The Office of the State Council issued a document: Diagnosis and treatment of serious diseases sinks in the county!

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　　The distribution of medical resources in core cities is relatively mature.
Both hardware and software are relatively complete and systematic.
Relatively speaking, there are large regional differences in the broad market, which poses a greater test for the enterprise's grassroots market team
.
At the same time, the main products of the traditional grassroots market are mainly chronic disease general medicines, but the current grassroots market is gradually moving from general practice to specialist development.
Expanding multidisciplinary capabilities around core disciplines will be an important demand pain point
.

 

　　Opinions of the General Office of the State Council on Promoting the High-quality Development of Public Hospitals

 

State 　　Council issued (2021 ) No.
18

 

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

 

　　Public hospitals are the main body of China’s medical service system.
In recent years, especially since the 18th National Congress of the Communist Party of China, the reform and development of public hospitals has been an important part of deepening the reform of the medical and health system, and has achieved significant phased results to continuously improve the fairness of basic medical and health services.
Accessibility, the prevention and control of major epidemics such as the new crown pneumonia, and the protection of the lives and health of the people have played an important role
.
In order to promote the high-quality development of public hospitals and better meet the people's increasing demand for medical and health services, with the consent of the State Council, the following opinions are hereby put forward
.

 

　　1.
General requirements

 

　　Guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implement the spirit of the 19th National Congress of the Communist Party of China and the 2nd, 3rd, 4th, and 5th Plenary Sessions of the 19th National Congress of the Communist Party of China.
Government-led, charity-led, and public hospital-led, adhere to the integration of medicine and prevention, the combination of peace and emergency, and equal emphasis on Chinese and Western medicine, with the goal of establishing and improving a modern hospital management system, strengthening system innovation, technological innovation, model innovation, and management innovation, and speeding up high-quality medical care Expansion of resources and a balanced layout of regions, and strive to through five years of hard work, the development mode of public hospitals has changed from scale expansion to improved quality and efficiency, the operation mode has changed from extensive management to fine management, and resource allocation has changed from focusing on material elements to focusing more on talents and technology elements.
Better provide high-quality and efficient medical and health services, prevent and resolve major epidemics and sudden public health risks, and provide strong support for building a healthy China
.

 

　　2.
Constructing a new system for high-quality development of public hospitals

 

　　 (1) Build national and provincial high-level hospitals
.
With the goal of promoting national medical progress, relying on existing resource planning to set up national medical centers, clinical medical research centers, regional medical centers (all including Chinese medicine, the same below) and traditional Chinese medicine inheritance and innovation centers, forming key clinical specialties and focusing on development To tackle difficult and critical diseases diagnosis and treatment technology, carry out cutting-edge medical science and technology innovation research and achievement transformation, implement high-level medical personnel training, and drive the national medical level to a new level
.
Focus on diseases with high provincial mortality and high transfer rate, strengthen the technical and talent support of national high-level hospitals to provincial hospitals, accelerate the filling of shortcomings in professional specialists, improve provincial diagnosis and treatment capabilities, and reduce cross-provincial medical treatment
.

 

　　 (2) Give full play to the leading role of public hospitals in urban medical groups
.
According to grid-based layout management, the establishment of a compact type led by a tertiary public hospital or a hospital representing the medical level of the jurisdiction (including social hospitals and traditional Chinese medicine hospitals), and several other hospitals, primary medical and health institutions, public health institutions, etc.
as members The Urban Medical Group is responsible for the integrated and continuous medical services such as prevention, treatment, rehabilitation, and health promotion of residents in the grid
.
The hospitals within the group strengthened collaboration, combined with the actual construction of superior professional specialties, formed a development pattern with distinctive characteristics, complementary specialties, misaligned development, and orderly competition, and promoted grassroots medical and health institutions to improve their service capabilities and management levels
.
Promote contracted services of family doctors with general practitioners as the main body, effective linkage of general medicine specialties, and organic integration of medical and prevention
.
Strengthen the standardization of public health departments in public hospitals, and improve public health service capabilities
.

 

　　 (3) Give full play to the leading role of county-level hospitals in the county medical community
.
In accordance with the principles of county-town integration and rural integration, actively develop a compact county-level medical community led by county-level hospitals
.
Strengthen the capacity building of county-level hospitals (including Chinese medicine hospitals), upgrade core specialties, consolidate support specialties, create superior specialties, improve the prevention and treatment capabilities of tumors, cardiovascular, cerebrovascular, respiratory, digestive and infectious diseases, and increase the rate of county visits
.
Strengthen the counterpart assistance of the city's tertiary hospitals to the county-level hospitals, and gradually make the county-level public hospitals reach the second-class level
.
Strengthen the division of labor and cooperation and business integration between county-level hospitals and professional public health institutions, and implement public health services
.
Strengthen the overall management of county-level hospitals to township health centers and village clinics, give full play to the technical support role of county-level hospital medical staff to the family doctor team, and enhance residents' health "gatekeeper" capabilities
.
Accelerate the realization of full coverage of county-run TCM medical institutions, and support TCM hospitals to take the lead in forming a county medical community
.

 

　　 (4) Establish and improve a major epidemic treatment system with hierarchical, stratified and diversion
.
Relying on existing resources, accelerate the establishment and construction of national medical centers, regional medical centers, provincial medical centers, and provincial regional medical centers for infectious diseases, trauma, and major public health incidents
.
Support some powerful public hospitals to moderately construct and develop multi-hospital districts based on the control of the single-unit scale, and quickly switch functions in the event of a major epidemic
.
Each prefecture and city chooses a general hospital to improve the ability to treat infectious diseases in a targeted manner, and upgrade the infrastructure and equipment of the existing independent infectious disease hospitals
.
Relying on a county-level hospital within the county, strengthen the construction of infectious disease departments and relatively independent infectious disease wards
.
Give full play to the unique role of traditional Chinese medicine in the prevention, control and treatment of major epidemics, plan and deploy traditional Chinese medicine epidemic prevention and emergency medical rescue bases, and build a high-level Chinese medicine epidemic prevention team
.
Give full play to the role of military hospitals in the prevention, control and treatment of major epidemics and national biological security defenses
.
Continue to strengthen the management of nosocomial infection prevention and control, and improve the ability to respond to major epidemics
.

