The nation's first designated third -level medical institution medical insurance and pharmaceutical service evaluation report was released

A few days ago, the Guangdong Provincial Medical Security Bureau released the "Evaluation Report for Medical Insurance and Medical Service (2021)" (2021) (hereinafter referred to as "report"). Three -level medical insurance designated comprehensive medical institutions and 45 medical insurance medical services of fixed -level medical insurance designated Chinese medicine medical institutions were evaluated and ranked. This is the country's first designated third -level medical institution medical insurance and pharmaceutical service evaluation report.

Establishing and improving a fixed -point pharmaceutical service evaluation system and information disclosure system is an important decision -making and deployment of the Party Central Committee and the State Council, and it is also an important function of the medical insurance management department. "The evaluation of medical services is an innovative measure for reform in the field of medical security in our province. The report of the pharmaceutical service evaluation report and ranking is the first time in China." Xiao Xue, secretary of the party group and director of the Guangdong Medical Security Bureau, said at the press conference.

Zhongshan No. 1 Hospital and Provincial Hospital of Traditional Chinese Medicine ranked first in the list

During the evaluation process, the Provincial Medical Security Bureau has repeatedly held a demonstration meeting and seminar participated by experts and scholars from colleges and universities, and scientific research institutions in the province, and established a policy specification, medical insurance quality, medical services, medical insurance operations, and sustainable development. Wait for 5 first -level indicators, 13 second -level indicators and 50 third -level indicators. Collect data in accordance with the requirements of "unified source, unified caliber, and unified format". There were 1,561 million cases on the homepage of this evaluation, 364 reports of medical insurance departments and medical institutions, 121,000 questionnaires for medical staff, 117,000 questionnaires for outpatient patients, and 73,000 questionnaires of hospitalization patients. Establish an expert analysis team, formulate unified data quality control rules, and organize more than 20 experts in the fields of medical insurance, medical insurance and other fields to carry out 4 rounds of professional quality control to ensure that the data is true, accurate, and reliable, and to ensure the credibility of the evaluation process and results.

The "Report" will rank fixed -point three -level comprehensive medical institutions and designated three -level Chinese medicine medical institutions. Among the top 10 in the total score of traditional Chinese medicine medical institutions, 4 in Guangzhou, 2 Foshan City, and 1 each of Zhongshan, Shenzhen, Shaoguan and Yunfu City. Guangdong Province Traditional Chinese Medicine Hospital, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou Panyu District Traditional Chinese Medicine Hospital, and Zhongshan Traditional Chinese Medicine Hospital have the top 5 total scores.

Among the top 50 comprehensive medical institutions in the total score, 15 are concentrated in Guangzhou, and there are no corrections on the list of Heyuan City, Shanwei City, Chaozhou, and Zhanjiang City, showing that the medical insurance and medicine of the designated third -level comprehensive medical institutions in Guangdong Province shows There is an imbalance in service development.

The development of medical insurance and pharmaceutical services for the third -level traditional Chinese medicine medical institution in Guangdong Province also has an unbalanced phenomenon: TCM medical institutions in Chaozhou, Jieyang, Shanwei, Zhaoqing, and Zhanjiang are absent from the top 30 ranking.

Evaluation results may be linked to medical insurance payment

At present, domestic medical insurance and pharmaceutical service management still lacks a scientific and complete quantitative evaluation system. The results of this evaluation technology plan and analysis will have a demonstration and leading effect on other parts of the country. Yu Xueqing, dean of the Provincial Academy of Medical Sciences, introduced that the evaluation report fully presented the current status of medical insurance and pharmaceutical services and the strategic purchase of medical insurance funds in designated medical institutions. Wait for the ranking of 8 dimensions, and conduct in -depth analysis of 50 three -level indicators, and put forward policy recommendations, which will have a profound positive impact on promoting the high -quality development of medical insurance and pharmaceutical services in our province.

Han Huidong, director of the Medical Service Management Office of the Provincial Medical Insurance Bureau, introduced that next, the Provincial Medical Insurance Bureau will gradually increase the evaluation of specialized hospitals including maternal and child health care hospitals, and guide the medical insurance bureaus in various places to conduct medical institutions below the second and secondary medical institutions. Evaluation, strive to achieve full coverage of medical insurance and pharmaceutical services in designated medical institutions in the province; are exploring the establishment of evaluation results to linked to medical insurance payment and flight inspection to increase the enthusiasm of medical institutions to participate in the evaluation; Carry out evaluation work and create a "Guangdong model" for the evaluation of medical insurance and medicine services.

Report highlight

According to the service capabilities of medical institutions, the medical institution is divided into 4 categories to analyze the results of various three -level indicators:

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Teaching, Provincial Hospitals: Affiliated Medical Institutions and Provincial Medical Institutions;

Municipal hospitals: Local City Hospital or First People's Hospital (three), there are only one city in various cities;

County and district hospitals: 3-way hospitals outside the city or the first people's hospital, and the county-level and district-level three-level hospitals outside the First People's Hospital; 32 ">

County and district hospitals (third -level): third -level hospitals of prefectures, counties, and district -level non -three -level nails. in

According to the "Report Content", Guangdong medical institutions have the following characteristics and deficiencies.

