"Henan Baixian County Promotion Project" County Hospital Dean Forum (Phase II)

"County governance, the world is safe." The county's medical and health service system is the cornerstone of the entire medical and health service system. County hospitals are the main places for medical treatment at the grassroots level. In the new period, how to consolidate the grassroots level, based on the long -term, so that the masses can enjoy better medical services at their doorsteps is a topic of the health administrative department, hospital managers, medical staff and people.

Henan is a large population province. The county (city) People's Hospital, as the leading medical service system of the county and the hub connecting the urban and rural medical service system, not only undertakes 70%of the province's common diseases, multiple disease diagnosis and treatment. The task of diagnosis is also a key link for implementing the hierarchical diagnosis and treatment system and the construction of medical consortia.

On September 7, the "Henan Bai County Improvement Project" County Hospital Dean Forum (second phase) was held by the Henan Provincial Health and Health Commission, hosted by the Medical and Health News Agency, and co -organized by Huizhi Pharmaceutical Co., Ltd. 259,200 people learn online.

Li Hongxing, Director of the Medical and Health and Medical Management Department of Henan Province, and Chen Linjun, editor -in -chief of the Medical and Health Newspaper, attended the event and delivered a speech. Zhang Yingjian, deputy dean of the First Affiliated Hospital of Henan University of Science and Technology, presided over the opening ceremony. Yang Dongke, a fourth -level investigator at the Medical Security Bureau of Henan Provincial Medical Security Bureau, Yan Yanhui, Dean of the Gongyi General Hospital, Wang Ying, director of Huai'an Medical Insurance Center, and Fang Fengqin, deputy director of the Pharmacy Department of Henan Provincial People's Hospital, surrounded the "Reform of Medical Construction Medical Insurance Payment". "In -depth promotion of county -tight medical communities in the county and building a high -quality and high -efficiency integrated medical and health service system" "DRG/DIP (DRG is to pay for groups according to disease diagnosis, DIP is paid according to the disease score) payment method and influencing factors" " "Interpretation of the Consensus of Henan Provincial Pharmaceutical Management Experts" conducts theme sharing and exchanges. Zhang Xiangyang, deputy dean of the People's Hospital of Yiyang County, Lang Shengli, deputy dean of Qinyang People's Hospital, Zhao Weibing, Deputy Dean of Wenxian County People's Hospital, Ma Linlin, Deputy Dean of the Second People's Hospital of Mengjin District, Luoyang City, and Ma Linlin Vice Dean Chang Xiaofeng, Liu Wusheng, deputy dean of Wuzheng County People's Hospital, and other county hospitals and deputy deans participated in the "how to build a close -tight county medical supply body" and "how to do the hospital operation management under DRG/DIP Discussion and exchanges in the "how to implement the scientific management of the National Pharmaceutical Pharmaceuticals".

This forum is the second session of the high -quality development forum of the "Henan Bai County Promotion Project". The series of forums are planned to use the combination of online and offline in 2022 to focus on the operation and management of county hospitals, medical quality, discipline construction, and discipline construction, and discipline construction. The construction of close medical communities and management of patients with chronic diseases aims to explore effective methods and paths for high -quality development of county hospitals and drive the comprehensive improvement of regional medical services.

Building a county medical community is the "wonderful side" of the county medical reform

In recent years, Henan Province has promoted the construction of close medical communities in tight counties in Henan Province. From the beginning of the province, 28 counties (cities) piloted the construction of close medical communities in the county, and comprehensively pushed the construction of close -tight county medical communities. By 2021, the construction of a high -quality promotion of close -up county medical communities was included in the list of key projects of the "I do a practical work for the masses" for the Standing Committee of the Provincial Party Committee. Henan has explored an integrated medical and health in compliance with the requirements of the central government, the actual and the needs of the masses in Henan, and the needs of the masses. Construction of a new road for service system.

"Building a tight medical supply body is the" Miao Fang "of the county medical reform. Gongyi City General Hospital adopts nine major measures to help the construction of the medical community, that is, the leadership of the party building leadership, the development of the discipline, the four levels of quality control, the strict service supervision, the performance, the performance, the performance The nuclear calculation, the top ten center construction, the six major systems, the two major systems, the two -in information, and the double packet of funds. "In this forum, the experience and effectiveness of Gongyanhui in promoting the construction of a close medical community in the county Participants discussed.

