Business Club August 20th August 19-21st, the “China Health Forum” hosted by the Ministry of Health, State Food and Drug Administration, and State Administration of Traditional Chinese Medicine was held in Beijing. The forum changed the theme of medicine to the theme of medical care. The key and difficult issues encountered in the development of the business include discussions, experience introductions and interactive exchanges. The following is a summary of the highlights of the speakers.

The cash expenditure per person for robbing 33 hospital beds per person in China is high

Guest speaker: Chen Wei, Minister of Health

Although the proportion of total health expenditure in GDP in China has shown several ups and downs during the past three decades, it has generally risen. In recent years, the state has attached importance to the development of health services. The data for the past three years shows that regardless of the total cost of health, Still, the increase in the proportion of health expenditure in GDP is significant. As the government becomes increasingly clear about its responsibilities and increases investment in health care, the proportion of government health expenditures and social health insurance expenditures in the total health expenditure is increasing, and the proportion of personal cash expenditures has declined. However, it should also be noted that personal cash expenditures are still at a relatively high level. Therefore, it is necessary to further increase government investment to effectively solve the problems of patient care and expensive medical services.

In 2009, from the perspective of hospital sponsors, government-run hospitals were in the dominant position, accounting for 47.6% of the total number of hospitals. From the perspective of building health resources, since the founding of the People's Republic of China, health resources have increased significantly, both institutionally and from the number of beds, and the service capacity of institutions has increased. The number of health personnel per 1,000 people, the number of licensed physicians, and every thousand people The number of beds in health institutions has shown a clear upward trend. However, compared with other developed countries such as Britain, France, Germany and Japan, China's health personnel are relatively inadequate, hospital beds are not enough, and health resources are still at a relatively low level.

In China, there are 14 physicians per 10,000 population, which is significantly lower than that of developed countries. The number of hospital beds per 10,000 population is 33, which is generally lower than that of developed countries. Therefore, the task of building health resources in China is still arduous.

An increase of 7 million people with chronic diseases is an increasing threat of chronic diseases

In the past 60 years, although our country’s health undertakings have made significant achievements, we must clearly understand the situation and remain sober-minded. In the face of new situations and new issues, China’s health reform and development are still facing severe challenges. Of course, it also faces tremendous opportunities for development.

In summary, the external challenges include the economic and social development has put forward higher requirements for the health industry, the people's expectations have been continuously improved, the society has undergone rapid transformation, has brought about multiple health challenges, changes in disease patterns and healthy transitions, and dual disease burdens. Heavy, chronic diseases are becoming more and more serious, and controllable risk factors have not yet been effectively controlled. Internal challenges include macroscopic institutional barriers, and the impact on the development of health services has become even more apparent. Institutional problems, such as drug use and project-based payment, have caused many problems, and structural problems have been further highlighted, with significant differences in health among major regions, between urban and rural areas, and among populations.

The double burden of disease in China is serious. Chronic diseases have increasingly become a major factor that affects the health of the people. The risk factors have continued to grow. The threats of chronic diseases such as malignant tumors, cardiovascular and cerebrovascular diseases, and diabetes have become increasingly prominent, accounting for more than 80% of death and disease burden.

What is worrying are the risk factors that cause chronic diseases, including smoking, high blood pressure, obesity, lack of exercise, and alcoholism. Although most of them are controllable, these risk factors have not yet been effectively controlled in China.

Taking hypertension as an example, patients increase at a rate of 7 million a year, and the total number is close to 200 million, but the awareness rate of hypertension is only 30%, and the effective control rate is only 8%. Hypertension-related stroke is the national population. The second cause of death, the first cause of death was cancer.

The average life expectancy in the eastern provinces is 80 years old and only 65 years old in the west

In China, there is an imbalance in health development. Regional differences in the allocation of medical and health resources are still very obvious. The differences in resource allocation directly affect the degree of utilization of medical and health services by residents, that is, the issues of fairness and science and technology. This has led to differences in regional health and resource allocation and development. As China's per capita life expectancy has increased from the previous 35 years to 73 years in 2005, the population health differences in different regions have become more significant, such as life expectancy, infant mortality, maternal mortality, etc. Regional and population differences have narrowed, but differences still exist. Health inequalities are a concentrated manifestation of unbalanced health development in China.

Whether in urban or rural areas, China’s health resources have increased. However, the uneven distribution of health resources in urban and rural areas remains a major issue. From the historical figures, rural health resources are significantly lower than those in cities. Therefore, strengthening the equalization of urban and rural health services and promoting the improvement of urban and rural health fairness are the major issues that need to be resolved.

If we look at the relationship between the average life expectancy and the level of economic development in the province as a unit, we can see that life expectancy is the abscissa, and there is a clear positive correlation with the ordinate of per capita GDP. In cities with eastern cities and cities with rapid economic and social development, the average life expectancy exceeds At the age of 76, some cities were close to or more than 80 years old and reached the level of the developed countries in the world. In some western provinces where the economy is relatively backward, the residents’ life expectancy is still about 65 years old, which shows that there are significant differences between the urban and rural social and economic development and the quality of life of residents in China.

