Ji'nan public hospital reform plan is released, appointment doctor will become an appointment office.
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implementation of the classification diagnosis and treatment to increase the reimbursement gap Qilu Evening News April 19th news (reporter Chen Xiaoli Liu Yafei) reform program pointed out, to promote the classification of diagnosis and treatment system, the construction of regional medical center and basic layer medical institutions function dislocation configuration, The service system of business coordinated development will push forward the focus of medical and health work and sink resources, so as to guide residents to seek medical treatment reasonably. By the end of 2016, the proportion of appointments transferred to public hospitals had increased to more than 20%.
, Xu Lingzhong, a professor of public health at the Shandong University, pointed out that "classification diagnosis and treatment can not be separated from the cooperation and support of medical insurance policy. In addition to the program, the medical insurance starting line can be calculated continuously. The difference between medical insurance reimbursement at different levels of medical institutions should be increased and the lever of medical insurance should be fully played." Use, shunt the patient. " Hierarchical diagnosis and treatment should avoid letting primary medical institutions end up being simply referral procedures for patients. Xu Lingzhong said, "if you do not want to improve the diagnosis and treatment of medical institutions at the grass-roots level, let patients truly believe the level of grass-roots medical institutions, only through compulsory policy diversion may increase the contradiction." In order to retain high level doctors, primary medical institutions also need policy tilt, appropriately raise their income level, and ensure that all kinds of drugs are well equipped.
"complete classification of diagnosis and treatment can not be realized overnight, just as it is difficult to change the way of life completely, and the change of medical habits will also take time." Therefore, Xu Lingzhong believes that the improvement of grading treatment and appointment referral needs a long-term process.
the program of health card sharing information in the health card of the hospital, proposed to further improve the function of the public health card, and docked with various carrier information such as medical insurance card and UnionPay card.
"from the perspective of Shandong Province, the medical insurance system between the 17 cities is independent of each other, and the provincial health insurance is independent." Xu Lingzhong said, "in addition to medical insurance, the medical cards between hospitals are independent, to different hospitals to do different cards, which causes the fragmentation of medical information, can not achieve information sharing, also is not conducive to the implementation of the appointment and referral." Xu Lingzhong said that if the hospital systems can be shared in real time, only a "health card" can go to different hospitals, which can bring great convenience to the patient. "Now many elderly people go to see a doctor with a medicine box, if the doctor can see the patient clearly through a health card." All the records of diagnosis and treatment will be more convenient. " It is clear that Ji'nan will build the "Ji'nan resident medical network" and the APP application system in the program. The results of the self-service appointment registration, payment and inquiry inspection, and the personal health archives "are on the hand", and the referral, telemedicine and health care will be formed. Health management and medical collaboration, such as "one Netcom".
corresponds to the current information fragmentation, and the appointment of a doctor now needs to log in to the official website of the different hospitals or the mobile client, if there is a unified one-stop platform that is more conducive to the patient's medical treatment.
Xu Lingzhong said, building such an information system requires huge financial input. Many developed countries and regions in Hongkong and the United States have realized this information sharing. "As early as 1999, I went to Hongkong to investigate the patient information in any hospital system, all the patients. The records of the diagnosis and treatment can be displayed.
"a chronic disease patient best fixed a doctor" program "proposed in the three level hospitals and specialist hospitals to set up a medical and nursing service team, as the provision of disease diagnosis and treatment, nursing service work unit, the implementation of team service. It is necessary to reform the mode of direct appointment of patients, change the appointment of medical teams or departments to patients, and arrange reasonable patients' visit by hospitals.
at present, the appointment is almost all the appointment to the specific doctor name, "because the well-known expert appointment limited number, the patient may be difficult to make a successful appointment, if a centralized reservation to the Department, it increases the chances of a successful appointment." Experts from the second hospital of Shandong University explained that "the Department can be assigned to the corresponding level of doctors according to the patient's specific condition, and the general condition is accepted by the general doctor, so that the real patient can see the expert." "The number of famous experts can not be seen too much. After the patients are shunted, they can appropriately reduce their burden and focus on the difficult problems; the young doctors also have the opportunity to take more patients to speed up their own growth." The expert said that the change in the way of appointment is of great benefit to both patients and doctors.