Gongyi City General Hospital was built in 1951. It is a three -level comprehensive hospital in Henan Province. In 2021, more than 319,800 cases were used to save nearly 60 million yuan in medical care and other expenses for the masses. Gongyi General Hospital and Beijing 301 Hospital, Beijing Famous Hospital Experts Group, Zhengzhou University First Affiliated Hospital, Henan Provincial People's Hospital and other hospitals establish collaborative relationships. Well -known experts are invited to bring teaching, treatment, inspection, and surgery every week; The five major centers of stroke, trauma, chest pain, dangerous maternal maternal and dangerous newborn children have reached standards for certification to give full play to the complementary role of multidisciplinary advantages; 10 experts in Gongyi City General Hospital are appointed as the dean of the grassroots member units and 38 disciplines of Gongyi General Hospital. More than 100 experts have implemented counterpart assistance, 80 new technologies and new businesses land at the grassroots level; Gongyi General Hospital led 20 grass -roots member units and 310 collective village clinics to establish ten centers to vigorously promote the "grassroots inspection+city hospital Diagnosis "mode.

The Chronic Disease Management Center of Gongyi City General Hospital established a health file for the city's residents, 122,000 patients with chronic disease management. In 2021, the management rate of chronic diseases in the basis of the basis reached 70%, an increase of 8.23%year -on -year; the Internet hospital was opened in May 2021.

In recent years, Gongyi City General Hospital has launched the "Hundred Village Operations" to build a county, township, and village traditional Chinese medicine service system, and initially formed a traditional Chinese medicine development system for "county with national medicine hall, town, village and traditional Chinese medicine corner" The visiting mechanism for the tour, inviting national and provincial famous Chinese medicine medicine to come to the hospital regularly, and arrange famous Chinese medicine in the county to take turns to take turns in the member unit; hold a suitable technical promotion training course for traditional Chinese medicine to promote the appropriate technology of traditional Chinese medicine. Gongyi General Hospital uniformly bidded the three Chinese medicine slices and 2 Chinese medicine formula particles suppliers. The demand for each member unit each month, uniformly distributed, and realized the "city", "same medicine", "same medicine", "same medicine", "same medicine", "same medicine", "same medicine", "The same price". Gongyi General Hospital divided the members of the medical community into four or five areas to establish a shared pharmacy, providing the medical communist units and patients with the commissioned Chinese medicine decoction tablets to be integrated (processing) to achieve integrated distribution services. Gongyi City General Hospital establishes a medical care center in the public Chinese medicine hospital, establishes a medical care rehabilitation center in the hospital, and establishes a day care center in the toilet to form a three -level medical care system for counties, townships, and villages. He can provide medical care rehabilitation services with unmanned elderly; arrange medical personnel at the nearest medical institution from patients to provide diagnosis and treatment for patients, and have accumulated more than 10,000 on -site services in 3 years.

Since 2020, in accordance with the principles of "total prepaid, balance reservation, reasonable overweight", 90%of the balance of the Gongyi Medical Insurance Fund deducting risk adjustment funds and the balance of major illness insurance shall be applied for specific management of the Gongyi General Hospital; Diseases, standardize referral processes, form a referral expert library by the General Hospital, Traditional Chinese Medicine Hospital, and Ruikang Hospital to jointly review and regulate external transfer; formulate grass -roots diagnosis and treatment diseases, regulate the process of transfers, cancel the two -way referral hospital for hospitalization. The line, guiding patients in an orderly manner, and realizing the annual overdue of more than 60 million yuan to the annual annual medical insurance fund for nearly 30 million yuan in the previous year.

In the discussion session, Zhang Xiangyang said that in how to promote the construction of close medical communities, I felt the efforts made by Gongyi General Hospital as leading hospitals to lead the community health service centers, township health centers and private hospitals. Platform, level 4 quality control, nursery centers, etc. Of course, the achievements of these achievements are unable to do it alone, and it also requires the support of the government, the Health and Health Commission, and the Medical Insurance Bureau.

Zhao Weibing said that the construction of a close -up of the county medicine in the county is the first to be resource integration. For example, Wenxian People's Hospital, from 2019 to the present, the establishment of medical sites and the configuration of personnel have been in place; 13 township health hospitals and Wenxian Traditional Chinese Medicine Hospital, Wenxian Second People's, Wenxian Maternal and Child Health Hospital Become a medical group, truly leading the party committee, and the development of various business elites through learning and dislocation, and the medical technology level of medical group member units has been further improved.

