Make the doctor more convenient, reduce the burden, more comfortable

    Source: People's Daily

    Original title: Make it more convenient to see a doctor to reduce the burden to see a doctor more comfortable

    Reporter: Yang Shang, Zhifeng Zhang and Nian Liu

    Deepening medical reform is at hand

    What is your idea of health care reform?

    Some people say that medical reform is a big chess game involving a series of policies and institutions.

    Some people say that medical reform is a report card, collecting one item of work and data;

    Some people also say that medical reform is a sense of access, connecting scenes and memories, always can make the "you, me and him" as an individual real sense.

Firmly grasp this matter, the people first, life first should be the whole Party and society must firmly establish an idea."

The Decision of the Third Plenary Session of the 20th Central Committee of the Communist Party of China proposed to "deepen the reform of the medical and health care system" and "implement the strategy of giving priority to health development."

In this year's "Government Work Report", medical reform is reflected in the lines: "Promote the expansion and sinking of high-quality medical resources and a balanced regional layout, implement a strong medical and health care project", "improve the drug price formation mechanism, formulate a list of innovative drugs, support the development of innovative drugs and medical devices", "deepen the reform of medical insurance payment methods, promote graded diagnosis and treatment"...

Deepening medical reform is also in everyone's side and eyes.

A string of codes, small and large. No need to bring a card, with the medical insurance code in the mobile phone, you can see a doctor, buy medicine, or remote medical records, online medical insurance business, but also bind the family account, benefit a family. Although the bar code is small, the function is convenient and powerful, behind which the medical insurance reimbursement is reducing the burden and supporting the bottom for urban and rural residents.

A class I drug. It goes down, it goes up. Anti-cancer targeted drugs such as Gleevec, famous for the movie "I am not a Medicine God", are no longer unattainable. On the one hand, there are national health insurance negotiations to reduce the high drug prices "down"; On the other hand, in addition to reform and innovation, more targeted drugs are included in medical insurance, and the reimbursement ratio is increased, while strengthening independent research and development to help the popularity of domestic drugs and the sea. From imitation to creation, from weakness to strength, the vision continues to become a reality.

The sick have access to medical care, the whole people are healthy, and the promise is fulfilled in every case.

More convenient to see a doctor

Do not cross provinces to see serious diseases, experts nearby to see chronic diseases, family doctors manage minor diseases

"The difficulty of seeing a doctor" lies in the imbalance of medical resources. The way to crack is to optimize the configuration, so that high-quality resources can be empowered at the grassroots level and used in the right place.

——Let people in the Midwest see experts from the East locally.

Since 2019, Beijing, Shanghai, Guangdong and other places have selected high-level medical institutions as export hospitals, and in the form of inter-provincial cooperation, 125 national regional medical centers have been built in regions with relatively weak medical resources, such as the central and western regions, to help local patients "treat serious diseases without going out of their own provinces".

In 2023, Beijing Jishuitan Hospital Guizhou Hospital was officially inaugurated. Guiyang resident Zhao Huili finally looked forward to the Beijing expert at her doorstep.

Chiu Huili suffered from severe lumbar spinal stenosis and local doctors advocated conservative treatment as she was over 70 years old. Jishuitan hospital deputy chief physician Marseille arrival, gave Zhao Huili choice of surgery hope. Dr. Ma studied and judged in detail, developed a personalized treatment plan, and finally completed the operation successfully. One month after the operation, Zhao Huili, who came to the hospital for review, stood upright and walked naturally.

——Let the masses look at experts from Top three hospitals at their doorsteps.

"Take the medicine on time, observe your physical condition at any time, and contact me as soon as you feel chest tightness or difficulty breathing." Guan Hongquan, a cardiologist at Wuhan Union Medical College Hospital, told Hou Bangqi, 78, in his consulting room at the Junshan District Health Center in Wuhan, Hubei province.

Hou Bangqi, who lives in Xiaojunshan community under the jurisdiction of Junshan Street, suffers from chronic heart failure, high blood pressure and other elderly diseases. Hou Fei son usually take him to see the official red right to see a doctor, only 15 minutes by car.

"It takes half as long as going to Chegu Hospital. You don't have to wait in line, you can see it when you come." Hou Fei said, "In recent years, the official doctor gave his father follow-up, and he understood the condition." The old man is recovering well. He used to use a wheelchair, but now he can take care of himself."

