The construction of grassroots medical community is a supply side structural reform in the medical field, an important symbol of the new round of in-depth medical system reform, an effective way to solve the problem of uneven distribution and inadequate development of grassroots medical and health resources, and an important measure to effectively solve the problem of difficult and expensive medical care for rural residents. Liling Second Hospital is the pioneer and beneficiary of the construction of the medical community. It has formed a close medical community with Wangfang Health Center, Fuli Health Center, and Litian Town Health Center, and has walked out the road of characteristic development to achieve both economic and social benefits. In 2019, the hospital business hit a new record high of 100 million again, and KPI ranked second in township hospitals in the province. The Second Hospital of Liling City has accumulated experience in the construction of grass-roots medical community and achieved results, but still faces some problems that need to be improved.

1、 Experience and practice

（1） Party building leads, unified management, and deepens the foundation of Party building. Take strengthening Party building as the first responsibility. Adhere to the leadership of the Party committee, take the Party building in the four hospitals and districts as the greatest achievement, give full play to the leadership role of the Party organization in managing the overall situation, making decisions, promoting reform and ensuring implementation, promote business development through party building activities, strive to build the Party branches of each branch into a stronger and more powerful force, and train party members and cadres into a more promising role. Frequently go deep into each branch, master first-hand information, and strive to find a fit between "upper situation" and "lower situation" to solve the problem of coordinated development of health centers. The General Hospital dispatched outstanding party members and cadres to each branch hospital to help the branch hospital make continuous progress in party building, poverty alleviation and public health work, expand new businesses such as infertility and reproductive health center, hemodialysis, neonatology, diabetes specialty, holmium laser minimally invasive therapy, and translate the learning achievements into the actual results of the development of the hospital.

（2） Establish rules and regulations, standardize management, and establish a long-term mechanism. The first is to formulate the articles of association. Establish the hospital council, formulate the articles of association of the medical community, standardize and clarify the responsibilities, rights and obligations of the general hospital and branches. Establish and improve the internal management mechanism, standardize the power operation rules and internal governance, and effectively improve the operation efficiency of the hospital. Second, improve the mechanism. The president responsibility system under the leadership of the Party Committee is implemented, and the three branches are under the unified management, giving full play to personnel, distribution, operation and financial autonomy. The president's office meeting listens to the business reports of lower level hospitals twice a month in the middle and at the end of each month, and studies and proposes solutions to problems. The third is to use talents. With the support of the Health Bureau, the personnel establishment of lower level hospitals will be transferred to the general hospital for management. The clinical comprehensive departments of the three branches are entrusted by the counterpart internal medicine department of the General Hospital. On the basis of the personnel assigned by the General Hospital, all the personnel are sent to the General Hospital for further study in batches, and the full coverage of rotation training is achieved within one year. Fourth, smooth referral. Establish a two-way referral mechanism of the medical community, unblock the downward referral channel, and the general hospital will promptly refer patients in the recovery period after surgery, patients in the recovery period of acute disease, and patients in the stable period of critical illness to the branch hospital for treatment and rehabilitation, gradually realizing the service model of small diseases to the branch hospital for the first diagnosis, and difficult and miscellaneous diseases to the general hospital for further treatment.

（3） Strict standards, standardized assessment, improve work efficiency. First, unified business management. The General Hospital regularly organizes all medical staff to carry out unified learning, training and examination, and invites provincial experts to come to the hospital for diagnosis, surgery, ward round and teaching. The second is to unify financial management. The General Institute is directly in charge of the branch financial affairs, and the reimbursement staff of each branch report the operation of the branch at the end of each month, and the Financial Department of the General Institute will uniformly issue financial statements. Third, unified performance management. Formulate performance appraisal scheme, set medical quality, work efficiency and other appraisal indicators, conduct strict monthly assessment, and honor rewards and punishments. Fourth, unified management of medicine and equipment. Set up a leading group for equipment, material procurement and infrastructure engineering of the branch, which is composed of the president of the General Institute, the vice president in charge of materials, equipment and logistics, to uniformly approve the materials, equipment procurement and infrastructure engineering of the branch.