Malinlin made suggestions from three aspects: In terms of national policy, the construction of medical communities needs to be compiled, human -social, medical insurance and other departments to cooperate to solve the problem of difficult people to see a doctor and expensive medical treatment. In the end, the three parties were achieved "the government's heart, the hospital's development, and the people's affordable people"; in terms of the health and health system, the local health and health commissions need to be fully authorized by the medical community leading hospital. After the monthly assessment is approved, the family doctors sign the work. The ultimate benefit is the common people in the jurisdiction; in terms of medical and health institutions, we must build a regional health information platform with the support of the Health Commission, and the public health information. The depth of the system allows the health files of each resident to go with the residents, and the personal health information is presented in the system in the medical community. In addition, the leading hospital must "repair the internal skills and strengthen itself" to improve the diagnosis and treatment ability of the disease, and retain the patients in the region. The hospital work together to do a hierarchical diagnosis and treatment, and the integration of medical and defense.

The constructing county medical practice should play a role in medical leverage

"Let the people from getting sick and less sick, and to promote the development of medical communities in the county are inseparable from the regulating role of medical insurance leverage." In the forum, Zhang Yingjian said that the reform of medical insurance payment methods and the construction of medical communities are closely integrated. , Rehabilitation and other links, provide full -cycle health services and reduce the expenditure of medical insurance funds in disease treatment. It is an important goal of the current medical insurance payment reform. The medical community is a good carrier for achieving this goal.

Zhang Xiangyang said that through the close type of medical community of the county, the county, township, and village medical institutions are connected to reduce bad competition and waste of medical resources, allowing county medical resources to sink, so that residents can get better at the grassroots level to get better Medical and health services. These measures not only make the masses spend less and the medical insurance funds are more efficient, but also enable the medical community to obtain income through the balance of the fund, which will help steadily increase the salary of medical staff. This path has really achieved a win -win situation.

Wang Ying said that the payment method is a worldwide problem, because the medical insurance payment method is related to the medical institution, which is related to the complex and diverse uncertainty. The payment method is the most important reliance and grasp of medical insurance management. We must conduct scientific control and ensure the reasonable expenditure and compensation of medical expenses. The direction of DRG/DIP guidance is consistent. For medical insurance payment from the direct correspondence with the actual service cost of the hospital, the medical insurance fund payment has effectively restricted the irregular medical behavior. Reasonable medical care, control costs, reducing abuse and waste. This requires medical institutions to improve the quality of medical care and reduce complications, and also shorten the hospital date. If conditions permitted, more patients with suspicion and severe diseases should be encouraged to achieve more and more labor. More towards the characteristics of value medical care. Yang Dongke proposed the three development stages of medical insurance payment methods: the first stage is to pay at the number of payments; the second stage is to pay according to the quality of the quality; the third stage is a stage to be realized in the future, and pay more attention to the patient's experience. The reform of the medical insurance payment method allows China's medical and health institutions to enter the era of relying on big data management to form a full -scale and full -coverage information resource integration and sharing pattern. With the reform of the salary system of public hospitals, hospital performance management will also break the routine. The hospital's income is only related to the diagnosis and diagnosis and treatment operation of patients.

Yang Dongke said that the ultimate goal of the reform of the medical insurance payment method is a win -win situation: patients have enjoyed high -quality medical services, and hospital diagnosis and treatment are more standardized; medical insurance funds are sustainable, more efficient use, and more fine management.

Liu Wusheng shared actual combat cases around the topic of "hospital operation management under DIP payment". He said that after the implementation of the DIP payment method, how the hospital do a good job of development and transformation under the premise of reform is a question that each dean must think about, especially how the hospital realizes refined management and high -quality development.

At the same time, Liu Wusheng believes that DIP payment reform has had a significant impact on medical service behavior. It can not only control problems such as over -medication, over -use consumables and excessive inspection, but also optimize the structure of medical expenses, standardize medical service behavior, and reduce service costs. At the same time, the DIP payment reform has brought about the transformation of hospital managers' management concepts, and from the extensive management model of scale expansion to a refined management model of quality efficiency.