National 214 public hospitals have been selected for pilot reform

The following is a brief introduction to the progress of the five key areas of medical reform. The first is the establishment of a basic medical security system. By the end of last year, the coverage of basic medical security exceeded 90% of the population. Among them, NRCMS covered 832 million people, and urban medical insurance was 390 million. It can be said that this is the largest medical insurance enterprise in the world. In 40.4% of the regions, the ratio of reimbursement of new rural cooperative medical hospitalization expenses reached 60%, outpatient and unified counties reached 66%, and in 76% of regions, the maximum payment amount of new rural cooperative medical cooperatives reached 6 times of the per capita net income of farmers. Management services The level has also improved.

Main issues and solutions: The issue of increased funding pressure for the New Rural Cooperative Fund and the risk of over-expenditure of the fund require the timely improvement of new rural cooperative medical subsidies and the individual's funding standards. In view of the weak supervision of the new rural cooperative fund, it is necessary to further strengthen the supervision of the fund and strengthen the verification, retaliation, and settlement work of the new rural cooperative fund by improving the system, establishing the mechanism, enriching the supervision power, and accelerating the information construction, so as to ensure the safety of the fund.

The establishment of a national essential medicine system is the second priority. At present, 31 provinces, autonomous regions, and municipalities have established provincial-level centralized bidding and procurement platforms, 38.4% of government-run community health organizations, and 30.4% of government-owned township hospitals have achieved a homogeneity. Rate sales. This year, the government has established a basic drug system for primary medical institutions to exceed 60%, and 82.9% of the county's essential drugs have been included in the scope of reimbursement for new rural cooperative medical insurance. In the implementation of this system, there has been a situation of “two drops and two rises”. The so-called “two drops” means that the outpatient expenses at the grassroots level and the hospitalization expenses for the second time have fallen, while the outpatient visits and hospitalizations at the grassroots level have increased, and the people have benefited.

The main problems and solutions: First of all, all localities reflect that the national basic drug list still cannot fully meet the needs of grass-roots drug use. Therefore, the solution is to appropriately expand the scope of drugs in the list of essential drugs, and pay close attention to the introduction of a more comprehensive list of national essential drugs.

The second question is that the implementation of compensation for the zero compensation of essential medicines by grass-roots medical and health institutions is not in place. The answer is to speed up the implementation of financial subsidies and promote the establishment of a multi-channel compensation mechanism for essential drugs. At the same time, the operating mechanism of the grassroots institutions must be transformed.

The third problem is that the bidding and procurement of basic medicines needs to be regulated, and the solution is to speed up the introduction of the national procurement criteria for basic drug bidding.

The fourth issue urgently requires the introduction of village health clinics and non-government grassroots medical institutions to implement zero-difference policies for essential medicines. In this regard, the solution is to encourage qualified places and integrate township health centers and village clinics. The management of village clinics is the integration of villages. The scope of implementation of the basic drug system was included. At the same time, multi-channel compensation was explored, and non-public grass-roots medical institutions were encouraged to incorporate services into the implementation of the basic drug system.

The key work in the third area, the primary health care service system construction, the main progress is the end of last year, 29.2% of government-run county hospitals, 42% of government-run township hospitals and 35% of village clinics, and 60% of community health services The center has reached the construction standard.

In the area of ​​human resources construction, more than 4,700 professional doctors were recruited for township health centers. This year, 5,000 free admissions have been initiated, 20% have been run by the government, and 21.7% by the government-run community health service center. Branch management. What is particularly encouraging is that 42.8% of the counties and cities have formulated and implemented community-first referral and two-way referral, and 23% of the government-run township health centers and 22% of community health service centers have implemented performance-based pay. There are currently major problems. Grassroots comprehensive supporting reforms are still lagging behind. Therefore, the solution is to actively promote the comprehensive reform of basic medical and health institutions, establish a personnel management system, personnel distribution system, comprehensive compensation and performance assessment system for multiple channels, and change the management system of primary health care institutions. And operating mechanism.

The fourth key work in the near-term, the equalization of basic public health services, has made progress. 32.8% of urban residents and 17% of rural residents have established health records to provide hepatitis B vaccine for people under the age of 15 to more than 21 million people. 77% of the expected mission. The national funding standard for public health services reached 17 yuan per capita, and public health agencies have been included in the budget allocation in 73% of counties and cities.

The main problems are: First, the progress of basic public health service projects is not balanced. After some rural areas are still relatively late, the division of labor and business guidance mechanism between the second different medical institutions have not yet formed. To address these two issues, we have put emphasis on public health services. The idea of ​​co-ordination and integration between projects and the establishment of an effective mechanism for the division of labor among different medical institutions.

The last pilot project of reform of public hospitals has identified pilot cities of 16 national cities and 30 provincial and municipal pilot cities, and a total of 214 public hospitals. A unified public hospital management agency was established in 72.9% of the counties, and a clinical pathway was piloted in 32.2% of the hospitals.

