Guiding opinions on further promoting the development of the integration of medical and nursing care

The people's governments of all provinces, autonomous regions and municipalities directly under the Central Government, and the ministries and commissions and agencies directly under the State Council:

 

Promoting the combination of medical and nursing care is an important measure to optimize the health of the elderly and the supply of old-age services, and is an important way
to actively cope with the aging of the population and enhance the sense of acquisition and satisfaction of the elderly.
In recent years, the policy of integrating medical and nursing care has been continuously improved and positive progress has been made, but there are still some difficulties and blockages
in policy support, service capabilities, and talent construction.
All relevant departments in all localities should adhere to the guidance of Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, conscientiously implement the decision-making and deployment of the Party Central Committee and the State Council, further improve policies and measures, focus on solving difficult problems and blockages, promote the development of medical and nursing care, and continuously meet the needs of health and old-age services for
the elderly.
With the consent of the State Council, the following opinions are hereby put forward:

 

I.
Develop home-based community medical and nursing care services

 

(1) Actively provide home medical services
.
All localities should establish and improve home medical service specifications, technical guidelines and work processes in light of actual conditions, clarify relevant policies, and support qualified medical and health institutions to provide home medical services
such as home beds and home visits for the elderly with disabilities at home (including dementia, the same below), chronic diseases, advanced age, disability and other mobility problems or real difficulties.
Promote "Internet + medical health" and "Internet + nursing services", and innovate ways to provide convenient home medical services
for the elderly in need.
(The National Health Commission, the Ministry of Industry and Information Technology, the State Administration of Traditional Chinese Medicine, the State Administration of Disease Control, etc.
are responsible for the division of labor according to their duties, and local people's governments at all levels are responsible for implementation
.
) The following need to be implemented by local people's governments at all levels and will not be listed again)

 

(2) Strengthen the capacity
of community medical and elderly care integrated services.
Implement actions to improve the capacity of community medical and nursing care integration, and qualified community health service establishments, township health centers or community old-age service institutions, and special hardship support service institutions (homes for the elderly) use existing resources to internally renovate and expand a number of community (township) medical and nursing care service facilities, focusing on providing medical and nursing care integration services
for the elderly who are incapacitated, chronic diseases, advanced age, disabilities, and other elderly people with limited mobility or real difficulties.
Solidly do a good job in basic public health services, actively promote the implementation of the combination of elderly health and medical and nursing care services, and strengthen the prevention and early intervention
of geriatric diseases.
Give full play to the advantages of traditional Chinese medicine and integrated traditional Chinese and western medicine in health care, chronic disease prevention and treatment, etc.
, and promote traditional Chinese medicine into families, communities and institutions
.
Where conditions permit, the elderly may be vaccinated free of charge against influenza, pneumonia and other vaccines
in accordance with the principles of knowledge, consent and voluntariness.
On the basis of doing a solid job of contracted services for family doctors for the elderly, we will steadily increase the coverage rate
of family doctor contracted services for the elderly who are disabled, chronic, elderly, disabled, and other elderly family doctors with limited mobility or real difficulties.
(The National Health Commission, the National Development and Reform Commission, the Ministry of Civil Affairs, the Ministry of Finance, the Ministry of Natural Resources, the Ministry of Housing and Urban-Rural Development, the State Administration of Traditional Chinese Medicine, the National Bureau of Disease Control, the China Disabled Persons' Federation, etc.
are responsible for the division of labor according to their duties)

 

Second, promote institutions to carry out in-depth medical and nursing care services

 

(3) Support medical and health institutions in carrying out integrated medical and nursing services
.
Encourage medical and health institutions to set up medical service sites in old-age service institutions in accordance with laws and regulations to provide embedded medical and health services
.
Promote medical and health institutions to expand door-to-door medical services to old-age institutions, and provide services such as family beds and door-to-door inspections for eligible elderly people admitted to old-age institutions
.
All localities should optimize the layout of medical resources, strengthen the construction of rehabilitation hospitals, nursing homes (centers, stations) and hospice care institutions through new construction, renovation and expansion, transformation and development, support the development of geriatric medicine and palliative care, support the transformation of secondary and below medical and health institutions in areas with rich medical resources, and carry out rehabilitation, nursing and integrated medical and nursing services
.
Promote the construction of elderly-friendly medical and health institutions to facilitate the elderly to see a doctor
.
Public medical and health institutions carrying out home medical services, medical and nursing care combination contract services, and public medical and health institutions with surplus medical resources using existing beds to carry out old-age services should strictly implement relevant norms, and income should be included in the unified management
of medical and health institutions' income.
(The National Health Commission, the National Development and Reform Commission, the Ministry of Civil Affairs, the State Administration of Traditional Chinese Medicine, etc.
are responsible for the division of labor according to their duties)

