August 12，The National Health and Family Planning Commission is on the progress of the pilot work of the comprehensive medical reform of Anhui & rdquo; and the guidance of the construction of healthy urban health villages & rdquo;。

 

  Will on the way，Director of the Anhui Provincial Health and Family Planning Commission、Director Yu Dezhi, director of the Provincial Medical Reform Office, introduced the progress of Anhui medical reform。

 

  Pharmaceutical consumables procurement uses provincial tender、Methods for the purchase of medical institutions

 

  Anhui Provincial Hospital and 16 cities formed & ldquo; 16+1 & rdquo;，that is, 17 provincial direct hospitals are used as a group，Select a team leader unit、A supervisory unit，The quality of the medicines used is relatively high，Provincial hospital surgery is also complicated、Diseases are also complicated，So its medicine uses directory is different from the city and county。There are 16 cities in Anhui，Municipal Hospital、County Hospital、Township Health Center formed a consortium，& ldquo; 16+1 & rdquo;。

 

  First of all, centralized bidding and purchasing at the provincial level，It has a great decrease compared to the national retail guidance price，and take the bid price as the reference price of medical insurance payment，Then & ldquo; 16+1 & rdquo;，Sign a standard purchase and sales contract。That is, the provincial bidding is the threshold of Anhui Province，Medical Union is a quantity，Is the threshold of the hospital，1 & mdash; July，Compared with the guidance price of national pharmaceutical retail in the province，Save 4.63 billion yuan。Bringing volume is reduced by about 15%，Save about 1.86 billion yuan。Total saving 6.49 billion yuan。Carry out high -value medical consumables online procurement and large -scale medical equipment centralized procurement。1 & mdash; July，The province's medical institutions are calculated at an average of 16%of the purchase of the website，Save 290 million yuan。15 batches of large -scale equipment for large -scale equipment reduced purchase costs of more than 30%。

 

  Promote Paying by disease

 

  Anhui Province established a county -level public hospital clinical path management guidance center，Select 100 diseases，Push the clinical path management in all county -level hospitals，21 kinds of auxiliary medications are not included stake sports betting appin the form，Promote the comprehensive consideration of the hospital for cure cost，Reduce the proportion of medicine。The first quarter of 2016，75 county -level hospital clinical path patients account for 20.29%，The proportion of drugs decreased by 9.69%，Per capita auxiliary medication costs of patients with discharged patients decreased by 18.57%，Antibacterial drugs decreased by 4.28%，Disputes of doctors and patients are significantly reduced。In 2016, there are 67 third -level hospitals in the province、227 Hospitals above the second level pushing the clinical path management。

 

  Launched 53 diseases without infusion & ldquo; negative list & rdquo;，Hospital's outpatient infusion rate decreases significantly，Grassroots、The proportion of ordinary large infusion amounts of medical institutions above the county level and above continues to decline，From January to July, it was reduced to 6.9%、1.6%。July 2015，Launched 15 cesarean section surgery & ldquo; front list & rdquo;，The production rate of cesarean section of the province's delivery institutions fell from 45.08%before implementation to 0.46%。

 

  129 pilot diseases for standard prescriptions for village clinics，The infusion rate drops to 16.7%，Antibiotic di -couplet use rate will be reduced to 6.5%，Hormone usage drops to 2.1%，& ldquo; San Su Yitang & rdquo; Phenomenon has obviously improved。

 

  Establish a warning management system for key drug monitoring catalog，Regularly announced price high、Large dosage、Non -therapy auxiliary drug monitoring directory and report。January-July，Procurement of key drugs in primary medical and health institutions accounted for 4.1%，Compared with 18.6%before the announcement, the purchase amount of medical institutions at the county level and above accounts for 11.6%，Compared with 13.9%before the announcement, it also decreases。

 

  Gradually build a new order of hierarchical diagnosis and treatment

 