 

　　3.
Leading the new trend of high-quality development of public hospitals

 

　　 (1) Strengthen the construction of clinical specialties
.
To meet the clinical needs of major diseases, we will build clinical specialties, focusing on the development of clinical specialties such as critical illness, tumor, cardiovascular and cerebrovascular, respiratory, digestion, infection, pediatrics, anesthesia, imaging, pathology, laboratory, etc.
, and the development of specialties will promote the improvement of diagnosis and treatment capabilities and levels
.
Continuously improve the medical quality management system and standard system, and raise the level of homogeneity of medical services in public hospitals of different regions and levels
.
Increase support for Chinese medicine hospitals
.
Strengthen the construction of superior specialties of traditional Chinese medicine
.
Strengthen the construction of related disciplines in the "double first-class" construction
.

 

　　 (2) Promote medical technology innovation
.
Facing the frontiers of life sciences and biomedical technology, facing national strategic needs and major scientific issues in the field of medicine and health, strengthening basic and clinical research, and promoting the output of new technologies, new products, new programs and new strategies for original disease prevention, diagnosis and treatment
.
Strengthen scientific research to support the response to major epidemics and public health emergencies
.
Promote the transformation of scientific and technological achievements, and the income obtained is mainly used to reward personnel who have made important contributions
.
Improve the service invention system
.
Relying on existing resources, build a batch of national TCM clinical research and scientific and technological achievements incubation and transformation bases, formulate a batch of special TCM diagnosis and treatment plans, and transform into a batch of TCM advanced equipment and new TCM drugs
.
Accelerate the development of commercial health insurance and promote the introduction of new medical technologies into clinical use
.

 

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　　 (1) Improve the operation and management system
.
Fully implement the basic medical and health and health promotion laws and other laws and regulations to provide legal guarantees for improving the hospital's governance capabilities and standards
.
Integrate medical, teaching, scientific research and other business systems and human, financial, and material resource systems, establish a hospital operation management decision support system, and promote the scientific, standardized, and refined hospital operation management
.
Establish a standard system for disease combination with big data methods to form quantified treatment standards, drug standards, and consumables standards for disease severity and resource consumption in each disease group, and improve the hospital's case combination index (CMI), cost output, and doctor performance Monitoring and evaluation are carried out to guide the hospital to return to its functional positioning, improve efficiency, save costs, and reduce the burden of patients for medical treatment
.

 

　　 (2) Strengthen comprehensive budget management
.
Based on the hospital’s strategic development plan and annual plan goals, implement full-caliber, full-process, full-staff, and full-scale budget management, which runs through budget preparation, approval, execution, monitoring, adjustment, final accounts, analysis, and assessment.
Implement budget performance management in terms of quantity, quality, effectiveness, cost, benefit, etc.
, strengthen budget constraints, and promote the effective allocation and use of resources
.
Regularly disclose the relevant financial information of the hospital and actively accept social supervision
.

 

　　 (3) Improve the internal control system
.
Focus on major risks, major events, and important processes in business management and economic management, carry out risk assessment and internal control evaluation, strengthen internal authorization approval control, budget control, asset control, accounting control, government procurement control, information disclosure control, etc.
, Prevent financial risks, business risks, legal risks and integrity risks
.
Strengthen the process management of the key links of cost consumption, and reduce the energy consumption expenditure of 10,000 yuan of income
.
Promote the "one-stop" service for hospital logistics
.

 

　　 (4) Improve the performance evaluation mechanism
.
Adhere to and strengthen the public welfare orientation, comprehensively carry out the performance appraisal of public hospitals, continue to optimize the performance appraisal index system, and focus on the assessment of medical quality, operational efficiency, sustainable development, and satisfaction evaluation
.
Reform the internal performance appraisal methods of public hospitals, based on the employment contract, focusing on the completion of job responsibilities, and linking the appraisal results with salary distribution
.
Improve the performance appraisal system of urban medical groups and county medical communities, promote the sinking of resources, and improve the ability of grassroots services and the health of residents
.

 

　　5.
Activate the new impetus for the high-quality development of public hospitals

 

　　 (1) Reform the personnel management system
.
Reasonably formulate and implement staffing standards for public hospitals, and establish a dynamic increase mechanism
.
Implement the autonomy of employment in public hospitals, and make overall consideration of the treatment of internal and external personnel in the establishment
.
Implement the job management system, rationally set up positions according to different categories of medicine, nursing, medicine, technology, management, etc.
, scientifically compile job responsibility letters, implement competitive employment and contract management, and encourage talents to stand out
.
Increase the number of nurses and gradually bring the overall medical-care ratio in public hospitals to around 1:2
.

 

　　 (2) Reform the salary distribution system
.
Implement the requirement of “allowing medical and health institutions to break through the current wage control level of public institutions, allowing medical service income to deduct costs and withdraw various funds in accordance with regulations to be mainly used for personnel rewards”, reasonably determine and dynamically adjust the salary level of public hospitals, and reasonably determine personnel expenditures As a percentage of public hospital business expenditures
.
Establish a salary system that mainly reflects job responsibilities and the value of knowledge, implement job-based responsibilities, job-based wages, appropriate responsibilities and salaries, and assessments
.
Within the approved total salary, public hospitals can adopt a variety of methods to allocate independently
.
Hospitals can independently set up salary projects that reflect the characteristics of the medical industry, labor characteristics and job value, give full play to the guarantee and incentives of various projects, and pay more attention to the guarantee function of the salary system
.
Encourage the implementation of an annual salary system for the main responsible persons
.

