Release date: 2018-01-26
Constructing a graded diagnosis and treatment system is the fundamental strategy for reconstructing China's medical and health service system and improving service efficiency. Through the implementation of graded diagnosis and treatment, patients are gradually guided to the community in the community, rehabilitation in the community; common diseases, minor illnesses to secondary hospitals; major illnesses and problems Acute diseases such as complexes enter tertiary hospitals. The construction of various forms of medical associations is an effective carrier to promote the classification of medical treatment systems.
At present, 91.1% of tertiary hospitals nationwide participate in the pilot program of the medical association. The local models are different, compact and loose, showing a blooming situation everywhere, but the problems arising from the construction of the medical association are common and cannot be ignored.
Luo Aijing, member of the Hunan Provincial Political Consultative Conference and secretary of the Party Committee of the Xiangya Third Hospital, believes that there are four main problems from the current operation of the medical association:
The first is "not reasonable." Due to the lack of systematic medical management system and operational mechanism, the medical association as a constraint to break the administrative management structure, the medical cooperation between the hospitals and the complete medical cooperation can not be achieved. Lack of rigorous medical management system coordination, as well as the inter-institutional grading diagnosis and treatment system as an effective guarantee. Under the current system, outpatient clinics are still the main business volume of tertiary hospitals, and they lack the motivation to sink medical resources. In terms of the ability to provide medical services, tertiary hospitals are much higher than primary hospitals, and the construction of medical associations has increased the “siphon†effect of hospitals. This "siphon" effect includes both "siphoning" patients from the grassroots and doctors at the "siphon" grassroots level, especially county hospitals.
The second is "not going down." The support and support of medical insurance is not enough. Many local medical associations are now experiencing difficulties, mainly because the medical insurance settlement policy is not supported enough. For example, the establishment of joint wards and specialist clinics in tertiary hospitals in tertiary hospitals, how the medical insurance quotas are settled, and how the two hospitals are properly allocated affects the enthusiasm of the medical association and the sustainability of grading diagnosis and treatment. The difference in service prices between medical institutions at different levels is not obvious, the difference in the proportion of medical insurance reimbursement is not large, and the basic drugs that are transferred to the community are not available. As a result, most residents still choose tertiary hospitals, and the effect of restricting residents' medical treatment is not obvious.
The third is "can't stand." On the one hand, the lack of talents in primary health service institutions, low academic qualifications, low professional skills and service levels, can not meet the needs of downward referral. Among the nearly 4 million doctors in the country, there are only about 180,000 general practitioners, less than 5%, and developed countries are generally 50%. On the other hand, grassroots medical staff are not motivated by the first consultation, and talents cannot stay, leading to grassroots doctors becoming a veritable person. The "second setter".
The fourth is "unable to connect." Some medical institutions have not yet realized an information sharing platform. When patients are referred to the clinic, the information and records of the visits cannot be read each other. The inspections and tests do not recognize each other. The results of the inspections are not recognized by the second and third grade hospitals, resulting in an increase in the medical costs of patients. The implementation of graded diagnosis and treatment. Information sharing has not yet achieved a unified platform. Medical institutions at all levels have their own internal independent information systems, and there is no interconnection between residents' health information management.
Luo Aijing suggested that, first of all, the top-level design should be perfected so that the medical association can truly “join the heartâ€. From the legal level, the legal orientation of the medical association is clarified, the internal and external responsibilities, rights and obligations of the medical association are clarified, and the traditional administrative means are used to avoid the "Lang Lang match." From the policy level, it clarifies its development direction and principles to be followed, and makes clear provisions on fiscal compensation policies and management systems, so that all localities have laws to follow and have rules to follow.
At the same time, deepen the reform of the system and mechanism, transform the government functions, implement the separation of management and management, enable medical institutions to break down barriers and realize the effective play of market functions; formulate indicators and standards for evaluating the cooperation of medical associations, and develop evaluation systems. Evaluation should take into account efficiency, quality and fairness. When considering how to evaluate the effectiveness of graded diagnosis and treatment in tertiary hospitals, the monitoring index system should be established based on the source of the patients and the difficulty of diagnosis and treatment of the disease. The critical and invasive index and the proportion of the third and fourth grade surgery can be considered as reference. Indicators, and standardized according to the nature of the bed and the specialist.
The second is to unify comprehensive management, discipline development, performance distribution, and personnel training, enhance cultural identity, and allow grassroots talents to “retainâ€. With the third-level hospital as the core, the management concept and thinking mode of the primary hospitals will be updated and re-created, so that the same concepts and thinking will continue to take root, sprout and result in the primary hospitals, and change the management concepts, working methods and living habits of the primary hospitals. The performance distribution of grassroots hospitals and tertiary hospitals will be unified and integrated, and the enthusiasm of all levels of personnel will be more effectively mobilized to promote the sustainable and healthy development of medical associations. Steadily improve the operational skills of grassroots health workers. Set up special funds, give play to the role of tertiary hospitals, and gradually carry out training on clinical skills operation and diagnostic analysis of grassroots medical staff, organize assessment feedback, and further improve the comprehensive quality and ability level of grassroots health technicians in our province.
The third is to reform the payment method of medical insurance, so that the tertiary hospitals are “willing to let goâ€. Promoting the reform of medical insurance payment methods based on disease types can fundamentally change the operation mode of public hospitals relying on “big cakesâ€, and can distinguish the payment standards of some diseases in tertiary hospitals and primary hospitals, and promote the third level. The hospital has diagnosed and treated patients with intractable diseases. Unify the scope, variety and brand of drugs used by medical institutions at all levels, improve the drug supply and marketing mechanism, and ensure the homogenization of drugs at all levels of medical institutions.
The fourth is to force telemedicine to let information communication "run up." Standardize and standardize the procedures for remote consultation, secondary consultation and two-way referral, including electronic health records and digital informationization of disease diagnosis and treatment materials. Standardization and standardization are beneficial to improve the efficiency and effectiveness of two-way referrals and remote consultations, and to smooth doctor-patient communication and rehabilitation of patients and patient participation. Patients are readily available for appointments, follow-up visits, medical advice, necessary expectations, and health data collection. Original title: Four major problems in the development of medical associations to be solved
Source: Economic Information
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