Introduction
Coordinate and balance the level of performance-based wages at the county and township levels, and when the income of personnel at the grass-roots level does not reach the level of personnel of the same level in county-level public hospitals, the total amount of performance-based wages can be approved according to the actual situation, taking into account the development stage, tasks, regions, financial conditions, incentive needs, etc.
On the morning of June 20, the Information Office of the Shandong Provincial Government held a press conference to interpret the "Implementation Opinions on Comprehensively Deepening the Construction of a Close-knit County-level Medical and Health Community in Shandong Province" (hereinafter referred to as the "Implementation Opinions") to promote the construction of a new development pattern for the construction of county-level medical communities.
Xu Min, member of the party group and deputy director of the Shandong Provincial Health Commission, introduced that by the end of 2025, the policies and measures at the municipal level to support the construction of the county-level medical community will be further improved, and strive to more than 90% of the counties (cities, municipal districts with conditions can be referred to) to basically build a county-level medical community with reasonable layout, unified management of people, property and property, clear rights and responsibilities, efficient operation, division of labor and cooperation, continuous service, and information sharing, and the proportion of grassroots outpatient and emergency visits in the county will reach more than 65%. By the end of 2027, the management system and operation mechanism of the close-knit county-level medical community will be further consolidated, and the diagnosis and treatment pattern of "general diseases will be solved in cities and counties, and daily diseases will be solved at the grassroots level" will be basically established, and the people's sense of gain will be further enhanced.
The "Implementation Opinions" clarify 12 measures in 4 aspects. In terms of clarifying and consolidating work responsibilities, it is clarified that the county-level government bears the main responsibility for the construction of the county-level medical community, and the main person in charge of the county-level government is the first person responsible for the construction of the county-level medical community. In terms of optimizing the management system and operation mechanism of the county-level medical community, we will coordinate the promotion of policy support such as investment, planning, personnel, salary, and medical insurance, improve the quality and efficiency of monitoring and evaluation, and give full play to the role of assessment. In terms of highlighting the main position of the county-level medical community service, it is required to increase the sinking and sharing of resources, implement the requirements of urban public tertiary hospitals to help the county-level medical community, accelerate the promotion of national health management, and refine the service path of key diseases, major diseases and key groups in the county. In terms of collaborative support policies for innovation departments, we continued to optimize policies such as establishment and salary; Continuously improve the medical security policy, and implement the total payment of the medical insurance fund for the close-knit county-level medical community that realizes the "six unifications".
In the process of building a close-knit county-level medical community,
What are the key areas to focus on?
Xu Min said that the construction process focuses on the following four links:
The first is to clarify the functional positioning of the institution,
Promote integration with division of labor
Each member unit of the medical community not only divides labor at different levels, but also coordinates development, and provides full-life cycle prevention and management services for residents in the jurisdiction in accordance with the integrated and integrated service path of key diseases, major diseases and key populations at the county level. Among them, the leading hospital focuses on the diagnosis and treatment of patients with serious diseases and difficult and complex diseases, referral up and down, technical training, quality control and other services. At the township and village levels, it mainly provides diagnosis and treatment of patients with common and frequent diseases, timely transfer of severe patients, and undertakes the transfer of patients in the recovery and stable periods, as well as basic public health and health management services for the population in the jurisdiction.
County-level traditional Chinese medicine hospitals can take the lead in establishing county-level medical communities or undertake overall coordination functions such as regional traditional Chinese medicine resources and discipline construction, and explore the establishment of county-level integrated service paths for traditional Chinese medicine dominant diseases. County-level maternal and child health care institutions have strengthened maternal and child health services and management functions in their jurisdictions, and further improved the maternal and child health service systems at the county, township, and village levels. Professional public health institutions such as the Center for Disease Control and Prevention are to participate in the county-level medical community's technical guidance, business training, and dispatch of personnel to coordinate medical prevention and prevention work in light of actual conditions.
The second is to strengthen the optimization and integration of county resources.
Promote the homogeneity of medical services
Integrate existing resources, reasonably establish human resources, financial management, medical quality control, medical insurance management, information and data management centers of the medical community, and promote unified or overall management of administration, personnel, finance, business, medication, information, logistics, etc. With the county as the unit, improve the central pharmacy model, optimize the operation and settlement mechanism of resource sharing centers such as medical testing, and coordinate the establishment of clinical service centers such as cancer prevention and treatment at the county level, so as to continuously improve the homogeneity of services and management.
The third is to deepen the implementation of urban support for rural areas.
Promote the sinking of high-quality resources
Implement the requirements for urban public tertiary hospitals to send assistance teams from county-level medical communities to provide guidance all year round, and county-level hospitals' professional and technical personnel and management personnel stationed in township health centers to cover all of them. Organize and carry out the activity of "10,000 medical nurses into the countryside", establish a ladder assistance working mechanism, and realize the "four sinking" of personnel, technology, service and management through the development of expert consultation, clinical teaching, business and technical assistance, etc., so as to provide better medical services for the masses.