 

　　 (3) Improve the evaluation system for the training of medical personnel
.
Strengthen early clinical, multi-clinical, and repeated clinical practice for medical students, and strengthen medical humanities education
.
Implement standardized training for resident doctors, standardized training for specialist doctors, and continuing medical education systems, and strengthen the education of Chinese medicine teachers
.
Accelerate the cultivation of high-level compound medical talents, and cultivate a group of international-level strategic talents, leading talents and innovative teams
.
Strengthen the training and training of nurses in the elderly, pediatrics, critically ill, infectious diseases and other nursing professionals who are in short supply, promote the scientific management of nursing posts, and improve the level of nursing service
.
Reform and improve the talent evaluation mechanism, adhere to hierarchical and categorized evaluation, reasonably set evaluation standards, highlight the performance orientation of moral ability, increase the number and quality of clinical work, explore the implementation of a representative work system, and dilute the number of papers
.
We will steadily delegate the authority to review professional titles, and explore pilots of tertiary public hospitals with reasonable job settings, complete personnel management, and willingness to conduct independent reviews to independently conduct senior professional title reviews
.

 

　　 (4) Deepen the reform of medical service prices
.
Steadily and orderly pilot exploration of price optimization of medical services
.
Establish and improve a medical service price formation mechanism that adapts to economic and social development, makes better use of the role of the government, fully participates in medical institutions, and reflects the value of technical labor services
.
Make overall plans and take into account the needs of medical development and the affordability of all parties, and regulate the overall level of medical service prices
.
Establish a sensitive and orderly price dynamic adjustment mechanism, carry out regular price adjustment assessments, and adjust the price of medical services in a stable and orderly manner if the conditions for starting are met, straighten out the relationship between price comparisons, support public hospitals to optimize the income structure, and increase the income of medical services (excluding medicines and consumables) , Inspection and laboratory testing income) as a percentage of medical income
.
Speed ​​up the review of new medical service price items
.

 

　　 (5) Deepen the reform of medical insurance payment methods
.
Promote a diversified and compound medical insurance payment method based on disease-based payment, carry out national pilots of payment by disease diagnosis-related groupings, carry out pilots of regional point method total budget and disease-based score payment, and explore bed-based payment and outpatient payment per head Pay
.
Explore the implementation of total payment for close medical consortia, strengthen supervision and assessment, retain the balance, and share the reasonable over-expenditure
.
Scientifically formulate the total medical insurance budget, reasonably determine and dynamically adjust the payment standards according to the type of disease, according to the bed day, and according to the head of the population
.
Standardize the management of medical insurance agreements, clarify the settlement time limit, and refine the settlement rules to ensure that the funds are paid in full and in time
.
Guide and promote public hospitals to actively participate in the reform of the centralized procurement and use of drugs and medical consumables organized by the state, and implement the policy of retention of medical insurance funds
.
Encourage all localities to explore medical insurance payment methods that meet the characteristics of traditional Chinese medicine
.

 

　　6.
Build a new culture of high-quality development in public hospitals

 

　　 (1) Strengthen patient demand orientation
.
Adhere to the faith of a pure doctor, respect the laws of medical science, abide by medical ethics, and follow the technical specifications of clinical diagnosis and treatment to provide the people with safe, appropriate, high-quality, and efficient medical and health services
.
Continuously improve medical services, implement time-based appointments for diagnosis and treatment and centralized appointments for examinations, and carry out services such as clinic (bedside) settlement and mutual recognition of examination and examination results
.
Strengthen patient privacy protection, carry out public welfare and charity, social work, and volunteer services, and build friendly hospitals for the elderly
.
Strengthen health education and publicity, do a good job in doctor-patient communication, increase understanding and trust, and create a good social atmosphere for building a harmonious doctor-patient relationship
.

 

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　　 (2) Strengthen the construction of the leadership team and cadre talent team of public hospitals
.
Select and match the leading members of the hospital, especially the party secretary and dean
.
The party committee secretary and the dean are set up separately.
The party committee secretary generally does not concurrently hold the administrative leadership position.
The dean is a member of the Communist Party of China and serves as the deputy secretary of the party committee
.
Adhering to the principle of party management of cadres, the hospital’s party committee shall formulate and implement specific methods for the selection and appointment of the heads of the hospital’s internal organizations in accordance with relevant regulations on the selection and appointment of cadres
.
Adhere to the principle of party management of talents, improve the management methods for talent training, use and introduction, establish a system for hospital leadership members to contact and serve high-level talents, and explore the establishment of a talent evaluation system focusing on medical ethics, ability, and performance
.

 

　　 (3) Comprehensively improve the quality of party organization and party member team building in public hospitals
.
Promote the standardized and standardized construction of party branches
.
Establish a system and mechanism for the party branch to participate in the discussion and decision-making of major issues such as talent introduction, team building, professional title and rank promotion, performance appraisal, salary distribution, awards and awards, and control politics, medical ethics and medical ethics
.
Implement the "dual leader" cultivation project for party branch secretaries
.
Establish and improve the "dual training" mechanism for cultivating business backbones into party members and party members into business backbones
.

 

　　 (4) Implement the responsibilities of party building in public hospitals
.
Establish and improve the unified leadership of the party committees at all levels, the organization departments take the lead, the health department is specifically responsible, the education, state-owned assets supervision and management and other departments are jointly managed, and the responsibility system and work structure are implemented at each level
.
The party committee of public hospitals assumes the main responsibility for the party building work, the party committee secretary is the first person responsible for the party building work, and other members of the leadership team implement the "one post with two responsibilities"
.
Fully carry out the public hospital party organization secretary to grasp the grass-roots party building report and appraisal, and incorporate the party building work into the hospital grade evaluation and inspection work content, as an important basis for the annual assessment and the selection and appointment of cadres
.

 

　　8.
Strengthen organization and implementation

 

　　 (1) Implement work responsibilities
.
All localities should promote the high-quality development of public hospitals as a key task in deepening the reform of the medical and health system, strengthen leadership responsibilities, guarantee responsibilities, management responsibilities, and supervision responsibilities, and coordinate the promotion of high-quality development of public hospitals and the reform of systems and mechanisms
.
All localities and relevant departments should further deepen the reform of "delegating management and service" and adjust and improve relevant policies to create a good environment for the high-quality development of public hospitals
.

 

　　 (2) Implement input responsibilities
.
Implement the government's investment policy for public hospitals that meet the regional health planning, and implement the investment preference policy for Chinese medicine hospitals, infectious disease hospitals, psychiatric hospitals, children's hospitals, maternity and child care hospitals and other specialized hospitals in accordance with regulations
.