  As a big agricultural province，Anhui for the actual situation of provincial conditions。Adhere to residents' health，Give full play to the leverage of medical insurance funds，Integrated County、Township、Village third -level resource，Clarify the three -level functional positioning，Establishing a responsibility and co -sharing、Tight -type county medical communities shared by interests，Provide prevention & mdash; treatment & mdash; rehabilitation，Cover the whole life cycle、continuous、Coordinated comprehensive health management。Do & ldquo; Three strengthening & rdquo;: strengthen referral service and technology assistance，Realize the diagnosis of county hierarchical area; strengthen public health and chronic disease management，Reduce the occurrence of the disease，Delay the development of critical illness; strengthen medical quality and patient safety，Improve residents' medical treatment。& ldquo; A & rdquo ;:，Establishing a residents' health and medical insurance fund & ldquo; dual goalkeeper & rdquo; system，Make limited health resources to maximize the benefits of protecting the health of the people。Since 2015，There are two batches of 40 counties to carry out pilots，Covering population 28.915 million，56.3%of the number of My stake betting apppeople covered by Xinnonghe。In the first half of this year，Pilot county's total hospital hospitalization costs decreased by 638 million yuan，The expenditure of Xinnonghe funds decreased by 402 million yuan，Farmers' personal burden reduced 236 million yuan，The average hospitalization cost is reduced by 221 yuan。The first batch of 15、The second batch of 25 pilot county hospitals outside the county and counties fell 11.87%year -on -year、8.20%; inpatient patients in the county increased by 11.05%year -on -year、12.13%; the number of inpatients in the township health centers increased by 12.08%year -on -year、4.83%。

 

  Establishing a pediatric medical consortium，Improve the overall service level of pediatrics，New model of innovative children's medical grading service。Implementing the outpatient time limit number system of urban third -level hospitals，Improve the medical experience，Guide patients for diversion。Establish a unified medical convenience service platform in the province。Urban Public Hospital Outpatient Clinic、The proportion of the number of discharge services continues to decline，Grassroots service quantity increased steadily。Cancel two lines of revenue and expenditure of grass -roots medical and health institutions，Enhance the operating vitality of the organization。Reform senior professional title review standard，Cancellation of promoted deputy high English papers requirements。

 

  In specific operations，Vice Chairman of Luzhou CPPCC、Jin Weiga, Secretary of the Municipal Party Committee of Tianchang Municipal Party Committee，disorderly competition in hospitals below the county，Patients with disorderly consultation，Small illness to the big hospital，Famous doctors are widespread in the past in the past，It also caused the county -level people's hospital to be unwilling to transfer patients to the township hospital，Township and Township Health Center is also unable to treat patients。To solve this problem，Under the direct guidance of the Anhui Provincial Health and Family Planning Commission，Explore the establishment of a county medical service community，referred to as & ldquo; Medical community & rdquo;，Realize minor illnesses without going out of hometown、Do not get out of the county、It is convenient to see a doctor。Three hospitals in the city and township health centers in the county are、The village clinics are formed into three medical services community，Realizing resource integration in these three medical services、Order consultation、Order service。

 