Fourth, focus on the whole life cycle service,
Accelerate the promotion of national health management
Focus on early prevention, early detection, early diagnosis, early treatment, and early rehabilitation, focusing on relying on county-level clinical service centers, refining the service paths for key diseases, major diseases, and key populations in the county one by one, and doing a good job in the guidance mechanism for family doctors' first diagnosis and graded treatment of residents, the follow-up diagnosis and treatment, medication, and health management mechanisms for key groups in basic public health services and health examinations, and the closed-loop and occlusion of the transfer, follow-up, rehabilitation, and nursing mechanisms for discharged patients in the county, so as to protect the whole process and full-cycle health of residents.
At the same time, the document emphasizes improving the quality and efficiency of monitoring and evaluation. All cities and counties shall, in accordance with the requirements of compactness, homogeneity, cost control, division of labor, and healthy development, pay close attention to the evaluation standards and monitoring indicators of the compact county-level medical community, strengthen operation monitoring, timely warn and correct deviations, and prevent county-level hospitals from "siphoning" grassroots health resources, unreasonable rise in medical expenses, difficulties in capital turnover, financial operation risks, and risks in the use of medical insurance funds.
In terms of comprehensively deepening the construction of a close-knit county-level medical community,
What are the reform measures for health insurance?
Huang Xiaojun, deputy director of the Shandong Provincial Medical Security Bureau, said that in recent years, the Provincial Medical Insurance Bureau has conscientiously implemented the deployment requirements of the Provincial Party Committee and the Provincial Government, and has done the following three aspects of work around key tasks such as promoting the construction of a close-knit county-level medical community:
1. Refine support measures,
Vigorously promote the construction of a close-knit county-level medical community
Pay attention to the leverage adjustment role of medical insurance, and promote the improvement of the allocation and use efficiency of medical and health resources at the county level.
The first is the implementation of total payment for the medical community. For the close-knit county-level medical community that realizes the "six unifications" of personnel management, financial management, asset management, business management, drug consumables catalog, and drug consumables distribution, the total payment of the medical insurance fund will be implemented, and the medical insurance fund will be allocated to the leading hospital, allowing redistribution within the medical community, and promoting the division of labor and cooperation of different levels and types of medical institutions within the medical community.
The second is to implement the policy of surplus retention and reasonable overexpenditure sharing. The surplus funds generated by strengthening health management and controlling the unreasonable growth of medical expenses are allowed to be uniformly transferred and used within the medical community. Compensation shall be given to reasonable overexpenditures within the medical community due to a significant increase in the number of people seeking medical treatment.
The third is to strengthen supervision and assessment. Indicators such as the growth of medical expenses within the medical community, the rate of medical treatment in the county, and the proportion of expenditure of the primary medical insurance fund will be included in the performance assessment of designated medical institutions, and the assessment results will be linked to the year-end liquidation of the medical insurance fund, so as to effectively improve the service quality and efficiency of the medical community and the efficiency of the use of funds.
2. Optimize medical insurance services,
Efforts should be made to improve the level of medical protection for the grassroots people
Adhere to the integration of expanding designated points, improving benefits, and expanding networks, and effectively enhance the accessibility of medical treatment for the grassroots people.
First, we will continue to expand the designation of primary medical insurance. At present, a total of 36,900 village clinics have been included in the designated management of medical insurance to achieve real-time online settlement, of which 32,200 village clinics have implemented integrated management, providing a strong guarantee for the masses to seek medical treatment nearby.
The second is to improve the level of primary medical insurance treatment. Increase the reimbursement ratio within the scope of the hospitalization policy of primary medical and health institutions to no less than 85%; The reimbursement rate for outpatient medication for hypertension and diabetes has been increased to about 70%, effectively reducing the burden of medical treatment on the grassroots people.
The third is to expand the grassroots medical insurance network. 35,000 grassroots medical insurance work sites have been built, 38,000 medical insurance people around the masses have been cultivated, and the five-level medical insurance service network at the provincial, municipal, county, township and village levels has been fully covered.
3. Strengthen policy inclination,
Actively support the development of primary medical and health institutions
Coordinate and promote key reforms such as payment, centralized procurement, and pricing, guide the sinking of high-quality resources, and promote the improvement of the level of primary medical services.
The first is to strengthen payment policy support. The annual new medical insurance fund focuses on primary medical and health institutions, and includes common and frequent diseases suitable for development at the grassroots level into the primary disease group (species) of the medical insurance payment method reform, and implements "the same price for the same disease in the same city", and by the end of 2025, there will be no less than 20 groups and 80 types of DIP primary diseases in the DRG primary disease group and DIP primary disease respectively. [DRG/DIP primary disease group (species): In the context of the reform of payment methods according to disease diagnosis-related groups (DRG) and payment according to disease score (DIP), some common and frequent diseases with relatively simple conditions, suitable for diagnosis and treatment in primary medical and health institutions, and have the ability to diagnose and treat at the grassroots level are selected as primary disease groups (types), and the same price for the same disease in the same city is implemented, so as to guide the sinking of resources. ]
The second is to strengthen policy support for centralized procurement. Innovate and carry out the activities of centralized procurement of drugs at the grassroots level, highlight the strengthening of the supply guarantee of drugs at the grassroots level, and promote the sales of centralized procurement drugs in 16,100 integrated management village clinics, which has improved the accessibility of centralized procurement of drugs.