（4） Optimize the service, improve the level and ensure the satisfaction of the masses. First, strengthen the informatization construction. The information management system of Zoomlion Hospital was established, which effectively solved the problem of information sharing between the general hospital and the branch hospital. The inspection results of the general hospital and the branch hospital were mutually recognized, avoiding repeated inspections, saving inspection costs, and greatly facilitating people's medical treatment. Second, promote the development of traditional Chinese medicine. We won the support of the First Affiliated Hospital of Hunan Traditional Chinese Medicine, and successfully joined the "Hunan Traditional Chinese Medicine" medical alliance, Create Zhang Di The famous doctor studio has enabled people to truly enjoy the quality services of provincial hospitals at their doorstep, benefiting more than 5000 people. Wangfang Town Hospital accelerated the development of traditional Chinese medicine, and the revenue from traditional Chinese medicine services increased from 8.2% in 2016 to 43.2% in 2019.

2、 Achievements and problems

（1） Main achievements. The construction of the medical community of the second hospital in Liling City has created the Liling model of regional medical services, promoted KPI to enter the second place in the province, built the province's first township second-class comprehensive hospital, and won the honors of the national public satisfaction hospital, the national top 100 township hospitals, and so on. Specifically First, the common people get substantial benefits. In 2019, the internal referral rate of the medical community accounted for 35.7% of the city's total, and the local referral rate reached 95.1%. Without leaving the town, people could enjoy the quality services of secondary and tertiary hospitals, and the satisfaction rate of the masses increased to 98.5%. Second, doctors have passion. In 2019, the salaries of medical staff in the general hospital and branch hospitals will reach 96000 yuan and 81000 yuan respectively. The salary level of medical staff will increase year by year, and their enthusiasm for work will rise significantly. The third is more standardized management. The hospital sense, medical safety, quality, medical ethics and medical ethics in the medical community have been significantly improved by implementing homogeneous management. Unreasonable drug use and unreasonable inspection have been effectively controlled, and the proportion of drugs has dropped 10.3 percentage points year-on-year. Fourth, the hospital has developed. The capacity of the three hospitals has been significantly improved, greatly facilitating the masses to see doctors, and effectively reducing the burden of the masses in the jurisdiction. For example, after joining the close medical community, the total income of Fuli Health Center increased by 58.4% year on year in 2019, and the ranking of public health rose from the original 17th to the 7th.

（2） Prominent problems. There are still some problems that cannot be ignored, Specifically First, the integration of medical resources is not high. At present, the implementation of the policy of the medical community is mainly reflected in the level of business integration. Although a certain degree of synergy has been formed, there is still a lack of synergy in financial security, medical insurance policies, medical service prices and staffing, resulting in weak control over resource integration; Second, the linkage degree of benefit distribution is not high. In the construction of the medical consortium, the form is more important than the essence, and the quantity is more important than the quality. The awareness of "responsibility community" and "interest community" is not strong, and there is still "connection without connection", and there is inequality in the distribution of interests. The mechanism of overall optimization of performance appraisal, benefit distribution and fund allocation in the medical community needs further exploration and practice; Third, the carrying capacity of hierarchical diagnosis and treatment is not high. As the payment methods related to hierarchical diagnosis and treatment are not sound enough, the efforts to guide patients to transfer to grass-roots hospitals and seek medical advice in the county are weak. Under the control framework of total medical expenses, the relatively low budget of basic level medical insurance affects the motivation of basic level hospitals to increase patient diagnosis and treatment and the enthusiasm of leading hospital resources to the basic level; The medical insurance policy did not give the township hospitals a greater preference in terms of reimbursement ratio or expense settlement, which led to the objective existence of "reverse flow" of patients; Fourth, the sharing of information construction is not high. The informatization level between the hospitals led by the medical community and the constituent units is uneven, the construction specifications are inconsistent, and the internal data cannot be integrated. The internal information system system driven by the second line and each other, which focuses on the continuous diagnosis and treatment of patients, needs to be improved. At the same time, the external information systems of the Medical Community, health agencies, local government departments and other departments have not been interconnected, leading to the lack of strong internal information system platform support for long-term integrated and continuous diagnosis and treatment business.

