Guiding Opinions on Promoting the High-quality Development of Family Doctor Contracting Services

On March 15, the National Health and Medical Commission issued guidelines on promoting the high-quality development of family doctor contracted services, requiring the expansion of service supply and the orderly expansion of source channels for family doctors
.
Encourage all kinds of doctors to provide different forms of contracting services to primary medical and health institutions, actively guide qualified second- and third-level hospital physicians to join the family doctor team, and use primary medical and health institutions as a platform to carry out contracting services
.
Support social forces to carry out contract services
.
Encourage all localities to provide policy guidance and support in terms of contracted service fees, medical insurance reimbursement, service items, and referral green channels in light of their actual conditions, creating conditions for socially-run medical and health institutions to carry out contracted services and meeting residents' personalized and diversified health needs
.
All localities should support socially-run medical and health institutions to provide contracted services
.
The original text is as follows: Health Commissions, Finance Departments (bureaus), Human Resources and Social Security Departments (bureaus), Medical Insurance Bureaus, and Traditional Chinese Medicine Bureaus of all provinces, autonomous regions, and municipalities directly under the Central Government: In order to implement the party's health and health work policy in the new era, and promote the implementation of Healthy China Strategy, implement the requirements of the "14th Five-Year Plan for National Economic and Social Development of the People's Republic of China and the Outline of Vision 2035", and further accelerate the development of family doctor contracted services.
The following guiding opinions are hereby offered
.
1.
General requirements (1) Development ideas
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Actively increase the supply of contracted services for family doctors and expand the coverage of contracted services; strengthen the connotation of contracted services, highlight all-round full-cycle health management services, promote effective contracting and standardize contract performance; improve the incentive and guarantee mechanism for contracted services, strengthen policy coordination, and consolidate contracted services Policy effectiveness, and promote the high-quality development of family doctor contract services
.
(2) The main objective
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Accurately grasp the work rhythm, and on the premise of ensuring the quality of service and the sense of acquisition and satisfaction of contracted residents, gradually and actively expand the coverage of contracted services, and gradually build a family doctor system with family doctors as the gatekeepers of health
.
Starting from 2022, on the basis of the existing service level, the coverage rate of contracted services for the entire population and key populations will increase by 1 to 3 percentage points every year.
The coverage rate of contracted services for key groups is over 85%, and the satisfaction rate is about 85%
.
2.
Expand service supply (1) Orderly expand the sources of family doctors
.
Family doctors can be general practitioners, other types of clinicians (including traditional Chinese medicine) practicing in medical and health institutions, rural doctors and retired clinicians
.
Encourage all kinds of doctors to provide different forms of contracting services to primary medical and health institutions, actively guide qualified second- and third-level hospital physicians to join the family doctor team, and use primary medical and health institutions as a platform to carry out contracting services
.
A family doctor can either be the subject of the contract individually or form a team to provide contract services
.
(2) Support social forces to carry out contract services
.
Encourage all localities to provide policy guidance and support in terms of contracted service fees, medical insurance reimbursement, service items, and referral green channels in light of their actual conditions, creating conditions for socially-run medical and health institutions to carry out contracted services and meeting residents' personalized and diversified health needs
.
All localities should support socially-run medical and health institutions to provide contracted services
.
(3) Strengthen the training and training system for family doctors
.
Strengthen the standardized training of general practice residents, assistant general practitioner training, job transfer training, and order-oriented free medical student training, promote the examination of rural general practice assistant physicians, and actively expand the team of family doctors
.
Optimize the clinical diagnosis and treatment service capabilities of family doctors and the general practice concept, knowledge, and skills training system, and focus on strengthening targeted and highly operable practical skills training
.
3.
Enrich service content (1) Improve medical service capabilities
.
Further improve the infrastructure and equipment conditions of primary medical and health institutions, strengthen the basic medical service functions of primary medical and health institutions, enhance the ability of family doctors to carry out diagnosis and treatment of common diseases, frequently-occurring diseases, and chronic disease management, and encourage township health centers and community health service centers.
According to the needs of the masses, we will carry out service projects that meet the corresponding qualification requirements in accordance with relevant diagnosis and treatment specifications, and expand service functions such as rehabilitation, combination of medical care and elderly care, palliative care, and intelligent auxiliary diagnosis and treatment
.
(2) Improve the quality of basic public health and health management services
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Actively provide public health services such as preventive health care, implement basic public health service projects and other public health services for contracted residents, strengthen the prevention and guidance of chronic diseases, and promote the opening of electronic health records to contracted residents
.