The third is to strengthen price policy support. Establish a dynamic adjustment mechanism for the price of medical services, organize cities to give priority to adjusting the prices of medical service items with higher frequency of use at the grassroots level, and continuously optimize the income structure of primary medical and health institutions.
comprehensively strengthen policy support,
Continue to optimize the establishment, salary and other policies!
The notice makes it clear that the development and construction expenditures such as capital construction and equipment purchase of government-run grass-roots institutions shall be arranged in full by the governments of districted cities and counties (cities and districts) in accordance with the development and construction plans; Operating costs such as personnel expenses and operating expenses are compensated through financial subsidies and service charges; Personnel training, recruitment and other capacity improvement expenditures, by the financial department according to the relevant personnel training planning and talent recruitment plans and other reasonable arrangements for subsidies. Implement the government's investment policy for public hospitals in line with regional health plans in accordance with regulations. The new financial health expenditure should be appropriately tilted towards the grassroots institutions within the county-level medical community.
Continue to optimize the staffing, remuneration and other policies. In terms of establishment and use, personnel recruitment, personnel arrangement, professional title evaluation, etc., the county-level medical community is given more autonomy, and the county is managed by the township and the township is hired by the village. Implement the requirements of "allowing medical and health institutions to break through the current level of wage regulation and control of public institutions, and allowing medical service income to be used mainly for personnel rewards after deducting costs and withdrawing various funds in accordance with regulations", and balance the performance wage level at the county and township levels, and when the income of personnel in grass-roots institutions does not reach the level of personnel at the same level in county-level public hospitals, the total amount of performance wages can be approved according to the actual situation, taking into account the development stage, undertaking tasks, region, financial situation, incentive needs, etc.
Li Benjun, deputy head of the People's Government of Chengwu County, shared the experience of Chengwu County in improving service functions and improving the overall service capacity of the county, and also emphasized the importance of government financial investment guarantee and strengthening policy support, and shared specific implementation plans.
In the strengthening of township branches, it is mentioned that: first, 80 million yuan was invested in construction funds, 6 new township health centers were built, and 2 township health centers were renovated and expanded. Second, a one-time investment of 46 million yuan has been made to purchase advanced medical equipment and rehabilitation equipment for 13 health centers, which has greatly improved the ability of auxiliary diagnosis and treatment. The third is to implement the "one hospital, two departments" assistance model, which has sent more than 1,300 experts, more than 700 lectures and trainings, and directly served more than 40,000 people. Fourth, we will strengthen the construction of county-level medical sub-centers, and continue to promote them from six aspects, including strengthening services, optimizing the environment, storing talents, strengthening specialists, improving technology, and emphasizing medical prevention, so as to further deepen the connotative development of county-level medical communities and strengthen the grassroots.
In the comprehensive strengthening of policy support, it is introduced: First, talent support is in place. The "Implementation Plan for Strengthening the Introduction and Cultivation of Talents in the County Medical Community in Chengwu County" and the "Opinions on Further Standardizing the Internal Personnel Deployment of the Medical Community" were promulgated, and the "three articles" of talent introduction, cultivation and use of talents were carried out, and 117 professional and technical personnel were recruited for the branch hospital and 230 village doctors were recruited for the central village clinic. Second, financial support is in place. Every year, on the basis of keeping the original financial security unchanged, 20 million yuan is specially allocated for the construction of the medical community, and 30,000 yuan/year of operating funds are ensured for 105 central village clinics, and the county finance pays the pension insurance of the village medical enterprise, which effectively stimulates the entrepreneurial passion of the officers. Third, medical insurance support is in place. Under the premise of implementing the DRG payment method (a medical insurance payment model based on disease diagnosis-related groups, aiming to measure the quality and efficiency of medical services and medical insurance payment), the county medical insurance bureau implements the total payment of the medical insurance fund for the medical community, and strictly improves the mechanism of surplus retention and reasonable overexpenditure sharing. and actively strive for policy and financial support from the higher-level medical insurance departments, and tilt towards the medical community to the greatest extent; The county medical insurance bureau spends no less than 3 million yuan of medical insurance fund budget every year for the reimbursement of medical insurance for diagnosis and treatment in the central village clinic, so that the masses can achieve reimbursement without leaving the village. In 2023, the county will allocate 249 million yuan of residents' medical insurance funds, accounting for 75.3% of the county's available residents' medical insurance funds, and real money will support the development of the medical community.
Source: Huayi.com is comprehensively compiled from Health Shandong and Shandong Provincial Health Commission (reprinted for sharing only, the copyright belongs to the original author.) If there is an error or infringement of the source, please contact us, we will correct and delete it in time, thank you! ）