  The operating mechanism of the medical community uses four sentences to express，is the first clinic at the grassroots level、Two -way referral、Slowly divide、Liech up and down。The first clinic of the grassroots is the institution that can choose to go to the grassroots after the onset of the residents，For example, village clinics、Town Health Center for diagnosis，Diagnosis and treatment of diagnosis and treatment by the general physician，If you need to refer it，Green channel through the medical community，Referendum treatment from the town to the Municipal People's Hospital。Some My stake betting appafter treatment at the Municipal People's Hospital，Patients have reached the rehabilitation period，Reversing downward，Transfer to the town hospital for treatment for rehabilitation，This realizes two -way referral。Last year, the city hospital referred to 2668 people，This is unimaginable in the past，The county hospital takes the initiative to transfer the patient to the town health center，The lower -level turn is 1140 people。Slowly divide，It is according to the patient's disease situation、According to the disease spectrum、Depending on the disease of different diseases，Guide patients to the most suitable medical institution for diagnosis and treatment，Prevent over -medical treatment，It also guarantees that he has a saturated treatment that meets the needs of individuals。For example, in April this year, we have a patient in the village，He feels physical discomfort，Go to the village clinics for treatment，Village doctors in the village and clinics have been diagnosed，Find the patient's dizziness、Face yellow、Symptoms of anorexia，Developed his illness through the WeChat information group to the platform of the medical community，Deputy Chief Physician of the People's Hospital of the Municipal People's Hospital immediately told him，Let this village doctor introduce the patient to the town's hospital for liver function test。Discovery liver function abnormalities at the liver function examination at the town hospital，Hurry up to the Municipal People's Hospital through the green channel，The last diagnosis is acute hepatitis。This has achieved a slow division of governance、Interaction of referrals up and down。

 

  Liech up and down，The people's hospital is led in the medical community、Town Health Center、Village Clinic，There is a upper -to -bottom guidance function，Including medical skills guidance、Lower training、Multi -point occupation、Go to the clinic。There is a town patient with a sudden cerebral infarction，After transferring to the Municipal People's Hospital through the green channel，After half a month of treatment，Patients enter the rehabilitation period，We transfer him to the town health center in time，Continue treatment。Director of the People's Hospital of the City Every Tuesday afternoon、Deputy Director dedicated to inspect、Inspection House、View，After a period of treatment，Patients can already go to the ground。This reduces the patient's family to the support cost of our city、Traffic costs、Working costs，Realized patients with less payment、Less Run，Can cure the disease。

 

  There is a vital issue for medical communities，How to make the medical community really play a role，instead of formal virtual community。We must build the medical community into a community of interests、Community of development、Responsible community。Bind the funding for the basic medical and health service project to every medical community coordinating management，It also includes the implementation of the new Nonghe Fund in the county medicine communist in accordance with the head budget payment management，Mobilized the enthusiasm of the medical community。stake betting appThere are three medical communities in our city，If the New Rural Hehe Fund finally has a surplus in the medical community，The ratio of & ldquo; 631 & rdquo;，Let the Municipal People's Hospital、Township Health Center、The village clinics share this balance，Used to mobilize the enthusiasm of medical staff，Used for development。Leading Hospital of the Municipal People's Hospital also to the lower -level village clinics of the medical communist、Town Hospital has talent support、Talent training、Remote assistance functions，It also realized resources to share，Doctor go down，The grassroots are stronger，The service capacity of our township health centers has increased significantly。

 

  In 2015, the prevalence rate of patients in the county in Luzhou City reached 91.1%，It is relatively high in the county level。Tianchang City to Yangzhou is 50 kilometers，75 kilometers to Nanjing Yangtze River Bridge，There are more than 40 three -level hospitals in Yangzhou and Nanjing，So our patients turn to Nanjing normal，91%of patients with a hierarchical diagnosis and treatment medical community stay in the county to receive appropriate and saturated services。

 

  Implement the burden of patients after a hierarchical referral diagnosis and treatment reduction，Fund reduction of medical insurance，I have specific numbers。For example, the treatment of appendicitis as an example，If the People's Hospital in our city is treated，The cost of the disease is 3500 yuan，If you go to the town health hospital for treatment is 1500，This can save 2,000 yuan，Patients have reduced cost burden，Fund also reduced expenditure，Patients do not need to go to the city to accompany。So，We believe that the medical community is an effective mode to solve the rural grass -roots graded diagnosis and treatment paths，We will increase the intensity of exploration under the direct guidance of the Provincial Health and Family Planning Commission。May 13 this this this this this this was this，Comrade Li Bin, the National Health and Family Planning Commission, specifically investigated this work in Tianchang，Requires us to actively explore the rural hierarchical diagnosis and treatment system with Chinese characteristics。