Policy Support For The Construction Of Medical Alliance To Speed Up Again And Break Through The Barriers Of Interests Of Participants

The construction of medical alliance, which allows high-quality medical resources to sink and regional resources to be shared, meets the support of the policy and accelerates the landing speed.

The state health administration of the people's Republic of China (hereinafter referred to as the "joint measures for the administration of health and physical education" of the people's Republic of China (hereinafter referred to as the "joint measures for the administration of traditional Chinese medicine (hereinafter referred to as the" joint measures ") issued by the state health administration of the people's Republic of China (hereinafter referred to as" the joint measures for. According to the measures, the administrative departments of health and health at the prefectural, municipal and county levels shall formulate the construction plan of the regional medical consortium, divide the service areas into several grids according to the geographical relationship, population distribution, medical demand of the masses, distribution of medical and health resources, and integrate the medical and health resources within the grid, and establish a tertiary public hospital or a hospital representing the medical level of the jurisdiction First, a number of other hospitals, grass-roots medical and health institutions, public health institutions and other members of the medical consortium.

Sun Hongtao, chief physician of cardiovascular surgery of Fuwai Hospital of China Medical Hospital and founder of doctor group of great medical association, said in an interview with 21st century economic reporter: "it is a good original intention that the construction of Medical Association can improve the level of diagnosis and treatment at the grassroots level and serve more grassroots people."

At present, all three-level public hospitals in China have participated in the construction of medical alliance, which has become a scale. According to the National Health Commission, by the end of 2019, 1408 urban medical groups, 3346 County medical communities, 3924 cross regional specialist alliances, 3542 telemedicine collaboration networks for remote and poverty-stricken areas, and 7840 social medical institutions have joined the medical consortium. In addition, according to the data of the sixth health service survey, 46.9% of the two-way referral patients were referred by the Medical Union, which was higher than other referral methods.

Although the construction of Medical Association has achieved success, there are still many problems in the realization of core objectives. In the aspect of overall quality management, the founder of Lianchen Company Limited told Beijing that "the overall quality of medical treatment has not been improved completely by the founder of Lianchen company in the 21st century."

Active exploration

The promulgation of the "measures" is also the National Health Commission to sort out the pilot work of medical consortium construction, summarize and refine the typical experience of various regions, and form a standardized document for the management of medical alliance, which is of great significance to promote the sustainable and standardized development of medical consortium and to build a hierarchical diagnosis and treatment system.

This year is a crucial year to deepen the medical reform. As an important carrier of the construction of hierarchical diagnosis and treatment system with Chinese characteristics, the medical alliance can promote the connection of high-quality medical resources, gradually break down barriers and obstacles in administrative division, financial investment, medical insurance payment, personnel management, etc., promote the improvement of grassroots service ability, promote the implementation of family doctor contract service, and finally focus on the structure The establishment of hierarchical diagnosis and treatment system has achieved remarkable results in solving the problem of people's medical treatment and enhancing the people's sense of gain.

As a matter of fact, the medical association is a new thing brought about by the reform. Its business is to improve the construction of urban and rural medical service system and improve the medical safety and medical effect of the majority of patients. In recent years, Medical Association has been listed as the key measures of the new medical reform, and medical institutions at all levels all over the country have responded.

Since then, the construction of the joint medical system in China has been promoted in the spring of 2018, and the construction of the joint medical system has been accelerated in China. Shi lichen pointed out that "at present, there are four operation modes of medical alliance, namely, urban medical group, county medical community, cross regional specialty alliance and telemedicine collaboration network."

In the process of the construction of Medical Association, various regions actively explore and emerge a number of typical experience. Huzhou of Zhejiang Province, Rizhao of Shandong Province, Huadu City of Guangzhou City and Dalian city of Liaoning Province have promoted the grid layout management of Urban Medical Union to realize the sinking of high-quality medical resources and the sharing of regional resources. Deqing of Zhejiang Province and Youxi of Fujian Province promoted the construction of close county medical community and effectively improved the county medical service capacity.

The role of Medical Alliance in the rational allocation of regional medical resources has been well documented. Foreign countries have been trying medical cooperation system for a long time. Taking Britain as an example, according to the classification of regional medical demand, a three-level medical network of "community medical service regional hospital teaching hospital" has been established. Community hospitals provide daily medical care and outpatient services, secondary hospitals are responsible for the treatment of emergency and major accidents, and tertiary hospitals are responsible for the treatment of difficult and miscellaneous diseases and emergencies.

Strict hierarchical diagnosis and treatment and referral system is the core of foreign joint medical system, and also the main goal of China's medical consortium construction. Foreign perfect and mature hierarchical diagnosis and treatment system, based on excellent grass-roots health human resources, clear functional positioning of medical institutions, medical service network system of mutual recognition of information, borrowing force of Regional Medical Association Construction and financial and material resources investment of government, also provide a lot of reference experience for the construction of Medical Alliance in China.

Post epidemic acceleration

This year is a key node in the construction of Medical Association.