 

　　 (3) Establish an evaluation system
.
The National Health Commission and the State Administration of Traditional Chinese Medicine have established an evaluation index system for the high-quality development of public hospitals, which is organically integrated with public hospitals’ performance evaluation
.
The local government evaluates the high-quality development of public hospitals within its jurisdiction in accordance with the principle of territoriality, and fully considers the actual conditions of public hospitals at all levels and types, and does not implement a “one size fits all” approach
.

 

　　 (4) Summarize the promotion experience
.
Health administrative departments at all levels and Chinese medicine authorities should work with relevant departments to strengthen research and guidance, excavate, summarize, refine, and popularize typical experiences, so as to promote the high-quality development of public hospitals across the country to achieve practical results
.

　　Medical Network, June 7 News On June 4, China Government Network released the "Opinions of the General Office of the State Council on Promoting the High-Quality Development of Public Hospitals (Guobanfa [2021] No.
18)" (hereinafter referred to as the "Opinions"), clearly speeding up The expansion of high-quality medical resources and the balanced distribution of regions require all localities to promote the high-quality development of public hospitals as a key task of deepening the reform of the medical and health system, strengthen leadership responsibilities, guarantee responsibilities, management responsibilities, and supervision responsibilities, so as to create good quality development for public hospitals.
Environment
.

 

　　For the pharmaceutical industry, how patients can truly stay in the county determines the pattern and potential of the entire county pharmaceutical market
.
It is worth noting that the "Opinions" emphasizes the dominant position of public hospitals in China's medical service system, focuses on the deployment and development of compact urban medical groups and county medical communities, and explores integrated management in accordance with the grid layout to meet the clinical needs of major diseases.
Demand-oriented, promote the shift from treatment-centered to health-centered, promote the sinking of high-quality resources, shift the focus of work, and promote hierarchical diagnosis and treatment
.

 

　　Grassroots county market shuffle

 

　　With the goal of establishing and improving a modern hospital management system, strengthen system innovation, technological innovation, model innovation, and management innovation, accelerate the expansion of high-quality medical resources and the balanced distribution of regions, and strive to change the development mode of public hospitals from scale expansion to quality improvement through five years of hard work The operation mode has shifted from extensive management to refined management, and the allocation of resources has shifted from focusing on material elements to focusing more on human resources and technology elements, in order to better provide high-quality and efficient medical and health services, prevent and resolve major epidemics and sudden public health risks, and build a healthy China.
Strong support is the overall requirement of the new policy issued by the State Council
.

 

　　The "Opinions" put forward to lead the new trend of high-quality development of public hospitals and strengthen the construction of clinical specialty
.
To meet the clinical needs of major diseases, we will build clinical specialties, focusing on the development of clinical specialties such as critical illness, tumor, cardiovascular and cerebrovascular, respiratory, digestion, infection, pediatrics, anesthesia, imaging, pathology, laboratory, etc.
, and the development of specialties will promote the improvement of diagnosis and treatment capabilities and levels ; Continuously improve the medical quality management system and standard system, and raise the level of homogeneity of medical services in different regions and different levels of public hospitals
.

 

　　Under the top-level design of the hierarchical diagnosis and treatment system, the primary medical market is ushering in an explosion
.
According to data from Minai.
com, drug sales in county-level public hospitals reached 305.
6 billion yuan in 2018.
Among them, systemic anti-infective drugs, digestive system and metabolic drugs, blood and hematopoietic system drugs, cardiovascular system drugs, and nervous system drugs are among the top Five
.

 

 

　　Although the potential of the county-level grassroots market is worth looking forward to, a comprehensive analysis of the pattern of China's clinical drug market over the past 20 years is not difficult to see that the drug varieties of county-level and lower-level medical institutions are quite different from those of higher-level medical institutions
.

 

　　It is not difficult to analyze the reasons behind this situation.
In the past, there was a shortage of patients at the grassroots level in counties, excellent doctors could not stay at the grassroots level for a long time, the level of diagnosis and treatment of primary medical institutions could not meet the needs of medical services, and patients with intractable and critical illnesses often went to cities.
Grade hospitals, which provide a breeding ground for the proliferation of high-rebate drugs with limited effects
.

 

　　In recent years, under the pressure of policies such as "restraint restriction order", clinical fee control, rational use of drugs, volume purchases, and medical insurance payment reforms, medical management and rational drug use supervision for primary medical institutions have become the focus of local governments in the past few years.
Focused work
.

 

　　The industry generally believes that with the gradual deepening of volume purchases across the country, irregularities such as unreasonable drug use, false high drug prices, and commercial bribery will be severely cracked down.
Measures such as detailed index management and comprehensive and strict control of auxiliary drugs will also Speed ​​up the reshuffle of the grassroots county terminal market
.

 

　　On the other hand, as early as 2019, the National Health Commission issued the "Notice on Promoting the Construction of a Close County Medical and Health Community", which increased the successful experience of the close medical community in Anhui, Sanming, Shanxi, Zhejiang and other places.
It is a county-level diagnosis and treatment policy
.
At the same time, the "Guiding Plan for the Development of a Pilot Construction of a Compact County-level Medical and Health Community" puts forward: "The Medical Community shall implement unified management of pharmaceuticals and consumables, unified drug catalogs, unified procurement and distribution, and unified payment for goods
.
"

 

　　Market analysts pointed out that after the unified management of drug access, it will become possible to carry out mass procurement within the county medical community
.
The total amount of medical insurance is paid and packaged, the medical community reduces the price of drugs in use, and the incentive to implement national centralized procurement prices will increase
.

 

　　Grassroots layout of major diseases

 

　　The "Opinions" also paid attention to the changes in demand for end-use drugs
.
It proposes to actively develop a compact county-level medical community led by county-level hospitals in accordance with the principles of county-town integration and rural integration, strengthen the capacity building of county-level hospitals (including Chinese medicine hospitals), upgrade core specialties, and consolidate support for specialties.
Create superior specialties to improve the prevention and treatment capabilities of tumors, cardiovascular, cerebrovascular, respiratory, digestive and infectious diseases, and increase the rate of treatment in the county
.

