Xu Yucai

(Keynote speech at the 3rd China County Health Development Forum in Beijing on April 23, 2016)

one 、 Grading diagnosis and treatment is imperative

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two thousand and sixteen year nine Month   The General Office of the State Council issued the Guiding Opinions on Promoting the Construction of Hierarchical Diagnosis and Treatment System

The government work report of the fourth session of the 12th National People's Congress proposed that this year 70% Around prefectures and cities to carry out pilot level diagnosis and treatment

two 、 Five misunderstandings should be avoided in promoting grading diagnosis and treatment

one 、   Enforce "grading" and "diagnosis and treatment". Hierarchical diagnosis and treatment are not artificially "divided", but are "strong" at the grassroots level. Therefore, it is not appropriate to formulate a hierarchical diagnosis and treatment disease category directory and stipulate the level by level referral.

two 、 There is no difference between big and small diseases, so it is incorrect to often say that "serious diseases do not leave the county and minor diseases are at the grass-roots level". I'm afraid no one can tell whether diabetes and hypertension are serious or minor diseases, and colds can kill people.

three 、 It is also incorrect to open the proportion of medical insurance reimbursement to attract patients to stay at the grass-roots level, or even stipulate that hospitalization in large hospitals without referral will not be reimbursed. Everyone knows that "life is more important than money". If the economy permits, people will first choose hospitals and doctors who feel secure. The first requirement of medical services is "safety". No one is willing to give their lives and health to hospitals and doctors who feel insecure. In fact, excessively lowering the reimbursement rate of large hospitals deprives the poor of their right to medical treatment. Practice has proved that this method works, but its effect is limited.

four 、 One of the difficulties of graded diagnosis and treatment is that "the traditional concept of medical treatment needs to be changed", which means that the current medical security system does not have effective constraints on medical treatment, and patients have formed the habit of looking for "big doctors" and "famous doctors" in "big hospitals", affecting the implementation of graded diagnosis and treatment system. There is some truth in this, but not all of it is right. It is the wish of all patients to find a doctor who can rest assured.

five 、 The medical union, urban-rural integration and various counterpart support are difficult to play a fundamental role. The reason is that the grass-roots level lacks power and ability. The strict hierarchy of medical institutions and the wrong basic drug system have accelerated the rise of grassroots talents. It is unlikely that high-quality resources will sink through the medical union and other methods

three 、 Hierarchical diagnosis and treatment should adhere to the principle of "government guided market driven"

Guidance: Graded diagnosis and treatment should be based on the reality of China's economic, social and medical and health development, follow the laws of medical science, follow the principles of people-oriented, voluntary, urban and rural planning, and innovative mechanisms, focus on improving the ability of basic medical services, and take the graded diagnosis and treatment of common, frequently occurring, and chronic diseases as a breakthrough to improve the service network The operation mechanism and incentive mechanism should guide the sinking of high-quality medical resources, form a scientific and reasonable medical order, gradually establish a hierarchical diagnosis and treatment system in line with the national conditions, and effectively promote the fairness and accessibility of basic medical and health services.

First, make a scientific and reasonable layout of county medical institutions, promote the functional homing of medical institutions at all levels, and strengthen county health.

At present, the most fundamental "strengthening the grass-roots level" is to strengthen the leading role. General hospitals develop their strengths and complement their weaknesses, strengthen the construction of specialties for the most common diseases in the county. Traditional Chinese medicine hospitals highlight the characteristics of traditional Chinese medicine, private hospitals complement their weaknesses, and march into the "blue ocean". Be the backbone to solve the problems of common diseases and frequently occurring diseases. Firm the network bottom to prevent the village level network bottom from cracking.

The first is to scientifically design the layout of medical and health institutions at the county level, especially the regional medical and health service centers at the township level.

The second is to accelerate the establishment of the general practitioner system. First of all, we should speed up the pace of training. It is suggested that ① provincial and municipal medical colleges should set up general medicine majors, ② improve and improve the quality of "10000 doctors' job transfer training", and focus on the standardized diagnosis and treatment of chronic diseases.

Secondly, we need to revise the law. It is suggested that general medicine, clinical medicine, traditional Chinese medicine, preventive medicine and stomatology should be listed as the fifth largest category of licensed physicians when the Law on Licensed Doctors is revised.

Third, establish a general practitioner allowance and remuneration system for general practitioners, so that general practitioners have dignity and status and are no longer low-end products.

Third, accelerate the establishment of market-oriented human resources system. include:

one . Establish an attractive "grassroots subsidy" system.

two . Establish a strict system of service years for professional title promotion at the grass-roots level.

three . Consolidate the system of "deputy high school at the grass-roots level", and cancel it naturally when leaving the grass-roots level.

four . Thoroughly break the "hidden rules" in personnel adjustment, realize the reasonable and transparent flow of personnel in the county, and promote the optimization of grassroots talents.

In short, in personnel management, "coercion" is always difficult to endure, and a market-oriented human resources system must be established.

Fourth, innovate the new talent management model.

At present, in order to solve the problem of shortage of people at the grass-roots level, we have mainly adopted the revitalization plan, the grant plan, the recruitment of public institutions, the recruitment of licensed doctors, the training of free targeted medical students, and the open recruitment of college students. In order to retain, we have also set the necessary service life, but it is still difficult to solve the fundamental problem.

It is suggested that we should boldly break the boundaries of identity, introduce a policy to recruit qualified grassroots talents (including assistants) from rural doctors who have been trained by general practitioners, and realize the "excellent transfer" of rural doctors, which can not only solve problems but also activate the enthusiasm of rural doctors for learning and progress.

Fifth, take effective measures to optimize the medical practice environment.

There is also a very important reason why grass roots cannot keep good doctors is that the medical practice environment is poor.

It is suggested to improve as soon as possible through comprehensive measures such as improving laws.

The sixth is to improve hospital management and promote the functional "homing" of medical institutions at all levels by improving the selection and appointment of presidents and promoting the de administration of hospitals. Only when the function returns to its original position, that is, to strengthen the basic level and take their own responsibilities, can we take drastic measures. Not only can we stop the boiling water, but the "wartime state" of large hospitals can be alleviated, and hierarchical diagnosis and treatment can be carried out naturally according to "level" without "point".