Guan Hongquan works at the health center every Wednesday. Since 2019, Wuhan Union Medical College Hospital and Junshan Street Health Center have built a compact medical union, and five doctors from different departments will be sent to the health center for regular consultations every week. In 2022, Guan Hongquan got involved. More than two years, by his regular follow-up patients have been more than a dozen.

In recent years, the construction of intensive medical union has been continuously promoted. Many street and community health institutions are deeply integrated with higher level hospitals, and experts are stationed for a long time with a fixed cycle to diagnose and treat common diseases and common diseases nearby.

——Let family doctors become health stewards around the people.

Headache, brain heat, chronic disease control, do not always go to the hospital. At present, almost all prefectures, cities and counties (cities and districts) nationwide have contracted family doctor services, and more than 480,000 family doctor teams have been formed to provide health management and health follow-up services for contracted residents, especially key groups such as chronic disease patients and the elderly.

In Shankou village, Gaoqiao Town, Shaxian District, Sanming City, Fujian Province, 25-year-old village doctor Lin Shijiang is the family doctor of his fellow villagers. The elderly Liu Aizhen suffers from diabetes and has been regularly followed up by Kobayashi in accordance with basic public health service norms.

In order to let the old man can contact themselves at any time, Lin Shijiang early put the mobile phone number into the other party's mobile phone. Liu Aizhen usually uncomfortable, will dial the phone in the past, "Doctor Lin riding a motorcycle, arrived in a few minutes."

Because of the treatment of stomach disease, Liu Aizhen's medication has changed, and the blood sugar control effect is not good. Lin Shijiang help contact the town health center, find the family doctor team leader Zhang Juanjuan. Zhang Juanjuan coordinated the endocrine department of Shaxian District General Hospital doctors, through the remote platform to Liu Aizhen consultation, prescribed the appropriate drugs.

——Telemedicine will benefit people in remote areas.

Medical aid to Tibet provides high-quality medical resources to remote areas. Since 2015, 10 groups of nearly 2,000 medical personnel have left for Tibet. At present, Tibet has realized that more than 400 major diseases cannot leave the autonomous region, more than 2,400 general diseases cannot leave the prefectures and cities, and the vast majority of minor diseases can be effectively treated without leaving the townships or streets.

Dr. Hu Jianwei is from Zhongshan Hospital of Fudan University in Shanghai. He still remembers that when he met Zhuoma, a 15-year-old girl in Shigatse People's Hospital, she had a lot of vomiting blood and was in emergency condition.

Dr. Wu organized local doctors to perform a minimally invasive surgery to stop the bleeding. After examining the cause, it is difficult to find out. "Use the remote diagnosis and treatment system to consult with specialists in the rear." Hu Jianwei made a quick decision. After discussing with experts from Zhongshan Hospital Affiliated to Fudan University and Shanghai Children's Hospital, Hu Jianwei adjusted the examination plan to target the cause. After half a month of treatment, Zhuoma recovered and smiled.

Construction of national regional medical centers, implementation of basic public health service projects, promotion of family doctors contracted services into rural areas, medical assistance to Tibet and remote consultation... A series of medical reform measures to seek balance and promote sharing has enabled urban and rural residents, especially people in remote areas, to enjoy quality medical services nearby, effectively easing the difficulty of seeing a doctor.

This year's "Government Work Report" proposes to "improve wards and diagnosis and treatment conditions, and continue to improve medical services centered on patients." Measures are being implemented to ease the difficulty of seeing a doctor.

Reduce burden by seeing a doctor

Medical insurance negotiations, centralized procurement to reduce drug prices, long care insurance to unload the burden

"Seeing a doctor is expensive" because of the high price of some drug supplies and the lack of sharing mechanism. The way to crack is to squeeze out the price of "water" and further play the role of medical insurance.

——Making life-saving drugs available and affordable to the people.

Since 2018, the medical insurance drug catalog has been adjusted every year, and many new drugs have been included in the treatment fields of tumor and rare diseases. The advantage of medical insurance "group purchase" has significantly reduced drug prices, and the negotiation access mechanism has made many "high price drugs" open "civilian prices". By the end of 2024, the drugs negotiated during the agreement period have benefited nearly 900 million people, reducing the burden on patients by more than 900 billion yuan.