, however, it is worth noting that "a lot of chronic chronic disease patients are best fixed at the same doctor's name each time, helping the doctor to master the condition in an all-round way and make a more suitable treatment plan for the patient." Even with the same disease, different doctors will have different treatment plans, and frequent replacement of doctors is not appropriate. According to the disease type charge do not make "one knife" now to the hospital to see the hospital, every day will receive a bill of charge, some citizens can not avoid asking, although some expensive drugs are used but not necessary, the hospital will not arrange some of the treatment items do not need? In the future, hospital charges will also be reformed to avoid the public's concern. In the plan, it is proposed to establish a compound payment system based on payment by disease, paid by the head and paid by service unit. We encourage the implementation of payment by disease diagnosis. At the same time, we should comprehensively consider the quality and safety of medical services, basic medical needs and other factors to formulate clinical pathways and speed up the management of clinical pathways.
has a schedule to pay for the disease, and Ji'nan will expand the number of diseases paid by the disease species and the coverage of the hospitalized patients by the end of this year, and there are no less than 100 diseases paid by the disease.
in fact, in June 2015, the provincial Price Bureau, the Provincial Health Planning Commission and the Provincial Bureau of people's society jointly issued the proposal on further promoting the reform of the charge for disease by disease. In 2016, the number of hospitals in all county and urban public hospitals in the whole province should not be less than 50.
in recent years, all the provinces in our province have been launching a pilot program according to the disease type, but the patients who have declared are not many. Most of the experiments are not done at the end. "Can the patient be included in the charge of a single disease; it is necessary to consider the patient's age, his own health condition, and the condition of the disease." In many aspects of severity, even a small operation, the difference between 20 year old patients and 70 year old patients is very large, so the feasibility of simply charging the disease is lower. " A general surgeon of a third class hospital in provincial capital told reporters.
at the same time, according to the disease type charge also restricted hospital income, the enthusiasm of the hospital is not high, Xu Lingzhong pointed out, if the control is not strict, according to the disease charge may bring doctors to select the patient, and even some hospitals or doctors do not use good medicine in order to save the cost. At the same time, it will also bring more medical disputes, "different patients are different, unified clinical path management, this' one size fits all 'diagnosis and treatment will bring more problems?" The doctor raised his question.
the zero difference of the drug will be prescribed in a hospital that is cheaper than a drugstore. To go out to a drugstore, many people have such experience, and the aim is to save money. But starting next month, taking medicine at a municipal or district level public hospital in Ji'nan may cost more.
according to the schedule set out in the programme, since May, all public hospitals in Ji'nan have implemented the zero difference in drug sales, adjusted the price of medical services, and reduced the price of large instrument inspection.
not only that, there will be fewer opportunities for high priced drugs to appear on prescriptions. Ji'nan will formulate the "Ji'nan public hospital basic drug supply catalogue" as soon as possible. Under the premise of guaranteeing the needs of the medical insurance participants in the city, we will adjust the structure of clinical medication, reduce the proportion of high price drugs and high price drugs, and reduce the clinical application of auxiliary drugs and strange dosage forms and strange specification drugs.
drug prices have dropped, but some medical services are going up. It is understood that Ji'nan will study and formulate the medical service price reform program in public hospitals, and improve the price of service items that reflect the value of medical personnel's technical and labor services, such as diagnosis, operation, nursing, bed, Chinese medicine and so on. As for the rise, Jia Tanghong, director of the Ji'nan Municipal Health Planning Commission, said in an interview with this newspaper: "after the increase of expert diagnosis and treatment fees, the general expert number is about 100 yuan, and the well-known expert number will be higher.