementation of healthy China.

Today, the medical insurance system and related reform policies have provided opportunities for high -quality development of public hospitals and challenged. Mao Zongfu pointed out that the first is the change in the operating concept of public hospitals in the medical insurance management department. The "co -payment" model; second, the reform of the medical insurance payment method under the management of the total prepaid management, transmit the risk of the medical insurance fund to the medical institution, forced the medical institution to provide medical services and not over -service. More cautious, pay more attention to the clinical value of new technology and new businesses; again, a new round of medical service project price reforms characterized by the concentrated volume of pharmaceutical consumables and separation of "technical-consumption" have enabled medical institutions The road of development was blocked, and public hospitals forced public hospitals to focus on improving the level of medical technology and developing medical services characteristics and advantages.

In this regard, Mao Zongfu believes that "designated pharmaceutical institutions should organize training for the use system and policies of medical security funds, regularly check the use of medical security funds in the unit, timely correct the irregular use of medical security funds, take the development of medical service connotation development the road."

At the same time, in the comprehensive medical reform with the "three medical linkage" as the core, DRG paid reform is the "cattle nose" project, which has triggered a comprehensive reform of the hospital.

In November 2021, the National Medical Insurance Administration issued the "Three -Year Action Plan for the Reform of the DIP/DIP Payment Method", which clarified that the DRG/DIP reform of no less than 40%of the regions will be launched by 2022. By the end of 2024 DIP payment method reform work, by the end of 2025, the DRG/DIP payment method covers all eligible medical institutions that meet the qualified hospitalization services, and basically achieve full coverage of diseases and medical insurance funds.

Wei Li also stated at the meeting that the project payment under the total control of the comparison, policy orientation, DRG payment under regional total control is process management, pursuing the efficiency of medical insurance funds; in terms of distribution methods, the total annual total amount of the DRG entry group; payment method method In terms of the DRG disease group's technical payment standards; incentive methods are high -efficiency and high returns.

The essence of DRG paid reform is the "engine" based on the reform of the big data of the disease group. It takes the medical service behavior of the hospital as the product to carry out the ultimate evaluation. Wei Li believes that "reform can help promote the positioning of the regression function of the third -level hospital, forcing the hospital to pay attention to the medical service process and quality, and give birth to the comprehensive reform of the hospital and promote high -quality development."

However, DRG paid reform has also brought challenges. First of all, the hospital needs to promote the evaluation of big data of medical services. Objective, authentic and logical medical service big data has become an important cornerstone of high -quality development. At the same time, promote the reform of medical management, establish medical quality, diagnosis and treatment specifications, and develop service capabilities, new technologies, and new businesses. Secondly, promote the reform of the performance evaluation system, focus on hospital operating efficiency as the core, and promote the reform of the salary distribution system. In addition, promote the reform of cost management, comprehensive budget management, and full -cost accounting and control; promote the reform of drugs and consumables to reduce the proportion of drugs and consumption.

"Multi -party linkage is the key to the success or failure of the overall reform of the hospital." Wei Li said at the meeting that DRG paid reforms cannot advance unilaterally. It should be supported and promoted with the content of the full -cost accounting, KPI key performance indicators, and salary performance. Establish a multi -department linkage mechanism to strengthen the scientific, standardized, and refined hospital operation management.

In fact, since the official implementation of Wuhan DRG paid reform, various data have been optimized. Taking the First Hospital of Wuhan as an example, since 2021, the number of diseased groups has increased from 400 to 601, the DRG enrollment rate has increased from 95.97%to 100%, CMI has increased from 1.16 to 1.35, and the monthly total weight has increased from 6000. To 9000, the time consumption index dropped from 0.94 to 0.80, and the cost consumption index dropped from 1.22 to 0.99. At the same time, the hospital became the beneficiary of DRG paid reform, and the redemption rate reached 98%, which was far higher than the level of 85%in 2019. At the same time, Hubei Province has achieved certain results in promoting the reform of public hospitals. By the end of the "13th Five -Year Plan", the total medical resources in Wuhan area were reorganized. The number of three -level hospitals and the number of beds per thousand population ranked third in the country's deputy provincial cities. At present, Hubei Province has completed the acceptance and monitoring of the disinfection supply center of 100 third -level hospitals and 78 secondary hospitals. The preliminary review rate is 90%, and the standard rate is 100%after supervision and improvement. The current rate of infection of hospitals in the province drops from 2.86%in 2014 to 1.48%in 2021. The province's medical institution hospitals have a 48%reduction in the current rate of infection, and the incidence of breathing and related pneumonia will decrease by 51%.

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