Separate the meaning of medicine is to cut off the interest chain of hospitals and drug sales

In the past two years or so, while major progress has been made in the development of health reform, some experts in the health sector are also helping government departments to conduct some strategic research on future development. I hereby mention in particular the vice chairman of the National People's Congress Han Qide, who has led nearly 100 academicians and experts have gone through more than two years of time to conduct a healthy China 2020 strategic study. I report on the main results of this strategic study:

With regard to several major thinkings on health reform and development, we must first deal with the four issues that we are talking about, that is, the relationship between the four major systems. First of all, it is necessary to scientifically co-ordinate public health services and medical services, and adhere to the correct direction of reform. Although the functional orientations of these two major systems are different, we must strengthen the integration of functions, support each other, and better implement the prevention and control tasks. The construction and development of the two major service systems must adhere to the guidance of public welfare. The link between these two systems is mainly in the urban and rural primary health care institutions, and the disposal of public health emergencies and personnel training.

It is necessary to correctly handle the relationship between the medical service system and the medical security system in an effort to achieve medical treatment for the disease. This involves the development and reform of the so-called supply and demand sides. The two complement each other and cannot be neglected, nor can they be partial to one side. In medical reforms, both the demand side and the supply side are adhered to, and a better balance between the interests and needs of the supply and demand sides is a major reform progress with Chinese characteristics. It is necessary to harmonize the development within the framework of the health system. The two systems must support each other and be formed together, and have an important foundation for the health system with Chinese characteristics. The relationship between medical care and medical insurance is generally one of the two medical practitioners. At the same time, the new type of rural cooperative medical care gives full play to the advantages of so-called one-handedness, that is, both the construction of medical service capabilities and the medical security system form a benign interaction with each other. Support, but also restrict each other.

It is necessary to accurately grasp the relationship between the medical service system and the drug supply guarantee system, and strive to promote the basic drug system. Drugs are an important tool and means of medical services, and also an important part of medical services, and improve the medical service system and drug supply guarantee system. The purpose and goal are the same. They are all aimed at conquering the disease and improving health. The substance and connotation of medicines we talk about separately means cutting off the economic interests between medical institutions and drug sales, gradually canceling the old mechanism of supplementing medicines with drugs, and establishing a sound new mechanism for the development of medical services. It is the responsibility of developing the health service to return to the government and whole society. The establishment of a basic medicine system must be understood not only from the perspective of reducing the burden on the people, but also from the perspective of preserving and promoting the quality of the Chinese nation, and resolutely curbing the abuse of drugs, especially antibiotics.

In the next step of reform, it is necessary to define a major issue that is fundamental and non-essential. The main responsibility of the government is to guarantee the establishment of a basic medical service system, rather than the basic requirement that diversified specialized medical and health services need to give full play to the strength of the society and the power of the market, but the government also has irresponsible responsibility in terms of supervision.

With regard to the reform of public hospitals, experts proposed that the need to focus on the nature of the different public hospitals, the types of services, and the functions of the services should be highlighted. The Health China 2020 Strategic Study proposes that these hospitals, such as county hospitals, be directly targeted to the people to provide basic medical services. As the focus of the current reform, development and construction of public hospitals, it is more realistic and needs to strengthen the construction of a group of regional medical centers and national medical centers that have the functions of medical treatment, teaching, and scientific research. Therefore, the concept of 54321 is proposed. The so-called 5 is 50,000 township hospitals and social health service centers. In fact, Comrade Li Keqiang’s recent important assertion, we feel very targeted that the township health centers and community health service centers are actually public hospitals run by the government at the grassroots level. Of course, this platform also has the responsibility for disease prevention and public health. Above this 5, there are 4,000 county-level district hospitals, especially rural county hospitals. Above this level, it is 362 cities in our country that need to establish a comprehensive tertiary hospital function to support county hospitals, which is probably 300 Many hospitals. The above structure should be about 200 comprehensive hospitals and specialist hospitals in 31 provinces, districts and cities. Finally, at its top level, we hope to establish nearly one hundred medical and educational medical centers that represent the highest level in the country. The number of public hospitals that need to be built in public hospitals is about 5,000. We believe that such a consideration is more practical, and the establishment of an entire hospital system must be linked to the strengthening of the capabilities of public health institutions.

At the same time, we must further emancipate our minds, introduce policies, create space and a favorable environment, and give green lights to social capital in the field of medical services.

At present, we are in the crucial period of formulating the "Twelfth Five-Year Plan". Some experts have already put forward some suggestions for government decision-making, including achieving a per capita life expectancy of 75 years, which means 2015. The expert's research believes that as long as we change from medical reform to motivation, strengthening the intervention and control of health-impacting factors should achieve this goal. At the same time, infant and maternal mortality rates need to be further reduced to make greater contributions to the realization of the UN Millennium Development Goals and to promote global work.