 

　　Focusing on the needs of major diseases, truly implementing the plan of "Severe illnesses cannot leave the county" plan, and predicting potential growth opportunities in the primary medical market.
Foreign-funded pharmaceutical companies such as Bayer, Sanofi, Novo Nordisk are expanding their sales teams and targeting the grassroots.
The pharmaceutical market
.
At the same time, domestic-funded pharmaceutical companies such as Kelun Pharmaceutical, Chenxin Pharmaceutical, Wuzhou Pharmaceutical, and Zhenbaodao Pharmaceutical are not far behind, and have deployed ahead of schedule in the rural grassroots pharmaceutical market
.

 

　　These multinational pharmaceutical companies and local pharmaceutical companies that decided to enter the county earlier often have products for the treatment of chronic diseases
.
There are 270 million hypertensive patients and 130 million diabetic patients in China.
They are usually diagnosed in large hospitals .
However, follow-up regular follow-ups and renewed prescriptions usually choose hospitals nearby.
When the top three hospitals market is saturated, it can be imagined that they are in the county.
Pioneering space for medical institutions
.

 

　　However, with the in-depth advancement of graded diagnosis and treatment, county grassroots need not only chronic disease drugs, acute cardiovascular and cerebrovascular diseases represented by stroke and coronary heart disease, and respiratory diseases represented by chronic obstructive pulmonary (COPD) and asthma.
, The contradictions of unmet needs in major diseases such as lung cancer and breast cancer are gradually becoming prominent
.

 

　　From the perspective of terminal sales, the market competition of major disease drugs is divided into several levels: The first level is the core market competition of "top experts", especially a series of national academic leaders and provincial-level big-name experts, which are collectively referred to in the industry.
"KOL"; the second level is "first-line push" competition.
How many medicines can be admitted to hospitals and how many hospitals can prescribe prescriptions.
This requires sales teams to carry out landing work, especially in non-core market competition, which affects the regional/basic level.
The test of commercialization ability is extremely great
.

 

　　The market's response is the fastest
.
With the launch of the new medical insurance catalogue, grassroots market opportunities in the field of critical diseases have emerged, and pharmaceutical companies' own marketing organization structure, resource allocation and marketing methods will also change accordingly.
Major pharmaceutical companies are aggressively deploying to seize market share in the grassroots medical market
.

 

　　For example, AstraZeneca began to establish a county market team as early as 2015.
At present, its county team has covered 42,000 hospitals, 12,000 community hospitals, and 250,000 pharmacies.
Recently, it has cooperated with Junshi Biotech’s PD-1 Trepp Lizumab, Luye Pharma’s Bevacizumab and other tumor varieties have reached strategic cooperation; BeiGene established a "broad market team" responsible for the promotion of all products, including PD-1 tislelizumab, BTK A number of blockbuster products such as inhibitors Zebutinib, Disuzumab, and Lenalidomide have clearly sinking into the grassroots market
.

 

　　In fact, with tumors, cardiovascular and cerebrovascular, respiratory, digestive, and infectious diseases as anchor points, the treatment effect and prognosis of diseases with relatively large bases, there is an urgent need to improve the standardized diagnosis and treatment capabilities of grassroots hospitals
.
Prior to this, the State Council issued the "Opinions on the Implementation of the Healthy China Action", which identified the implementation of the cancer prevention and control action as one of the five actions for the prevention and control of major diseases, and clearly proposed the action to "enhance the ability of cancer diagnosis and treatment in the central and western regions and at the grassroots level.
" Request
.

 

　　The distribution of medical resources in core cities is relatively mature.
Both hardware and software are relatively complete and systematic.
Relatively speaking, there are large regional differences in the broad market, which poses a greater test for the enterprise's grassroots market team
.
At the same time, the main products of the traditional grassroots market are mainly chronic disease general medicines, but the current grassroots market is gradually moving from general practice to specialist development.
Expanding multidisciplinary capabilities around core disciplines will be an important demand pain point
.

 

　　Opinions of the General Office of the State Council on Promoting the High-quality Development of Public Hospitals

 

State 　　Council issued (2021 ) No.
18

 

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

 

　　Public hospitals are the main body of China’s medical service system.
In recent years, especially since the 18th National Congress of the Communist Party of China, the reform and development of public hospitals has been an important part of deepening the reform of the medical and health system, and has achieved significant phased results to continuously improve the fairness of basic medical and health services.
Accessibility, the prevention and control of major epidemics such as the new crown pneumonia, and the protection of the lives and health of the people have played an important role
.
In order to promote the high-quality development of public hospitals and better meet the people's increasing demand for medical and health services, with the consent of the State Council, the following opinions are hereby put forward
.

 

　　1.
General requirements

 

　　Guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implement the spirit of the 19th National Congress of the Communist Party of China and the 2nd, 3rd, 4th, and 5th Plenary Sessions of the 19th National Congress of the Communist Party of China.
Government-led, charity-led, and public hospital-led, adhere to the integration of medicine and prevention, the combination of peace and emergency, and equal emphasis on Chinese and Western medicine, with the goal of establishing and improving a modern hospital management system, strengthening system innovation, technological innovation, model innovation, and management innovation, and speeding up high-quality medical care Expansion of resources and a balanced layout of regions, and strive to through five years of hard work, the development mode of public hospitals has changed from scale expansion to improved quality and efficiency, the operation mode has changed from extensive management to fine management, and resource allocation has changed from focusing on material elements to focusing more on talents and technology elements.
Better provide high-quality and efficient medical and health services, prevent and resolve major epidemics and sudden public health risks, and provide strong support for building a healthy China
.

 

　　2.
Constructing a new system for high-quality development of public hospitals

 

　　 (1) Build national and provincial high-level hospitals
.
With the goal of promoting national medical progress, relying on existing resource planning to set up national medical centers, clinical medical research centers, regional medical centers (all including Chinese medicine, the same below) and traditional Chinese medicine inheritance and innovation centers, forming key clinical specialties and focusing on development To tackle difficult and critical diseases diagnosis and treatment technology, carry out cutting-edge medical science and technology innovation research and achievement transformation, implement high-level medical personnel training, and drive the national medical level to a new level
.
Focus on diseases with high provincial mortality and high transfer rate, strengthen the technical and talent support of national high-level hospitals to provincial hospitals, accelerate the filling of shortcomings in professional specialists, improve provincial diagnosis and treatment capabilities, and reduce cross-provincial medical treatment
.