 

(4) Improve the ability
of old-age institutions to integrate medical and nursing services.
On the basis of finding out the number of disabled elderly people, combined with the needs and wishes of occupancy, all localities should adopt various measures such as differentiated subsidies, promote the transformation of old-age institutions to increase nursing beds and facilities, support social forces to build specialized, large-scale, and outstanding medical and nursing care integration capacity of old-age institutions, and mainly accept disabled elderly people who
need long-term care.
All localities should guide and support pension institutions and medical and health institutions to carry out contract signing cooperation, provide services such as green channels for appointments and door-to-door inspections for pension institutions, do a solid cooperation mechanism and content, and improve the quality of medical and nursing care contract services
.
Encourage large-scale or mainly disabled elderly care institutions to set up medical and health institutions within them, support internal medical and health institutions to strengthen capacity building, and improve the quality of diagnosis and treatment services
.
(The Ministry of Civil Affairs, the National Development and Reform Commission, the National Health Commission, the State Administration of Traditional Chinese Medicine, the National Bureau of Disease Control, etc.
are responsible for the division of labor according to their duties)

 

Third, optimize service connection

 

(5) Strengthen the sharing
of medical and old-age resources.
All localities should promote the overall layout and resource sharing
of public service facilities such as community medical and health care, old-age services, and support for the disabled.
Promote the overall planning and adjacent construction of community health service institutions and community old-age service institutions, community rehabilitation stations, township health centers and special hardship support service institutions (homes for the elderly), village clinics and rural happiness homes, and care institutions for the disabled, and adopt a variety of effective methods to achieve resource sharing and service convergence
.
The medical and health institutions within the pension institutions will be included in the management of the medical consortium, and a two-way referral mechanism will be established with the lead hospital, rehabilitation hospital, nursing home (center, station) within the medical consortium, etc.
, to provide integrated and continuous services, and to achieve efficient coordination
of medical, rehabilitation, nursing and old-age service resources.
Encourage grassroots to actively explore the on-demand standardized conversion mechanism for pension beds and medical beds in relevant institutions
.
(The National Development and Reform Commission, the Ministry of Civil Affairs, the Ministry of Natural Resources, the Ministry of Housing and Urban-Rural Development, the National Health Commission, the National Medical Insurance Bureau, the State Administration of Traditional Chinese Medicine, the China Disabled Persons' Federation, etc.
are responsible for the division of labor according to their duties)

 

(6) Actively give play to the role of
informatization.
Relying on the national health information platform and the "Jinmin Project", build a national aging health information management system and a national old-age service information system, comprehensively grasp the health and pension status of the elderly, and carry out relevant services
at different levels and classifications.
Implement the development action of the smart health and pension industry, develop health management, pension guardianship, rehabilitation assistive devices, TCM digital intelligent products and home service robots and other products to meet the health and pension needs
of the elderly.
(The National Health Commission, the Ministry of Industry and Information Technology, the Ministry of Civil Affairs, the State Administration of Traditional Chinese Medicine, etc.
are responsible for the division of labor according to their duties)

 

Fourth, improve support policies

 

(7) Improve price policies
.
Public medical and health institutions provide door-to-door medical services for the elderly and other groups, and charge in
the form of "medical service price + door-to-door service fee".
The medical services, medicines and medical consumables provided shall be subject to the pharmaceutical price policy
implemented by the medical and health institutions.
The door-to-door service fee can be determined
by public medical and health institutions taking into account factors such as service radius, labor costs, transportation costs, and supply and demand.
Services that have been funded through family doctor contracts, long-term care insurance, etc.
, shall not be charged
repeatedly.
Public medical and health institutions carry out old-age services, separate accounting of income or separate accounting management, charging standards should comprehensively consider the cost of services, supply and demand, the ability of the masses to bear and other factors, in principle by the price department after approval of the implementation, with bidding conditions, encouraged to be determined
through bidding methods.
(The National Development and Reform Commission, the National Health Commission, the Ministry of Civil Affairs, the State Administration of Market Regulation, the National Medical Insurance Bureau, etc.
are responsible for the division of labor according to their duties)

 