"Each department should take the DIP payment reform as an opportunity to further play the functions of the leveraged adjustment of medical insurance, effectively standardize medical service behaviors, strengthen internal refined management, vigorously carry out new technologies and new projects, improve the" ability to treat the major illness ", promote high medical services high Quality development. "Chang Xiaofeng proposed in the discussion that the relevant departments of the hospital should eat through the policy requirements, based on the premise of the safety, controllable and benefits of the medical insurance fund, and the priority of the benefits. , Enhance the incentive and restraint function of medical insurance for medical services, gradually realize the transition from "paying medical insurance" to "value medical insurance", reduce the burden of medical treatment, ensure the medical needs of patients, and continuously improve the sense of gain, happiness and satisfaction of the people participating people. A degree to ensure the long -term development of the hospital.

How to ensure the effective supply of drugs in the county medical community

While building a county medical community, it is also necessary to ensure the effective supply and reasonable use of drugs. How to do a good job of medication and meet the needs of grass -roots people are also one of the topics facing county hospital managers.

"National drug band procurement is an important measure to coordinate the reform of the supply side of pharmaceutical services, and scientific management is a key starting point for completing the purchase of drugs. Scientific management, we are at the stage of continuous exploration and innovation. "After listening to the interpretation of the relevant policies of centralized procurement of drugs, Langsheng has a deeper understanding of the centralized procurement policy of drugs, and the implementation of scientific management of drugs in centralized procurement of drugs has been implemented. New idea.

Guided by the Henan Pharmaceutical Management and Drug Therapy Committee, the "Henan Provincial Medical Institutions Implementation Pharmaceutical Policy Expert Consensus" by the Henan Provincial People's Hospital led by the Henan Provincial Pharmaceutical Association and the Henan Provincial People's Hospital led by the Henan Provincial People's Hospital. On the 8th, the Second Executive Council of Henan Pharmaceutical Society was reviewed and approved on the 8th.

Fang Fengqin introduced in the lecture that the centralized procurement of drugs has entered the stage of normalization and institutionalization. As of May 31, Henan Province has implemented 6 batches of centralized procurement of drugs, 1 batch of centralized procurement of drugs in Henan Province, and regional alliances Organize 6 batches of centralized procurement. Before the end of this year, the number of concentrated procurement of drugs in each province will reach more than 350. Due to the different actual situations of each province, there are differences in the implementation of the specific requirements of centralized procurement of drug policies. Therefore, in combination with its own actual situation, it is necessary to explore the establishment of a set of centralized procurement of medical and health institutions at all levels of medical and health institutions in Henan Province.

Taking Henan Provincial People's Hospital for centralized procurement of drug management practice as an example, Fang Fengqin explained in detail the managers of the county hospital.

The People's Hospital of Henan Province has established the "4+7" working leadership group with the dean as the leader and the dean of the division of management;审方点评、药品不良反应监测；医务部负责临床科室目标责任的制定、检查督导、医生宣教、绩效考核等；信息中心负责对所有中选药品加注“国采”标识、相关数据采集、汇总、 Report; the Medical Insurance Office and the Propaganda Department are responsible for policy control, communicate with the medical insurance department, and promote multi -party publicity; the operation management department is responsible for the performance evaluation management and incentive mechanism; the patient experience department is responsible for promoting and explaining the patients. At the same time, do a good job of medicine labeling and guide priority and use it. Select medicines in centralized procurement to mark ("National Cai" or "Provincial Cai") in the hospital information system. Pharmaceuticals; regular (monthly), comprehensive statistics, selected drugs in the middle, the same name of the same name, the use of similar varieties, the proportion of drug procurement, dynamic monitoring and analysis of the progress; The names of the names and the same type of replacement varieties are adjusted and controlled; the use of the unable to complete the use of the schedule is taken, and corresponding measures are taken; the completion of the centralized procurement of drugs is linked to the performance of the clinical department.

Regarding the control measures of non -compliance varieties, Henan Provincial People's Hospital adopted overall analysis and comprehensive management. It has both in batches and horizontal comparisons. System, intelligent reminders of concentrated procurement drugs with poor progress, reminding reasonable use of centralized procurement drugs.

"Combined with the expert consensus and the centralized purchase of drug management in Henan Provincial People's Hospital, our hospital must follow up to do some work, such as establishing an incentive and restraint mechanism to further stimulate the vitality of the hospital and doctors. With the "medicine." Lang Shengli said that with the joint efforts of everyone, the use of the use of drugs and the implementation of related policies is fully available. (Reporter Zhu Xiaojuan text/picture)

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