By the end of 2016, there were 205 cities above the prefecture level in the country, which accounted for more than 60% of the cities above the prefecture level, forming four more mature models. Liang Wannian, director of the National Health and Family Planning Commission, believes that the medical association will bring about three major 'transformations' in the entire medical service system.

The phenomenon of concentration of medical treatment in large hospitals will gradually change. On April 14th, the State Council held a briefing on the policy of the State Council. Wang Hesheng, director of the State Council Medical Reform Office and deputy director of the State Health Planning Commission, introduced the 'Guiding Opinions on Strengthening the Construction and Development of Medical Complexes' (hereinafter referred to as the 'Opinions'). In this case, it is proposed that the pilot project for the construction of the medical association should be fully launched this year. All the three-level public hospitals should participate and play a leading role. At least one city with a significant effect should be built in each city of the comprehensive medical reform pilot province and the pilot city for graded diagnosis and treatment. In 2020, we will comprehensively promote the construction of medical associations.

Explore 4 medical association models in 205 cities

China's primary medical service institutions are weak, and many places use the medical association as an entry point to construct a division of labor coordination mechanism for different levels and different types of medical institutions, effectively promoting the sinking of quality medical resources. In 2016, nearly 10 million cases of various types of medical associations were transferred nationwide, a year-on-year increase of 62%; the number of cases was down 2.6 million, an increase of 117%. Wang Hesheng introduced that as of the end of 2016, there were 205 cities above the prefecture level in the country, which accounted for more than 60% of the cities above the prefecture level, forming four more mature models.

The urban medical group model represented by Shenzhen Luohu Medical Group and Jiangsu Zhenjiang Rehabilitation Medical Group. Leading by three-level public hospitals or hospitals with strong business capabilities, and joint community health service agencies, they cooperate in the medical associations with talent sharing, technical support, mutual recognition, prescription flow, and service convergence.

The county medical community model represented by Anhui Tianchang. The county-level hospital is the leader, the township hospital is the hub, and the village clinic is based on the county-township integrated management and division of labor coordination mechanism.

A cross-regional specialist alliance represented by the Children's Hospital of Beijing Children's Hospital.

A telemedicine collaboration network represented by the telemedicine network of the China-Japan Friendship Hospital. Telemedicine, distance learning, and distance training are provided by public hospitals for grassroots, remote and underdeveloped areas.

According to the 'Opinions', China will form a variety of forms of medical associations. In the city, the medical group is mainly established. The medical community is mainly established in the county, and the specialized alliances are formed across regions. The telemedicine collaboration network is vigorously developed in remote and poverty-stricken areas with insufficient medical resources.

Large hospitals have to be put down, the grassroots must be able to withstand

Tian Youzhong, executive chairman of the Health Service Industry Development and Reform Alliance, believes that to truly establish a medical association, two major difficulties must be overcome, namely, the sharing and balance of interests between the lower and lower levels of institutions, and the unified coordination of administrative affiliation.

Wang Hesheng believes that the core is to solve the problem of dynamic mechanism. Through the financial investment, medical insurance payment, personnel management and other supporting policies, mobilize the enthusiasm of the three-level public hospitals, solve the problem of the big hospitals willing to let go; through the dispatch of experts, specialist construction and other measures to promote the sinking of quality medical resources, improve the level of grassroots services, Solve the problems of the grassroots access; provide priority access, examination, hospitalization and other services to the contracted patients through the higher-level hospitals, smooth the post-operative recovery period, severe stable period and other patients to the lower referral channel, solve the problem that patients are willing to go By solving the mechanisms that facilitate the flow of medical resources, distribution incentives, and total payment for medical insurance, we must solve the problem of supporting policies.

Liang Wannian, director of the National Health and Family Planning Commission, believes that the medical association will bring about three “transformations” of the entire medical service system: the unit with the smallest assessment is transformed into the efficiency, effectiveness and effectiveness of the medical association, rather than individual medical treatment. Institutions; the relationship between doctors and patients has changed from a short-term, phased to a long-term, continuous, and accountable relationship. The service model has changed from sitting in a hospital to a specialist, a general practitioner to form a team to jointly provide contracting services for patients; It will be transformed into active control fees, and the number of services will be linked to the number of services, the quality of services, the satisfaction of ordinary people, the improvement of the health of ordinary people and the improvement of the overall service capacity of the grassroots.

People will be more convenient and save money when they see a doctor.

Mr. Zhao, who worked in Hangzhou, Zhejiang Province, rushed back to the Xintian Town Health Center in Tianchang, Anhui Province, and did a more complicated patch of hernia surgery. “There are more reimbursements here, and there are experts in the city, so I am thinking about coming back to do it. surgery'. The surgery on the day received on-site technical support from experts in the city, and the money was spent very little. Originally, the hospital and the city hospital formed a medical community. The Chinese medicine hospital added a large amount of equipment to the hospital. It also opened a remote consultation service. The medical community has a laboratory and a pathological center. The specimen can be sent to the center for diagnosis. Chinese medicine experts will go to the hospital for medical treatment, rounds and training.

Wang Hesheng believes that building a medical association can bring tangible benefits to the people.

Get medical attention nearby. Give play to the role of three-level public hospitals, use technical assistance, personnel training and other means to strengthen the capacity of health gatekeepers in primary health care institutions and achieve primary care at the grassroots level. At the same time, to promote the continuous recording and information sharing of electronic health records and electronic medical records, contracted patients can easily extract and use health files in the medical association. Encourage the establishment of medical imaging centers, inspection and testing centers, etc. in the medical associations, and gradually realize the mode of “basic inspection, hospital diagnosis” through the methods of “patients not moving, specimens moving, and information moving”.

Convenient medical treatment. Promote medical institutions to provide more efficient and quality services. For example, in the medical association to establish a referral green channel, the superior hospital provides priority referral, priority examination, priority hospitalization and other services to the grassroots referral patients. At the same time, it provides a convenient and affordable policy for patients at the grassroots level. Long-term prescription services for patients with chronic diseases signing up for no more than 2 months.

Get a full service. Focus on chronic diseases such as high blood pressure and diabetes, and do a real family doctor contract service. At the same time, it is led by three-level public hospitals or hospitals with strong business capabilities, attracting rehabilitation hospitals, nursing homes and other medical institutions to join, so that the masses can get integrated and convenient from disease diagnosis and treatment to rehabilitation and long-term care continuity services.

Save on medical expenses. For the medical association to implement medical insurance package prepayment, the original income of medical institutions has become a cost, which can guide medical institutions to actively control unreasonable expenses, and strive to maintain the health of the people and make the people less sick. On the other hand, through the leverage of medical insurance, the gap in reimbursement levels is reasonably set, reducing the disorderly flow across regions and reducing the burden of medical treatment for the masses.