(8) Increase insurance support
.
Timely include medical and health institutions within eligible old-age care institutions into the designated management of
medical insurance.
According to the characteristics of the combination of medical and nursing care, reasonably determine the total medical insurance control indicators of medical and health institutions within the nursing home, explore the implementation of bed-by-day payment for diseases such as hospice care and medical rehabilitation that require long-term hospitalization and the average daily cost is relatively stable, and encourage qualified places to prepay part of the medical insurance funds
to designated medical and health institutions that provide medical and nursing care services.
According to the procedure, the eligible therapeutic medical service items will be included in the scope of medical insurance payment, and the basic medical insurance fees that meet the regulations
will be paid in full.
Steadily promote the pilot of the long-term care insurance system to meet the basic nursing care protection needs
of the disabled elderly.
Encourage commercial insurance to include preventive health care, health management, rehabilitation, nursing care, etc.
for the elderly into the scope of
protection.
(The National Medical Insurance Bureau, the National Health Commission, the Ministry of Civil Affairs, the Ministry of Finance, the Banking and Insurance Regulatory Commission, the State Administration of Traditional Chinese Medicine, etc.
are responsible for the division of labor according to their duties)

 

(9) Revitalize land resources
.
Medical and health land and social welfare land can be used to build medical and nursing care projects
.
It is allowed to revitalize the use of existing vacant commercial buildings, factories, school buildings, office buildings, training facilities and other facilities in cities and towns to provide integrated medical and nursing services, and apply the transitional policy to continue to use land
according to the original purpose and type of rights for five years.
Improve land support policies, and give priority to ensuring the demand for land for medical and nursing care projects
that accept disabled elderly people.
Rural collective construction land is allowed and encouraged to be used for the construction of medical and nursing care projects
.
(The Ministry of Natural Resources, the Ministry of Housing and Urban-Rural Development, the Ministry of Agriculture and Rural Affairs, the National Development and Reform Commission, the National Health Commission, the Ministry of Civil Affairs, etc.
are responsible for the division of labor according to their duties)

 

(10) Implement fiscal and tax incentives
.
Where conditions permit, they can support the development of the combination of
medical care and elderly care through relevant industrial investment funds.
Implement relevant preferential tax policies, and support social forces to provide multi-level and diversified medical and nursing services
.
Through government procurement of services and other methods, uniformly carry out comprehensive assessment of the ability of the elderly, support qualified medical and health institutions to provide basic public health, family doctor contracts and other services for the elderly, and support eligible old-age institutions to provide basic old-age care for the elderly, family old-age bed contracts and other services
.
(The Ministry of Finance, the People's Bank of China, the State Administration of Taxation, the Banking and Insurance Regulatory Commission, the National Health Commission, the Ministry of Civil Affairs, the National Medical Insurance Bureau, the National Disease Control Bureau, etc.
are responsible for the division of labor according to their duties)

 

Fifth, multi-channel talent introduction and talent training

 

(11) Strengthen personnel training
.
Accelerate the cultivation of medical and health and pension service shortage talents, and include medical talents such as geriatric medicine, nursing, rehabilitation, and general medicine, as well as elderly care workers, nursing home presidents, and elderly social workers, and other elderly care service and management talents into relevant training projects
.
Encourage ordinary colleges and universities and vocational colleges to add health and pension related majors and courses, expand the scale of enrollment, and adapt to the needs of
the industry.
Vigorously carry out training in the field of medical and nursing care, give play to the role of relevant vocational skill level certificates, and further broaden the talent training path
that combines institutional training and institutional training.
Encourage the provision of medical and nursing care service positions for teachers' practice and student internships in relevant colleges and universities
.
(The Ministry of Education, the Ministry of Human Resources and Social Security, the National Health Commission, the Ministry of Civil Affairs, the State Administration of Traditional Chinese Medicine, etc.
are responsible for the division of labor according to their duties)

 

(12) Guide medical personnel to engage in integrated medical and nursing services
.
The recruitment, use and training of grass-roots health and health personnel should be inclined
to medical and health institutions that provide medical and nursing care services.
According to the situation of public medical and health institutions to carry out medical and nursing integration services, the total amount of
performance wages is reasonably approved.
When public medical and health institutions distribute their internal performance, they give appropriate preference to medical personnel who have completed better services such as home medical services and medical and nursing care contracts
.
Support medical personnel, especially retired and re-employed nurses with clinical experience, to practice in medical and health institutions that provide integrated medical and nursing care services, and to provide services in elderly care service institutions that provide integrated medical and nursing services
.
Encourage retired medical personnel to carry out volunteer services in medical and health institutions and old-age service institutions that provide medical and nursing care
services.
(The National Health Commission, the Ministry of Human Resources and Social Security, the Ministry of Education, the Ministry of Finance, the Ministry of Civil Affairs, etc.
are responsible for the division of labor according to their duties)