 

　　 (2) Give full play to the leading role of public hospitals in urban medical groups
.
According to grid-based layout management, the establishment of a compact type led by a tertiary public hospital or a hospital representing the medical level of the jurisdiction (including social hospitals and traditional Chinese medicine hospitals), and several other hospitals, primary medical and health institutions, public health institutions, etc.
as members The Urban Medical Group is responsible for the integrated and continuous medical services such as prevention, treatment, rehabilitation, and health promotion of residents in the grid
.
The hospitals within the group strengthened collaboration, combined with the actual construction of superior professional specialties, formed a development pattern with distinctive characteristics, complementary specialties, misaligned development, and orderly competition, and promoted grassroots medical and health institutions to improve their service capabilities and management levels
.
Promote contracted services of family doctors with general practitioners as the main body, effective linkage of general medicine specialties, and organic integration of medical and prevention
.
Strengthen the standardization of public health departments in public hospitals, and improve public health service capabilities
.

 

　　 (3) Give full play to the leading role of county-level hospitals in the county medical community
.
In accordance with the principles of county-town integration and rural integration, actively develop a compact county-level medical community led by county-level hospitals
.
Strengthen the capacity building of county-level hospitals (including Chinese medicine hospitals), upgrade core specialties, consolidate support specialties, create superior specialties, improve the prevention and treatment capabilities of tumors, cardiovascular, cerebrovascular, respiratory, digestive and infectious diseases, and increase the rate of county visits
.
Strengthen the counterpart assistance of the city's tertiary hospitals to the county-level hospitals, and gradually make the county-level public hospitals reach the second-class level
.
Strengthen the division of labor and cooperation and business integration between county-level hospitals and professional public health institutions, and implement public health services
.
Strengthen the overall management of county-level hospitals to township health centers and village clinics, give full play to the technical support role of county-level hospital medical staff to the family doctor team, and enhance residents' health "gatekeeper" capabilities
.
Accelerate the realization of full coverage of county-run TCM medical institutions, and support TCM hospitals to take the lead in forming a county medical community
.

 

　　 (4) Establish and improve a major epidemic treatment system with hierarchical, stratified and diversion
.
Relying on existing resources, accelerate the establishment and construction of national medical centers, regional medical centers, provincial medical centers, and provincial regional medical centers for infectious diseases, trauma, and major public health incidents
.
Support some powerful public hospitals to moderately construct and develop multi-hospital districts based on the control of the single-unit scale, and quickly switch functions in the event of a major epidemic
.
Each prefecture and city chooses a general hospital to improve the ability to treat infectious diseases in a targeted manner, and upgrade the infrastructure and equipment of the existing independent infectious disease hospitals
.
Relying on a county-level hospital within the county, strengthen the construction of infectious disease departments and relatively independent infectious disease wards
.
Give full play to the unique role of traditional Chinese medicine in the prevention, control and treatment of major epidemics, plan and deploy traditional Chinese medicine epidemic prevention and emergency medical rescue bases, and build a high-level Chinese medicine epidemic prevention team
.
Give full play to the role of military hospitals in the prevention, control and treatment of major epidemics and national biological security defenses
.
Continue to strengthen the management of nosocomial infection prevention and control, and improve the ability to respond to major epidemics
.

 

　　3.
Leading the new trend of high-quality development of public hospitals

 

　　 (1) Strengthen the construction of clinical specialties
.
To meet the clinical needs of major diseases, we will build clinical specialties, focusing on the development of clinical specialties such as critical illness, tumor, cardiovascular and cerebrovascular, respiratory, digestion, infection, pediatrics, anesthesia, imaging, pathology, laboratory, etc.
, and the development of specialties will promote the improvement of diagnosis and treatment capabilities and levels
.
Continuously improve the medical quality management system and standard system, and raise the level of homogeneity of medical services in public hospitals of different regions and levels
.
Increase support for Chinese medicine hospitals
.
Strengthen the construction of superior specialties of traditional Chinese medicine
.
Strengthen the construction of related disciplines in the "double first-class" construction
.

 

　　 (2) Promote medical technology innovation
.
Facing the frontiers of life sciences and biomedical technology, facing national strategic needs and major scientific issues in the field of medicine and health, strengthening basic and clinical research, and promoting the output of new technologies, new products, new programs and new strategies for original disease prevention, diagnosis and treatment
.
Strengthen scientific research to support the response to major epidemics and public health emergencies
.
Promote the transformation of scientific and technological achievements, and the income obtained is mainly used to reward personnel who have made important contributions
.
Improve the service invention system
.
Relying on existing resources, build a batch of national TCM clinical research and scientific and technological achievements incubation and transformation bases, formulate a batch of special TCM diagnosis and treatment plans, and transform into a batch of TCM advanced equipment and new TCM drugs
.
Accelerate the development of commercial health insurance and promote the introduction of new medical technologies into clinical use
.

 

　　 (3) Promote innovation in medical service models
.
Promote the multidisciplinary diagnosis and treatment model
.
Vigorously promote day surgery and increase the proportion of day surgery in elective surgery
.
Implement the overall responsibility system, strengthen basic nursing, and carry out continuous nursing services
.
Set up rational drug use consultation or drug treatment management outpatient clinics, and carry out precise drug use services
.
Vigorously promote the construction of the pre-hospital medical emergency network, innovate the emergency emergency service model, and effectively improve the pre-hospital medical emergency service capacity
.
Innovate the medical-prevention coordination mechanism, and establish a mechanism of mutual restraint between personnel communication, information communication, resource communication, and supervision and supervision
.
Promote the comprehensive diagnosis and treatment model of traditional Chinese medicine, the multi-disciplinary integrated diagnosis and treatment model, and the whole chain service model, and implement the pilot clinical collaboration between Chinese and Western medicine for major and difficult diseases
.