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There are many disciplines of "plateau" disciplines in Guangdong Medical Institutions and few "peaks" discipline

The report shows that both comprehensive medical institutions and traditional Chinese medicine medical institutions have fewer "peaks" disciplines, and there are many "plateau" disciplines, and the "peaks" and "plateau" disciplines are mainly concentrated in teaching and provincial hospitals.

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The report recommends that Guangdong continues to promote the layout of top medical centers with international influence, promote the advantages of clinical specialist specialist in the construction of differentiated development, and promote the construction of a high -level hospital layout in the Greater Bay Area; strengthen the high -level development planning of traditional Chinese medicine disciplines in the region. It is recommended that county -level hospitals and county -level hospitals (third -level) strengthen discipline construction, and jointly build more "plateau" disciplines through the construction of medical consortia.

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County and district hospitals should formulate and improve the door special policy

Regardless of whether it is a comprehensive medical institution or a Chinese medicine medical institution, county -level hospitals (third -level) are not good in the proportion of patients with specific diseases in outpatient diseases.

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The report suggested that relevant departments should formulate and improve the door special policy, covering the access standards, clinical paths, and treatment standards of door special in various regions. All medical institutions should deal with the conditional treatment in a timely manner in response to the qualified Mente patients. County and district hospitals, county -level hospitals (third -level) should be appropriately considered to expand the method of adding the sources of the door and adjusting the frequency of the specialist doctors of the specialist clinics to expand The number of patients with Mente patients will further optimize the proportion of Mente patients.

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Grassroots hospitals lack high -level medical talents

The report shows that high -level medical talents are mainly concentrated in teaching, provincial and municipal hospitals. Among the indicators such as the proportion of senior professional titles of medical staff and the proportion of doctoral degrees of medical staff, county -level hospitals (level three) have obvious disadvantages.

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The report recommends that county -level hospitals and county -level hospitals (third -level) should strengthen the construction of medical consortia, develop core medical technology, and use the local government's policy measures for the introduction of high -end medical talents to promote the introduction Policy support on subsidies, scientific research launch funds, housing security, children's enrollment, and preparation.

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Comprehensive teaching and provincial hospitals should pay attention to the proportion of medicines for medical insurance directory

The report shows that among the comprehensive medical institutions, teaching and provincial hospitals have performed well in the proportion of drugs in medical insurance directory. Only 7 are in excellent levels, 30 are good, 22 are generally, 41 are to be improved. Corresponding to it, county -level hospitals have the best performance. There are 26 excellent, 19 good, 32 generals, and 23 to be improved.

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The report recommends that the comprehensive medical institution should correctly understand the meaning of the proportion of medical insurance directory drugs, and fully implement and complete the relevant policies; in the process of teaching and provincial hospitals, in the process of giving full play to the diagnosis and treatment of suspicious diseases, they should give full play to the clinical value of medical insurance directory drugs. Based on the number of drugs, the number of drugs such as the number of drugs and the proportion of drugs affects the use of medical insurance directory drugs in clinical practice, and encourages clinicians to use medical insurance directory drugs as much as possible on the basis of ensuring medical quality.

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It is worth noting that among traditional Chinese medicine medical institutions, teaching and provincial hospitals performed the best in the proportion of drugs in medical insurance directory, while municipal hospitals performed well.

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Three -level comprehensive hospitals should improve service efficiency

Whether it is a comprehensive medical institution or a traditional Chinese medicine medical institution, there are different degrees of illegal conditions such as decomposing hospitalization, hanging bed hospitalization, and low standards. In comprehensive medical institutions, teaching and provincial hospitals perform poorly. County and district hospitals (third -level) performance is poor. in

At the same time, in the two indicators of time consumption index and cost consumption index, teaching and provincial hospitals in integrated medical institutions performed poorly.

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The report recommends that relevant departments have strengthened the supervision of the average hospitalization date and sub -expenses of comprehensive medical institutions through various means, prompting comprehensive medical institutions to improve the level of medical diagnosis and treatment, reduce the average hospitalization day of inpatient patients, reduce medical expenses, and improve service efficiency.

Medical institution on the list

Guangdong Province's designated three -level comprehensive medical institution evaluates total scores (10 before)

The First Affiliated Hospital of Sun Yat -sen University

Guangdong Provincial People's Hospital

Southern Medical University Southern Hospital

Sun Yixian Memorial Hospital of Sun Yat -sen University

Pearl River Hospital of Southern Medical University

Shenzhen Second People's Hospital

First Affiliated Hospital of Guangzhou Medical University

Shenzhen People's Hospital

Meizhou People's Hospital

Foshan First People's Hospital

The total score of the evaluation of the designated third -level Chinese medicine medical institution in Guangdong Province (10)

Guangdong Provincial Hospital of Traditional Chinese Medicine

Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital

Foshan Hospital of Traditional Chinese Medicine

Panyu District Hospital of Panyu District, Guangzhou

Zhongshan Hospital

Guangdong Second Traditional Chinese Medicine Hospital

Guangzhou University of Traditional Chinese Medicine Shunde Hospital

Shaoguan City Hospital

Shenzhen Traditional Chinese Medicine Hospital

Yunfu City Hospital

The article is sorted out: Guangdong Medical Security Bureau, Health Guizhou, China Economic Network, Yangcheng Evening News, Nanfang Daily, Guangdong Medical Insurance, Guangdong Health Headline, etc.

Capture: Hu Haiyan

Edit: Hu Haiyan

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