 

(13) Expand the team
of disability care services.
Improve the care capacity and level
of family caregivers of disabled elderly people through emergency assistance and care skills training.
Strengthen the training
of medical nurses and elderly caregivers, mainly for the care of the disabled elderly.
Volunteers are encouraged to provide respite services
for the families of elderly people who are disabled at home.
(The Ministry of Human Resources and Social Security, the National Health Commission, the Ministry of Civil Affairs, the State Administration of Traditional Chinese Medicine, the Ministry of Emergency Response, the Central Committee of the Communist Youth League, etc.
are responsible for the division of labor according to their duties)

 

VI.
Strengthen service supervision

 

(14) Strengthen industry supervision
.
Incorporate the combination of medical and nursing services into the comprehensive supervision and quality assessment of the medical and health industry and the old-age service industry, include the medical and health institutions within the medical and health institutions into the scope of "double random, one open" supervision and random inspection of medical and health institutions, and include the old-age services carried out by medical and health institutions in the scope of "double random, one open" supervision and random inspection of old-age institutions, and guide relevant institutions to continuously optimize the combination of medical and nursing services
.
All relevant departments should strengthen information sharing, improve the coordinated supervision mechanism of each performing its own duties, each taking its own responsibilities, cooperating with each other, and grasping and managing together, and strive to promote the solution of prominent problems
affecting the quality and safety of service.
(The National Health Commission, the Ministry of Civil Affairs, the State Administration of Market Regulation, the State Administration of Disease Control, etc.
are responsible for the division of labor according to their duties)

 

(15) Implement responsibilities for the prevention and control of infectious diseases and production safety
.
Medical and health institutions within pension institutions should strictly implement the requirements for the prevention and control of infectious diseases and the prevention and control of infection in medical institutions, properly arrange internal and external services, and resolutely prevent the spread of
diseases.
The places where medical and health institutions provide old-age services should be managed in a partition with the medical service area, so as to achieve physical isolation and independent setting.

During the outbreak of major infectious diseases in this region, medical and health institutions providing old-age care services should be equipped with full-time medical personnel and other necessary staff according to the epidemic situation, and non-urgent situations should not cross with medical service areas to use facilities, equipment, materials, etc.
, and if they really need to be used, they should strictly implement prevention and control measures
.
Relevant departments should strengthen supervision and guidance, promote the implementation of responsibilities, and resolutely prevent the risk
of epidemic.
All localities should urge relevant institutions providing integrated medical and nursing care services to strictly implement the main responsibility for safe production and fire safety, eliminate potential safety hazards in a timely manner, and safeguard the life safety and legitimate rights and interests
of the elderly.
It is strictly forbidden to use flammable and combustible color steel plate materials to build a place where
personnel are active.
Those who do not have the conditions for safe production and fire safety and have major potential safety hazards shall be dealt with
in accordance with laws and regulations.
(Each relevant department is responsible for the division of labor according to its duties)

 

All relevant departments in all regions should strengthen organizational leadership, and incorporate the promotion of the combination of medical and nursing care into relevant plans such as economic and social development planning and national health, medical and health service system, the development of the aging cause and the old-age service system
.
Establish and improve the multi-sectoral coordinated promotion mechanism, mobilize the extensive participation of social forces, based on old-age services and supported by medical and health services, promote the organic connection of medical and nursing care, and improve and implement various policies and measures
.
The National Health Commission, together with the Ministry of Civil Affairs and other departments, has strengthened supervision and guidance for all localities to eliminate the problem of difficulties in the combination of medical and nursing
care.
Strengthen policy training and publicity and guidance, organize the implementation of demonstration projects for the integration of medical and nursing care, timely summarize and promote typical experiences, and promote the high-quality development
of medical and nursing care.

 

National Health Commission, National Development and Reform Commission

 

Ministry of Education, Ministry of Civil Affairs

 

Ministry of Finance, Ministry of Human Resources and Social Security

 

Ministry of Natural Resources Ministry of Housing and Urban-Rural Development

 

Ministry of Emergency Response, State Administration of Market Regulation

 

National Health Insurance Agency

 

July 2022, 7