 

　　 (4) Strengthen the supporting role of informatization
.
Promote the in-depth integration of new-generation information technologies such as cloud computing, big data, Internet of Things, blockchain, and fifth-generation mobile communications (5G) with medical services
.
Promote the construction of smart hospitals and hospital information standardization with the “trinity” of electronic medical records, smart services, and smart management
.
Vigorously develop telemedicine and Internet diagnosis and treatment
.
Promote the development and application of intelligent medical equipment such as surgical robots and intelligent auxiliary diagnosis and treatment systems
.
Establish a drug traceability system, and explore the interconnection of prescription information in public hospitals and drug retail consumption information
.

 

　　4.
Enhance the new efficiency of high-quality development of public hospitals

 

　　 (1) Improve the operation and management system
.
Fully implement the basic medical and health and health promotion laws and other laws and regulations to provide legal guarantees for improving the hospital's governance capabilities and standards
.
Integrate medical, teaching, scientific research and other business systems and human, financial, and material resource systems, establish a hospital operation management decision support system, and promote the scientific, standardized, and refined hospital operation management
.
Establish a standard system for disease combination with big data methods to form quantified treatment standards, drug standards, and consumables standards for disease severity and resource consumption in each disease group, and improve the hospital's case combination index (CMI), cost output, and doctor performance Monitoring and evaluation are carried out to guide the hospital to return to its functional positioning, improve efficiency, save costs, and reduce the burden of patients for medical treatment
.

 

　　 (2) Strengthen comprehensive budget management
.
Based on the hospital’s strategic development plan and annual plan goals, implement full-caliber, full-process, full-staff, and full-scale budget management, which runs through budget preparation, approval, execution, monitoring, adjustment, final accounts, analysis, and assessment.
Implement budget performance management in terms of quantity, quality, effectiveness, cost, benefit, etc.
, strengthen budget constraints, and promote the effective allocation and use of resources
.
Regularly disclose the relevant financial information of the hospital and actively accept social supervision
.

 

　　 (3) Improve the internal control system
.
Focus on major risks, major events, and important processes in business management and economic management, carry out risk assessment and internal control evaluation, strengthen internal authorization approval control, budget control, asset control, accounting control, government procurement control, information disclosure control, etc.
, Prevent financial risks, business risks, legal risks and integrity risks
.
Strengthen the process management of the key links of cost consumption, and reduce the energy consumption expenditure of 10,000 yuan of income
.
Promote the "one-stop" service for hospital logistics
.

 

　　 (4) Improve the performance evaluation mechanism
.
Adhere to and strengthen the public welfare orientation, comprehensively carry out the performance appraisal of public hospitals, continue to optimize the performance appraisal index system, and focus on the assessment of medical quality, operational efficiency, sustainable development, and satisfaction evaluation
.
Reform the internal performance appraisal methods of public hospitals, based on the employment contract, focusing on the completion of job responsibilities, and linking the appraisal results with salary distribution
.
Improve the performance appraisal system of urban medical groups and county medical communities, promote the sinking of resources, and improve the ability of grassroots services and the health of residents
.

 

　　5.
Activate the new impetus for the high-quality development of public hospitals

 

　　 (1) Reform the personnel management system
.
Reasonably formulate and implement staffing standards for public hospitals, and establish a dynamic increase mechanism
.
Implement the autonomy of employment in public hospitals, and make overall consideration of the treatment of internal and external personnel in the establishment
.
Implement the job management system, rationally set up positions according to different categories of medicine, nursing, medicine, technology, management, etc.
, scientifically compile job responsibility letters, implement competitive employment and contract management, and encourage talents to stand out
.
Increase the number of nurses and gradually bring the overall medical-care ratio in public hospitals to around 1:2
.

 

　　 (2) Reform the salary distribution system
.
Implement the requirement of “allowing medical and health institutions to break through the current wage control level of public institutions, allowing medical service income to deduct costs and withdraw various funds in accordance with regulations to be mainly used for personnel rewards”, reasonably determine and dynamically adjust the salary level of public hospitals, and reasonably determine personnel expenditures As a percentage of public hospital business expenditures
.
Establish a salary system that mainly reflects job responsibilities and the value of knowledge, implement job-based responsibilities, job-based wages, appropriate responsibilities and salaries, and assessments
.
Within the approved total salary, public hospitals can adopt a variety of methods to allocate independently
.
Hospitals can independently set up salary projects that reflect the characteristics of the medical industry, labor characteristics and job value, give full play to the guarantee and incentives of various projects, and pay more attention to the guarantee function of the salary system
.
Encourage the implementation of an annual salary system for the main responsible persons
.

 

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　　 (5) Deepen the reform of medical insurance payment methods
.
Promote a diversified and compound medical insurance payment method based on disease-based payment, carry out national pilots of payment by disease diagnosis-related groupings, carry out pilots of regional point method total budget and disease-based score payment, and explore bed-based payment and outpatient payment per head Pay
.
Explore the implementation of total payment for close medical consortia, strengthen supervision and assessment, retain the balance, and share the reasonable over-expenditure
.
Scientifically formulate the total medical insurance budget, reasonably determine and dynamically adjust the payment standards according to the type of disease, according to the bed day, and according to the head of the population
.
Standardize the management of medical insurance agreements, clarify the settlement time limit, and refine the settlement rules to ensure that the funds are paid in full and in time
.
Guide and promote public hospitals to actively participate in the reform of the centralized procurement and use of drugs and medical consumables organized by the state, and implement the policy of retention of medical insurance funds
.
Encourage all localities to explore medical insurance payment methods that meet the characteristics of traditional Chinese medicine
.

 

　　6.
Build a new culture of high-quality development in public hospitals

 

　　 (1) Strengthen patient demand orientation
.
Adhere to the faith of a pure doctor, respect the laws of medical science, abide by medical ethics, and follow the technical specifications of clinical diagnosis and treatment to provide the people with safe, appropriate, high-quality, and efficient medical and health services
.
Continuously improve medical services, implement time-based appointments for diagnosis and treatment and centralized appointments for examinations, and carry out services such as clinic (bedside) settlement and mutual recognition of examination and examination results
.
Strengthen patient privacy protection, carry out public welfare and charity, social work, and volunteer services, and build friendly hospitals for the elderly
.
Strengthen health education and publicity, do a good job in doctor-patient communication, increase understanding and trust, and create a good social atmosphere for building a harmonious doctor-patient relationship
.

