Recently, the State Health Planning Commission, the State Administration of Traditional Chinese Medicine jointly issued the "Notice on promoting the pilot work of grading diagnosis and treatment" (Guowei Medical  No. 45). The document identifies 266 municipalities, including Beijing, as well as 266 prefecture-level cities such as Shijiazhuang City in Hebei Province as pilot hospitals for grading clinics and major pilot projects in 2016.
The document identifies 266 municipalities, including Beijing, as well as 266 prefecture-level cities such as Shijiazhuang City in Hebei Province as pilot hospitals for grading clinics and major pilot projects in 2016.
Shanghai, Xiamen, Jiangsu and Hangzhou are all specially named as advanced examples where other places can fully draw on mature experience.
The document also requires that the pilot health and family planning administrative departments in all pilot cities issue a pilot work plan and start the pilot work before September 15, 2016.
At present, there are more than 330 prefecture-level cities in China, and more than 80% of them will be included in the grading diagnosis and treatment pilot project. The nationwide grading clinic is on its way!
Cyberspace devices that, with the grading treatment system greatly advance the pattern of medical institutions will be changed, the pattern of medical device consumer market will be at least the following changes:
1, primary medical institutions to become the most important medical device market development.
According to the paper, the major hospitals will "reduce their burden" and focus their efforts on critically ill and complicated diseases. The primary medical institutions will receive a large number of common and frequently-occurring patients and patients with chronic diseases.
The number of patients will increase, but at present, the medical equipment configuration of medical institutions at county and township level in our country is generally low, and the equipment is in short supply or is relatively old-aged. With the progress of pilot grading clinics, county and township medical institutions, especially county hospitals and urban community health service centers, will become the top priority in the development of China's medical device market. In addition, medical devices in the western region will also enter the upgrading period.
2, procurement of medical supplies with the volume, the second bargain has become the trend.
The paper proposed that all pilot cities should explore ways to set up medical joint bodies, share internal responsibilities and benefit sharing, and encourage cities to establish integrated asset-based medical associations. However, they proposed to encourage nearby cities and establish voluntarily and avoid the formation of inter-provincial forms.
This means that on the one hand, Medical Association is no longer a loose organization, but tends to operate collectivized, unified management of domestic medical consumables, foreign, some joint implementation of the joint medical belt procurement, or jointly Consumption of secondary bargaining model, may become the mainstream.
On the other hand, the collection of supplies should also stay at the provincial level, inter-provincial and even the national collection of supplies long way to go.
However, with the amount of procurement, the second bargain also means that supplies cut prices, squeeze water potential will continue to spread. Expensive, imported, alternative high-value supplies shrinking market, cheap domestic high-quality supplies marketing world. Enterprises that survive the price change will also seek greater development.
3, six types of medical devices usher in a big market opportunity.
The paper proposed that we should sum up the promotion of family doctor service contracts in Shanghai and other places, improve the ability of Chinese medicine clinics, do a good job in the continuity of medical services for patients in rehabilitation, and speed up the promotion of Internet health services. This means that domestic medical devices such as blood glucose meters, sphygmomanometers and oxygen inhalers, as well as TCM medical devices, rehabilitation medical devices, wearable devices, etc., will be welcome.
In addition, the paper proposed that exploring and setting up independent medical institutions such as medical imaging diagnostic centers and medical testing laboratories in pilot areas to realize regional resource sharing means that the market opportunities for medical imaging equipment and testing instruments are also coming to an end .
Annex I: List of 270 pilot cities for grading clinics
Attachment 2: Notice on Pilot Project of Promoting Hierarchical Clinic (Guo Wei Yi Fa  No. 45)
Health and Family Planning Commission of all provinces, autonomous regions and municipalities directly under the Central Government, Chinese Medicine Administration, Xinjiang Production and Construction Corps Health Bureau:
In order to implement the "Guiding Opinions on Promoting the Construction of a Hierarchical Medical Treatment System" (Guo Ban Fa  No. 70, hereinafter referred to as the "Opinions"), the "Notice of the General Office of the State Council on Issuing 2016 Key Tasks for Deepening the Medical and Health System Reform" (Guo Ban Fa  No. 26) and the "2016 Government Work Report" on the basis of the relevant work requirements. On the basis of declarations made by all localities, the National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine have determined the four municipalities including Beijing Municipality and Hebei Province Shijiazhuang City and other 266 prefecture-level cities as pilot cities to carry out pilot work grading diagnosis and treatment (see Annex). Now on the promotion of grading diagnosis and treatment of the work put forward the following requirements:
First, raise awareness and strengthen leadership
The provincial and pilot health and family planning administrative departments (including the administrative departments of traditional Chinese medicine, the same below) should fully recognize the importance, arduousness and complexity of the classification and treatment work, give play to the role of pilot city in pioneering military work, and enhance their sense of responsibility and mission Sense, in accordance with the "Opinions" related to the work requirements, the classification system will be included in the construction of medical reform to deepen the overall arrangements for medical work, and conscientiously strengthen organizational leadership. On the basis of full investigation and demonstration, combined with the local medical practice, a clear and feasible pilot work plan with clear objectives and targets was formulated. The target, tasks and schedule of work were clearly defined. The management system was perfected and strictly implemented.
