Only by building a community can medical reform be stable and far-reaching



The cost of outpatient and inpatient medicines for patients in Guangdong dropped by 3.6% and 12.7% respectively. On the 22nd of last month, the Guangdong Provincial Health and Family Planning Commission held a communication meeting on the Guangdong Comprehensive Medical Improvement Exhibition, Duan Yufei, director of the Provincial Health and Family Planning Commission It was revealed that in January 2018, Guangzhou will launch a new round of price adjustments for medical services, "it is necessary to adjust the prices of items that reflect the labor value of medical staff as much as possible, and adjust the prices of large-scale inspections and inspections."

Those familiar with the medical field may have noticed that on the same day, the first "Basic Medical and Health and Health Promotion Law (Draft)" was submitted to the Standing Committee of the 12th National People's Congress for the first review. This "Draft", which lasted for nearly three years, not only emphasizes that citizens enjoy the right to health in accordance with the law, but also explicitly prohibits public medical institutions from cooperating with social capital to establish profit-making institutions. In fact, this clearly conveyed a signal that the state hopes to reduce the cost of people enjoying medical services through improved policy design. This is no different from the information released at the communication meeting, and it suffices to show that reducing the burden of medication for the masses has become a basic principle for deepening medical reform from top to bottom.

How to reduce the cost of people enjoying medical services? The usual direction is to adhere to the public welfare nature of medical services, and at the same time, in order to make up for the insufficient supply of public medical resources, allowing social forces to enter. How effective is this? The answer is unsatisfactory. The reason that the medical reform has been on the road is also related to the poor effect of the reform. Of course, this is not to say that there is a problem with the direction of the reform. The key is that the specific implementation path is eliminated by various resistances or loopholes. For example, the price of medicines has been high before, and the root cause is that there are too many intermediate circulation links, but the later "two-invoice system" (the medicine is sold from the pharmaceutical factory to the first-level distributor to issue an invoice, and the distributor sells it to the hospital. One invoice) reversed the "war situation" because it hit the point.

The key to achieving a win-win-win situation for healthcare reform is to build a community. In this regard, Shenzhen Luohu's approach can be used for reference: the grassroots focus on building a community of medical and health services, and its main practices can be summarized as building three communities.

The first is to manage the community and establish a hospital group that is the only legal person to promote the globalization of medical and health resources. Integrate multiple hospitals and several social health centers in the district to establish a hospital group with the sole legal person to realize unified management of human, financial and material affairs. At the same time, it promotes intensive management, optimizes resource allocation, optimizes and reorganizes internal resources, realizes mutual recognition of test results, and exchanges of medical resources. The original administrative and logistics functional departments were abolished and a logistics group was established, which reduced operating costs. More importantly, the establishment of a corporate governance structure, the territorial government fulfills the responsibilities of investors, entrusts the board of directors to perform decision-making and management powers, and the board of supervisors is responsible for overseeing matters.

The second is to serve the community, improve the medical service system, and promote the success of graded diagnosis and treatment. For example, to strengthen and build the social health center, the hospital group will attract doctors, add drugs, and add equipment to ensure the service capacity of the social health center, and gradually build a 10-minute high-quality medical and health service network. Create a social health examination and hospital diagnosis mode. The hospital deploys a mobile diagnostic vehicle to the social health center to provide examination and filming services, which are transmitted to the diagnosis center via a remote system, and the diagnosis report can be obtained within half an hour. People who go to the social health center for the first consultation and then go to the hospital group can enjoy the registration fee free, priority is given to the appointment of expert outpatient clinics, the priority arrangement of auxiliary examinations, and the priority arrangement of hospitalization services.

The third is a community of responsibilities, to straighten out the rights and responsibilities of all parties to improve the public welfare of medical and health services. Clarify the government's management responsibilities, let the government's main responsible comrades serve as the chairman of the hospital group, build an efficient medical decision-making mechanism, promote the sinking of human, financial and other resources to the grassroots, and promote the fair and accessible basic medical and health services. Establish a service performance-oriented compensation mechanism, and consolidate the government’s financial guarantee responsibilities for medical and health care in the form of "fixing fees, purchasing services, and special subsidies". At the same time, a board of supervisors was established to build a performance evaluation mechanism for the hospital group. The health status, medical expenses, and service quality of residents were used as evaluation indicators, and the evaluation results were linked to financial subsidies and the annual salary of group managers to consolidate the group's service supply responsibilities.

Practice has proved that this method of building a community has realized the transformation of the medical concept and mode, realized the improvement of service ability, patient satisfaction and medical staff income, and realized the hospital operating cost and the public medical treatment cost.