In May 2019, the state issued the notice on carrying out the pilot work of urban medical consortium construction and the notice on promoting the construction of close county medical and health community, which made it clear that by the end of 2020, 100 pilot cities would form a grid layout of medical consortia and achieve obvious results, and a new County medical and health service system would be initially built in 500 counties (including county-level cities and municipal districts) Department.

The new pneumonia epidemic is an effective assessment of the construction of major medical consortia across the country. Whether it is the supply and reserve of medical supplies or the burden of patients in emergency medical treatment, the advantages of the medical alliance need to be brought into full play.

"This epidemic not only shows us the areas that need to be improved in the loose type medical Union, but also the system advantages of the close type medical Union." Gu Jin, deputy to the National People's Congress and President of Shougang Hospital of Peking University, said in a recent public speech.

As for the role played by the medical alliance during the epidemic, Shi lichen said that the synergy of the medical alliance was mainly reflected in the screening and referral. For example, Dalian Medical Union conducted referral and centralized treatment for patients with nucleic acid detection problems in the epidemic situation. In the future, the role of the medical Alliance in public health events was mainly reflected in the linkage and coordination between the upper and lower levels.

Li Zhiqiang, vice president of Wuhan Central South Hospital, said at the online seminar on "thinking and change of Medical Union Construction in post epidemic era" held in May, the impact of the development and change of epidemic situation on the medical industry needs mutual help and mutual assistance between medical federations and overcome difficulties. It is necessary to take advantage of the advantages of provincial and ministerial teaching hospitals, rely on medical consortia and county medical communities, promote the implementation of hierarchical diagnosis and treatment, and coordinate the planning and construction of medical alliance , optimize the remote collaboration platform.

On July 20, the construction of the National Medical Center for major public health events started in Guanggu, Wuhan. It is the first national medical center set up outside Beijing and Shanghai, and the Sixth National Medical Center in China. The center will focus on infectious diseases, natural disasters, nuclear radiation, toxic diseases, unexplained diseases and other major public health emergencies. Based on the concept of integration of medical education and research and the integration of production, teaching and research, and in accordance with the management mode of "peacetime and wartime integration", the center will build itself into a leading domestic and international first-class country integrating prevention, early warning, treatment, management, training and research and development A medical center.

In this regard, Shi lichen analyzed that the construction of the center is a pilot project, which aims to integrate various local medical resources through the layout of medical centers.

It is urgent to break the situation

It is undeniable that the medical alliance played an important role in the outbreak of new crown pneumonia. However, this kind of Medical Association is a response mechanism under the "wartime state", which can not objectively reflect the degree of perfection of the construction of domestic medical association. At present, the construction of Medical Association in China is still in its infancy.

Sun Hongtao said that at present, there are still many problems in the construction of Medical Alliance: first, the system is loose and inefficient, and the theoretically designed hierarchical diagnosis and treatment and referral between the superior and the subordinate are not smooth, because each unit pursues its own economic benefits, resulting in the cooperation can not be long-term; secondly, the large-scale public hospitals siphon the high-quality patients and medical staff of primary hospitals for the sake of interests, This is contrary to the government's expectation that the Medical Association will sink the high-quality resources of high-grade medical institutions to the grass-roots level.

Shi lichen also holds the same view on this. He believes that "the current four modes of Medical Association in China are independent accounting, and they are mainly concentrated in the upstream procurement level, which is very loose, and it is difficult to form a community of interests."

Some scholars believe that the current difficulty in achieving hierarchical diagnosis and treatment is the inevitable result of the government's administrative allocation of resources, the management of medicine and the management of medical services. Governments at all levels continue to adopt various policies to strengthen the advantages of public medical institutions, especially high-level public medical institutions.

In sun Hongtao's opinion, blind expansion of large hospitals is not appropriate, because the common expectation of the society is that all hospitals should be balanced. The unlimited expansion of large hospitals will completely cover the non brand hospitals or private medical institutions, resulting in the situation that the strong are always strong.

At present, there are still some problems in private institutions' participation in the construction of medical consortia. Firstly, the medical consortia and doctors in some areas are limited within the public hospital system. Secondly, public medical institutions enjoy preferential policies in terms of tax and business housing, while private hospitals mostly need to bear their own responsibilities, and both are in unfair competition.

Shi lichen also pointed out that compared with public medical institutions, private institutions are more independent and pay more attention to interests, and management is more difficult than public institutions.

The construction of Medical Association involves multiple participants, which requires the government to promote the organization and coordination of departments, innovate the benefit distribution mechanism, form the interest community of relevant parties, encourage and guide hospitals, grass-roots medical and health institutions, medical personnel and even residents to voluntarily participate in the construction of Medical Association, so as to prevent the occurrence of "pushing but not connecting, connecting but not moving, moving and powerless" ”The situation.

According to Shi lichen, the key to solve the development problems of the medical association is to solve the problem of interest distribution. "As a Medical Association, it must be a community of interests first. Only by ensuring the unified allocation of medical resources can we solve the problems in the construction of the Medical Union, and then the problems of interest distribution, division of work and management coordination can be solved simultaneously."