3、 Countermeasures and suggestions

（1） Enhance the working force. The construction of the medical community involves multiple departments, so we must establish the awareness of a game of chess and not let a single unit fight alone. The medical security department should timely adjust and improve the medical service price to truly reflect the labor value of medical personnel; It is suggested that the establishment department of government institutions should check and approve the establishment of the medical community according to the two types of undertakings, namely, county hospitals and township hospitals, and appropriately increase the total establishment according to the carrying capacity; The financial department will further strengthen the financial support for the construction of the medical community; The human resources and social security departments have continuously deepened the reform of the personnel compensation system, preferentially inclined to the grass-roots level in terms of salary, professional title evaluation and employment and career development, and implemented the autonomy of personnel distribution within the medical community; The health department compacted the responsibilities of the member units of the medical community, gave full play to the advantages of the independent operation of the medical community, established and improved the performance evaluation system for the construction of the medical community, and linked the evaluation results with the payment of medical insurance, financial input, and the remuneration, appointment and removal, rewards and punishments of hospital leaders.

（2） Strengthen internal collaboration. We should focus on building the medical community into a community of services, responsibilities, interests, management and development, study and establish an effective mechanism to promote closer medical cooperation within the medical community, explore the transformation from blood transfusion type union to hematopoietic type union, and let the leading hospital change from "let me do" to "I want to do". We will unblock the medical communication channels of the medical community, expand the list of drugs used at the grass-roots level, add more drugs, and strive to open up the channels that restrict the development of the medical community. Give full play to the interest adjustment role of the medical insurance fund, further improve the lump sum payment method of medical insurance expenses of the medical community, and play the role of the medical insurance fund in guiding the supply and demand of medical services and restricting medical expenses. Fourth, we should strengthen coordination between the superior and the internal and external, and adjust the differential medical insurance compensation ratio of hospitals at the city, district and other places according to relevant policies. Optimize the allocation of large-scale medical equipment in the Medical Federation, make overall use of limited medical resources, encourage grassroots medical institutions to introduce third-party institutions to provide facilities and equipment use or related diagnosis and treatment services, and effectively improve the service capacity of grassroots medical institutions.

（3） Develop smart medicine. Comply with the development trend of informatization, further improve smart medicine, and promote the development of grassroots digital medicine. Informatization construction is a systematic project, which involves major changes in modern management modes, methods and concepts, and can only be effectively implemented if leaders pay attention to it. Liling Municipal Party Committee, Municipal Government and Health Bureau attach great importance to the construction of smart medical cloud platform with a total investment of 10 million yuan. We should improve the construction of health information sub platform as soon as possible, realize the sharing of information resources, open the bridge between hospitals and basic public health information systems, and truly realize the real-time sharing of information throughout the region.

（4） Increase publicity. Widely publicize the advantages of the medical community, as well as the service ability and level, so that the public can fully understand the specialty characteristics, medical ability and service level of hospitals in the medical community. Strengthen the publicity of relevant national and local medical policies and hospital systems, especially the reimbursement policy of medical insurance funds and the hierarchical diagnosis and treatment system, so that people can get medical treatment in an orderly manner, enjoy the "nanny style" services provided by the member units of the medical community, and get the best medical services without leaving the city. Transform the functions of village clinics from "seeing minor diseases" to "preventing diseases", give full play to the role of village doctors in publicizing health knowledge and guiding the masses to seek medical treatment in a correct and orderly manner, and strive for the referral rate and medical treatment rate in the field.

(The author is Wu Feihong, Deputy Secretary of the Party Committee and Deputy Director of Liling Maternal and Child Health and Family Planning Service Center)