Second, the pilot first, focus
In accordance with the relevant work requirements of "Opinions", the pilot health and family planning administrative departments in all pilot cities should work out and implement all the supporting policies and measures of the pilot projects around the pilot work program, and start the pilot work as soon as possible. On the basis of full implementation of the "Opinions", 2016 will focus on the following tasks:
(A) to further enhance grass-roots service capabilities. We will continue to strengthen the capacity building of grass-roots health care institutions and county-level hospitals, strengthen the promotion of appropriate technologies around the outbreak of diseases with a high transfer rate from outside the county, and upgrade the ability of diagnosis and treatment of diseases at county-level hospitals. By setting up medical associations, supporting counterparts and multidisciplinary practices by doctors, urban doctors above Grade 2 and above are encouraged to practice more in primary health care institutions or visits and visits on a regular basis to promote the flow of medical resources to the grassroots and rural areas and to improve grassroots services ability. Enhance the ability of Chinese medicine service and medical rehabilitation services in primary health care institutions, strengthen the construction of TCM special treatment area, promote the integrated service mode of traditional Chinese medicine and give full play to the role of traditional Chinese medicine in the prevention and treatment of common diseases, frequently-occurring diseases and chronic diseases.
(B) to promote family doctor signing service. Implementation of the "guidance on the promotion of family doctor service contract" (State Medical Reform Office  No. 1) related to job requirements, summed up the promotion of local doctors to promote the service experience of family doctors to develop on signing services and improve the management of policy documents, Establish and improve general practitioner system. Define the connotation and standard of contract service, standardize contract service charges and improve the mechanism of contract service incentive and restraint. The cost of contracting services is shared by the Medicare Fund, basic public health service funds and contracted residents.
(C) to explore the formation of medical associations. The provincial and pilot cities and township health planning and administrative departments should make overall plans and gradually establish a regional coordination service model of responsibilities, rights and benefits through the formation of medical joint bodies and use of information technology such as telemedicine to promote regional medical resources sharing and vertical Mobile, improve the classification of medical service system. On the basis of the original work, encourage the region according to the principle of proximity, the voluntary principle to set up medical joint body, to avoid the formation of inter-provincial formation of the medical joint body to establish responsibility sharing and benefit sharing mechanism to fully mobilize the enthusiasm of member units. In urban areas, it is also encouraged to establish asset-integrated medical association based on ownership in areas where conditions permit, and medical joint bodies focusing on resource sharing and technical cooperation may also be established. In the county area, we will focus on advancing the medical consortium that integrates county-level management with county-level hospitals.
(Four) the rapid implementation of scientific division.
Medical joint body as the carrier, day surgery as a breakthrough, according to the Medical Association of medical institutions and their functional positioning of the medical service capabilities, a clear body of the medical division of emergency service process.
1. To implement the functional orientation of medical institutions. Grade III hospitals mainly provide diagnosis and treatment services for acute and critical illnesses and complex diseases; urban secondary hospitals mainly receive acute referral patients, postoperative recovery patients and critically ill stable patients who are referred to tertiary hospitals; third grade Chinese medicine hospitals Mainly make full use of traditional Chinese medicine technology and modern science and technology to provide emergency treatment of critically ill and complex diseases of traditional Chinese medicine diagnosis and treatment services and traditional Chinese medicine treatment of outpatient services; two TCM hospitals mainly make full use of traditional Chinese medicine technology and modern Science and technology, to provide common disease in the region, frequently-occurring disease, chronic disease diagnosis and treatment of traditional Chinese medicine, emergency treatment of critically ill patients, difficult complex disease up referral service; chronic disease medical institutions for the diagnosis of clear, stable patients with chronic diseases, convalescent patients, Patients, advanced cancer patients provide treatment, rehabilitation, nursing services.
2. The establishment of medical institutions within the medical division of labor collaboration mechanism. Patients who exceeded the capacity of medical institutions to go to the higher level medical institutions nearby hospital; patients with chronic diseases diagnosed with stable disease, convalescent patients go to lower level medical institutions to provide continuity of treatment services for patients. Conditional areas, the establishment of patient referral center in the body, is responsible for coordinating the two-way referral service. In areas where grassroots Chinese medicine service system is not perfect and in which weaker capacity, we should treat TCM hospitals differently, and include TCM clinic outpatient services in the first consultation area, give full play to the service capabilities of TCM hospitals and meet the needs of the masses to look for Chinese medicine at the first visit .