 

　　 (2) Build a distinctive hospital culture
.
Excavate and sort out the history and cultural characteristics of the hospital and the academic thoughts and noble medical ethics of famous doctors, refine the hospital training, vision, and mission, and gather the spiritual force that supports the high-quality development of the hospital
.
Vigorously promote the great anti-epidemic spirit and lofty professionalism, inspire the inexhaustible motivation of medical staff to be extremely responsible for their work, extremely enthusiasm to the people, and to strive for excellence in technology, to sing the main theme of the sincerity of doctors and the benevolence of doctors, and to provide medical services full of humanistic care Win the trust and respect of patients and society
.

 

　　 (3) Caring for medical staff
.
Establish a long-term mechanism for protecting, caring and caring for medical personnel
.
Improve the working environment and conditions of medical staff, reduce workload, implement a system of study, work, rest and paid leave, and safeguard the legitimate rights and interests of medical staff
.
Encourage public hospitals to care for the growth of young medical staff by setting up youth learning funds and other methods
.
Improve the employee care and assistance mechanism to effectively solve the practical difficulties of medical staff
.
Establish a professional honor system for medical staff
.
Strengthen the safety of hospitals, strengthen the construction of the security team, and improve the necessary security inspection facilities
.
Bring the resolution of medical disputes into the track of the rule of law, improve and improve the mechanism for preventing and handling medical disputes, and severely crack down on medical-related crimes such as medical disturbances and violent injuries in accordance with the law, and resolutely protect the safety of medical personnel
.

 

　　7.
Uphold and strengthen the party's overall leadership over public hospitals

 

　　 (1) Fully implement and implement the dean responsibility system under the leadership of the party committee
.
Public hospital party committees play a leading role in directing direction, managing the overall situation, making decisions, promoting reforms, and ensuring implementation, and collectively study and decide major issues
.
Improve the decision-making system of the hospital’s party committee and dean’s office meetings, establish a regular communication between the secretary and dean, and a report system on the implementation of the dean’s responsibility system under the leadership of the party committee, and strive to build the unified leadership of the party committee, the division of labor between the party and the government, and the coordinated operation of the work Mechanism
.
In the public hospital charter, the content and requirements of party building work are clarified, the mechanism for the party committee to study and determine major issues in the hospital, the party leadership is integrated into all aspects and links of the entire hospital governance process, and the requirements for party building are implemented
.

 

　　 (2) Strengthen the construction of the leadership team and cadre talent team of public hospitals
.
Select and match the leading members of the hospital, especially the party secretary and dean
.
The party committee secretary and the dean are set up separately.
The party committee secretary generally does not concurrently hold the administrative leadership position.
The dean is a member of the Communist Party of China and serves as the deputy secretary of the party committee
.
Adhering to the principle of party management of cadres, the hospital’s party committee shall formulate and implement specific methods for the selection and appointment of the heads of the hospital’s internal organizations in accordance with relevant regulations on the selection and appointment of cadres
.
Adhere to the principle of party management of talents, improve the management methods for talent training, use and introduction, establish a system for hospital leadership members to contact and serve high-level talents, and explore the establishment of a talent evaluation system focusing on medical ethics, ability, and performance
.

 

　　 (3) Comprehensively improve the quality of party organization and party member team building in public hospitals
.
Promote the standardized and standardized construction of party branches
.
Establish a system and mechanism for the party branch to participate in the discussion and decision-making of major issues such as talent introduction, team building, professional title and rank promotion, performance appraisal, salary distribution, awards and awards, and control politics, medical ethics and medical ethics
.
Implement the "dual leader" cultivation project for party branch secretaries
.
Establish and improve the "dual training" mechanism for cultivating business backbones into party members and party members into business backbones
.

 

　　 (4) Implement the responsibilities of party building in public hospitals
.
Establish and improve the unified leadership of the party committees at all levels, the organization departments take the lead, the health department is specifically responsible, the education, state-owned assets supervision and management and other departments are jointly managed, and the responsibility system and work structure are implemented at each level
.
The party committee of public hospitals assumes the main responsibility for the party building work, the party committee secretary is the first person responsible for the party building work, and other members of the leadership team implement the "one post with two responsibilities"
.
Fully carry out the public hospital party organization secretary to grasp the grass-roots party building report and appraisal, and incorporate the party building work into the hospital grade evaluation and inspection work content, as an important basis for the annual assessment and the selection and appointment of cadres
.

 

　　8.
Strengthen organization and implementation

 

　　 (1) Implement work responsibilities
.
All localities should promote the high-quality development of public hospitals as a key task in deepening the reform of the medical and health system, strengthen leadership responsibilities, guarantee responsibilities, management responsibilities, and supervision responsibilities, and coordinate the promotion of high-quality development of public hospitals and the reform of systems and mechanisms
.
All localities and relevant departments should further deepen the reform of "delegating management and service" and adjust and improve relevant policies to create a good environment for the high-quality development of public hospitals
.

 

　　 (2) Implement input responsibilities
.
Implement the government's investment policy for public hospitals that meet the regional health planning, and implement the investment preference policy for Chinese medicine hospitals, infectious disease hospitals, psychiatric hospitals, children's hospitals, maternity and child care hospitals and other specialized hospitals in accordance with regulations
.

 

　　 (3) Establish an evaluation system
.
The National Health Commission and the State Administration of Traditional Chinese Medicine have established an evaluation index system for the high-quality development of public hospitals, which is organically integrated with public hospitals’ performance evaluation
.
The local government evaluates the high-quality development of public hospitals within its jurisdiction in accordance with the principle of territoriality, and fully considers the actual conditions of public hospitals at all levels and types, and does not implement a “one size fits all” approach
.

 

　　 (4) Summarize the promotion experience
.
Health administrative departments at all levels and Chinese medicine authorities should work with relevant departments to strengthen research and guidance, excavate, summarize, refine, and popularize typical experiences, so as to promote the high-quality development of public hospitals across the country to achieve practical results
.