According to the health status and service needs of contracted residents, provide high-quality health education services and optimize health management services to improve the sense of acquisition and satisfaction of contracted services
.
(3) Ensure rational drug use
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Implement policies such as the management of the essential drug list, strengthen the connection and unification of the drug lists between primary medical and health institutions and hospitals above the second level, and further meet the needs of contracted residents for essential drugs
.
In accordance with the relevant regulations on long-term prescription management, long-term prescription services are given priority to eligible contracted chronic disease patients.
In principle, long-term prescriptions for 4 to 12 weeks can be issued
.
By 2025, all township health centers and community health service centers should provide long-term prescription services
.
(4) Carry out door-to-door service
.
For people with real needs, such as the elderly and the disabled with limited mobility, disability and dementia, services such as door-to-door treatment, follow-up management, rehabilitation, nursing, palliative care, health guidance, and home beds should be provided in light of the actual situation, and the quality of medical care should be strengthened.
Supervision to ensure medical safety
.
(5) Optimizing referral services
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To coordinate regional high-quality health resources, urban medical groups and county-level medical associations lead hospitals should hand over a certain proportion of medical resources such as expert number sources and appointment equipment inspections to family doctors for management and control.
Patients referred by doctors are given priority for treatment, examination and hospitalization
.
(6) Strengthen traditional Chinese medicine services
.
Adhere to both Chinese and Western medicine, strengthen the construction of Chinese medicine departments and Chinese medicine halls in grass-roots medical and health institutions, improve the conditions and facilities of Chinese medicine service sites, promote the general inclusion of Chinese medicine services in the content of contracted services, strengthen the allocation of Chinese medicine personnel in the contracted teams, and encourage family doctors ( Team) to master and use traditional Chinese medicine techniques such as acupuncture, massage, cupping, moxibustion, etc.
, and provide traditional Chinese medicine treatment services
.
(7) Form an orderly medical treatment order
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Further promote the appointment and intelligent triage of primary medical and health institutions, and vigorously guide and promote the contracted residents to be received by family doctors when they visit primary medical and health institutions
.
Family doctors should comprehensively grasp the health status of contracted residents and their family members through daily diagnosis and treatment services, strengthen contact with contracted residents, and guide contracted residents to gradually form the choice of medical treatment for the first consultation in primary medical and health institutions
.
The contracted residents can actively promote the use of credit payment, settlement between clinics, etc.
, integrate payment links such as registration, inspection, inspection, diagnosis and treatment, and medicine collection, implement one-stop settlement, and reduce the number and time of waiting in line
.
4.
Optimizing service methods (1) Promote flexible service agreements
.
The service agreement shall clarify the responsibilities and rights of both parties and list the service list
.
The service agreement can be valid for 1 to 3 years.
According to the needs of residents and the actual work of primary medical and health institutions, family doctors with a stable service relationship are allowed to sign service agreements with a validity period of 2 or 3 years with the contracted residents
.
Support family doctors and residents to sign service agreements with families as units, and encourage all localities to explore signing service agreements with functional communities such as party and government organs, enterprises and institutions, industrial parks, and commercial buildings as contract objects
.
(2) Strengthening the integration of medical and preventive medicine in all specialties
.
Through the direct participation of specialist doctors in contracted services and the priority referral of family doctors to specialist doctors through green channels, the contracted residents will be provided with "one-stop" full-specialty integrated services, strengthening the collaboration between general practitioners and specialist doctors, and promoting the integration of grass-roots medical care and prevention.
Enhance the continuity, synergy and comprehensiveness of contracted services
.
(3) Encouraging combined contracting
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Encourage all localities to follow the grid layout of urban medical groups and county-level medical communities to guide tertiary hospitals to adopt a "contracting and slicing" method, through various channels such as counterpart support, co-construction of departments, talent sinking, and multi-site practice.
Promote the sinking of high-quality medical resources, strengthen the contracting service force with the grassroots medical and health institutions in the jurisdiction, and jointly provide the family doctor contracting service
.
(4) Promote "Internet + contract service"
.
Based on the regional national health information platform, build or improve the family doctor service and management information system to provide residents with online services such as signing agreements, health consultation, chronic disease follow-up, and two-way referral
.
The service behavior recorded by the information system is used as an important indicator for evaluating the performance of the family doctor's service contract
.
Strengthen the exchange and sharing of regional health information, open up data channels between the family doctor service and management information system, the diagnosis and treatment system of medical institutions, and the basic public health system, and actively promote the application of new technologies such as artificial intelligence
.
(5) Provide health consultation services
.