3. Gradually advance day surgery. Take medical association as the starting point, and gradually push forward the day-to-day operation mode of division of labor and cooperation among the tertiary hospitals and their secondary hospitals and primary health care institutions. The tertiary hospitals gradually implemented day surgery to optimize the flow of medical services and improve the efficiency of medical services. To provide efficient daytime surgery services to patients under the premise of ensuring medical quality and safety, tertiary stable hospitals were transferred to secondary hospitals And grass-roots medical and health institutions, the establishment of postoperative patient follow-up system to guide the lower-level medical institutions do patients with postoperative rehabilitation, and open day-to-day surgical green channel for the primary health care institutions.
(E) to speed up the construction of medical and health information, and promote regional medical resources sharing. Accelerate the construction of regional medical and health information platform, and gradually realize the continuous recording of electronic health records and electronic medical records as well as information sharing among different levels and different types of medical institutions. The use of telemedicine and other means of information to promote the vertical flow of medical resources to improve access to quality medical resources and the overall efficiency of medical services. The development of Internet-based health services, give full play to the Internet, big data and other information technology in the grading diagnosis and treatment. Explore the establishment of medical imaging diagnostic centers, medical laboratories and other independent medical institutions, to achieve regional resource sharing.
(Vi) strengthen departmental coordination, improve supporting policies. The provincial and pilot health and family planning administrative departments should strengthen communication and collaboration with relevant departments such as reform (price), finance and human resources and social security, innovate institutional mechanisms, improve supporting policies, make overall plans for coordination and promotion, and promote classified treatment System construction to create conditions. Further improve the medical price policy and implement the pricing measures at different levels. We will improve the medical insurance payment policy, promote the reform of the medical insurance payment method, and improve the performance pay distribution mechanism. Implement the financial subsidy policy. Through the grading diagnosis and treatment pilot, the formation of more can be copied, can promote the useful experience.
Third, to strengthen assessment, timely summary
The provincial and pilot health and family planning administrative departments should set up a pilot effectiveness evaluation mechanism and a performance evaluation method, earnestly implement the responsibility system and accountability system. Establish follow-up and supervision systems for key tasks, set annual quantitative targets for pilot tasks, strengthen policy guidance, and conduct regular supervision and inspection on the pilot work carried out within the jurisdiction. Seriously organize the baseline survey to provide baseline data for pilot evaluation in the future. Establishing a system of periodic reporting of work data of graded medical clinics, strengthening the monitoring of the pilot projects, collecting relevant data and using data technology to carry out data analysis. Timely grasp the progress of the pilot work, summed up the promotion of useful experience.
We should step up exchanges and study, draw lessons from the mature experience of other pilot areas, innovate our thinking and keep pushing forward. The pilot cities and counties health planning and administrative departments to develop the pilot program of work, you can refer to reference for residents in Shanghai voluntary community health service centers in the family doctor signed a voluntary basis, and then choose a district-level medical institutions, a municipal medical institutions to sign, The "111" signed medical institutions portfolio, with the majority of people over the age of 60 as the main body, on the principle of voluntary signing, and on the basis of good service, gradually promoted the establishment of a hierarchical medical treatment system. Xiamen City, with high blood pressure and diabetes as the breakthrough point, set up a team of specialists, general practitioners and health managers to connect the big hospitals and community hospitals with "three teachers in charge" as a link. Jiangsu Province, through the formation of a medical complex, implements resource sharing, information interconnection, personnel deployment and homogeneous service in its internal departments. Hangzhou family doctor to promote the main level of the signing of the work.
Fourth, strengthen publicity, public opinion guidance
The provincial and pilot cities and counties health planning and administrative departments should step up publicity and education, carry out relevant training for administrative staff and medical personnel, and establish a hierarchical medical treatment system as a necessary requirement for fulfilling social responsibilities and promoting career development, and enhance their initiative and improvement Positivity. Give full play to the role of the media, step up publicity on the promotion of service capabilities and grading diagnosis and treatment of primary health care institutions, and strive for recognition and support for the system of grading medical treatment and treatment by all sectors of society and the broad masses of the people. Widely publicize disease prevention and control knowledge, to promote patients to establish a scientific concept of medical treatment, near, give priority to primary care medical institutions.
Pilot cities and counties, health and family planning administrations are required to issue the pilot work plan before September 15, 2016 and start the pilot work. Please provincial health planning and management departments to collect the summary of the pilot area of ?? the pilot cities and towns formally issued the pilot program of work, and in September 30, 2016 submitted to the National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine for the record.
The provincial health and family planning administrative departments monthly summarizes the pilot work within the jurisdiction, and the work progress of the monthly submitted to the State Health and Family Planning Commission before the next January 15 medical Haishu. The National Health and Family Planning Commission will conduct timely supervision and inspection on the pilot work carried out at various levels of clinics in accordance with the "Assessment and Evaluation Criteria for Hierarchical Clinicians" attached to the Opinions.
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