Based on the basic health conditions of the contracted residents, through face-to-face, telephone, social software, family doctor services and management information systems, we provide targeted health consultation services for contracted residents, including health assessment, health guidance, health education, disease prevention, Medical guidance, psychological counseling, etc.
, close the relationship between the contracting parties, increase mutual trust and interaction, and develop a long-term and stable service relationship
.
(6) Highlight key groups of people
.
The elderly, pregnant and lying-in women, children, the disabled, people who have been lifted out of poverty, family members with special family planning, and patients with hypertension, diabetes, tuberculosis and severe mental disorders should be the key groups for contracted services, and priority should be given to contracting and serving
.
Poverty alleviation areas should gradually incorporate chronic disease patients and the elderly from groups such as unstable poverty alleviation households, marginal households prone to poverty, and sudden and severe difficulties into the scope of key groups of contracted service groups, focusing on the care of major chronic disease patients.
Standardize management and health services
.
V.
Improve the guarantee mechanism (1) Strengthen organizational leadership
.
All localities should strengthen their territorial responsibilities, issue specific implementation plans in a timely manner based on actual conditions, and refine work goals and measures
.
It is necessary to strengthen overall planning and coordination, establish and improve the family doctor contract service guarantee system, and form a working mechanism led by the government, with departmental cooperation, grass-roots medical and health institutions as the platform, and with the participation of various social resources, to ensure that various tasks are implemented in place, and the coverage of contracted services continues to expand.
, the quality and satisfaction of contracted services continued to improve
.
(2) Improve the incentive mechanism
.
The contracted service fee is the fee for the family doctor (team) to establish a contractual service relationship with the residents, perform the corresponding health service responsibilities, and provide medical services, health services and other necessary convenience services in a package
.
The contract service fee is shared by the medical insurance fund, basic public health service funds and contracted residents
.
It is necessary to reasonably calculate the settlement standard of contracted service fees for family doctors.
In principle, no less than 70% of the contracted service fees will be allocated to the salary distribution of the personnel participating in the contracted service of family doctors, and the contracted service fees will be paid after the assessment
.
Medical institutions above the second level should give preference to physicians participating in contracted services in the distribution of performance wages
.
Clarify the connotations of the basic service package and personalized service package in the contracted service of family doctors, and adjust the fee settlement standards accordingly
.
(3) Play the guiding role of basic medical insurance
.
In the dynamic adjustment of medical service prices, priority should be given to medical service items that reflect hierarchical diagnosis and treatment and the high value of technical labor services, so as to promote medical treatment nearby
.
Promoting outpatient medical services in primary medical and health institutions to pay per capita, guiding the masses to take the initiative to seek medical treatment at the primary level, and promoting the contracted residents to make more use of primary medical and health services
.
Conditional regions may explore paying the outpatient fund of contracted residents to primary medical and health institutions or family doctors (teams) on a per capita basis.
Referral fees
.
The medical insurance department strengthens agreement management, improves settlement methods, ensures that insured persons receive high-quality medical services, strengthens performance evaluation, and improves the incentive policy for the retention of surplus
.
Continue to implement differentiated payment policies for medical institutions at different levels, and reasonably set the reimbursement level gap between primary medical and health institutions and second-level and above medical institutions
.
(4) Strengthening publicity and guidance
.
Strengthen the publicity of family doctor contracted services, expand the awareness rate of contracted services, and guide more residents to use contracted services
.
Focus on publicizing the connotation and content of contracted services, and reasonably guide residents' expectations
.
It is necessary to discover typical cases of high-quality and efficient promotion of family doctor contract services, and to play a positive role in demonstration and guidance, so as to create a good social atmosphere for the development of family doctor contract services
.
(5) To enhance the professional honor of family doctors
.
Encourage and support family doctors (teams) to be first in the evaluation, focus on finding typical models of family doctors with good service quality and high public recognition, and establish a positive image of family doctors who are enthusiastic about serving the masses.
Appropriately incline to family doctors to improve the recognition and trust of family doctors in the whole society
.
(6) Strengthen supervision, assessment and evaluation
.
Strengthen the assessment and supervision of the quality of contracted services of family doctors, take the number of contracted services, the proportion of key populations, renewal rates, health management effects, service quality, and contracted residents' satisfaction as evaluation indicators, and use information technology and residents to return visits and other methods.
Regularly conduct supervision and evaluation of grassroots medical and health institutions and family doctors, and the evaluation results are linked to funding allocation and performance distribution
.
The National Health and Health Commission will, together with relevant departments, conduct annual and 5-year evaluations on the progress of contracted services of family doctors in various regions, and report the results to various regions
.