Xiao Shi, a resident of Jinan, Shandong province, is one of the beneficiaries. He was diagnosed with the rare disease spinal muscular atrophy (SMA) when he was 10 months old.

In 2019, specific drugs adapted to SMA were approved for sale in China. One cost nearly 700,000 yuan, the patient will use 6 in the first year, and then 3 per year. In 2021, in the form of charitable donations, the drug will be reduced to 550,000 yuan. In March 2021, Little Stone's parents borrowed enough money to raise 550,000 yuan to give their child a special medicine.

In November 2021, SMA special drugs were successfully negotiated and officially entered the medical insurance catalog the following year. In 2022, combining drug price reduction and medical insurance reimbursement factors, the injection of special drugs by small stone only cost about 40,000 yuan. There are about 30,000 people with the same condition nationwide. Now, they have access to Medicare's life-saving drugs.

——To further reduce the burden of medication on patients.

In addition to the negotiation of the medical insurance catalogue to allow more new and good drugs to be included in the medical insurance, for common drugs and "old drugs" that have passed the patent period and are produced by a number of enterprises, the state also organizes centralized procurement with volume to form a reasonable price in the competition. In terms of drugs, the state has organized 10 batches of collection and purchased 435 kinds of drugs, with an average price reduction of more than 50%. High value medical consumables such as heart stents, artificial joints, intraocular lenses and cochlear implants have also fallen significantly.

In early 2020, Lai Xiaoling, a resident of Xiangtan City, Hunan Province, who has more than 800 degrees of myopia in both eyes, went to the central hospital for ophthalmology. The diagnosis was cataracts in both eyes, requiring intraocular lenses.

     "At that time, one of the artificial lenses was 12,299 yuan." Lai Xiaoling has a deep memory of this, "it is difficult to bear it all at once, so I first gave the left eye with poor vision surgery and made do with the right eye."

Over time, she felt the loss of vision in her right eye. She visited the eye department of the downtown hospital again. The intraocular lens used in that year was included in the collection and further reduced to 6,990 yuan. After surgery, she could read the instructions on the bottle with her right eye.

The collection policy makes the price drop, but "the price reduction cannot reduce the quality". This year's "Government Work Report" proposed to "optimize the drug and consumable collection policy, strengthen quality assessment and supervision, so that people can feel more at ease with medication."

For a long time, the drug regulatory departments have strictly supervised the quality of drugs, especially the quality of selected drugs, adhere to "full coverage" and "zero tolerance", and implement two "full coverage" of selected enterprises inspection and selected varieties sampling inspection of national collected drugs every year, which currently covers all varieties of used national collected drugs and more than 600 drug manufacturers involved. In general, China's drug safety situation is generally stable, and drug quality continues to improve.

——To ensure that people with severe disabilities are cared for and well cared for.

In 2016, Nantong, Jiangsu Province, was included in the first batch of national long-term care insurance pilot cities. At present, the pilot has been steadily advancing across the country, covering 49 cities and nearly 190 million people, with a total of more than 2.7 million disabled people enjoying the treatment. In Nantong, disabled level 2 and above insured persons can enjoy long-term care insurance treatment. In terms of financing standards, the insured person pays 30 yuan, and the rest is transferred by the medical insurance fund and government financial subsidies.

Shen Nienying, a resident of Nantong, selected a care service agency, and two nursing staff came to the house twice a week to provide care services such as bathing and haircuts for long-term bedridden mothers, each time for about 1 hour. Later, her disabled brother also began to enjoy such care.

     "I have two severely disabled people in my family, each of whom spends less than 2,000 yuan per year on personal care and can enjoy more than 20,000 yuan in care treatment." Shen Nian Ying fingers to settle accounts.

Nantong's long-term care insurance designated service agencies have grown from 2 to 361, driving nearly 10,000 people to employment, of which nearly 8,000 are "4050" people with employment difficulties.

     Adjust the list of medical insurance drugs, and carry out negotiations on medical insurance drug access; Organize centralized procurement of drugs and high-value medical consumables, and continuously increase the types of collection; Steady progress has been made in the trial of the long-term care insurance system to solve the problem of caring for severely disabled people... A series of medical reform measures to reduce the burden and increase well-being have helped patients effectively reduce the burden of seeing a doctor.

     This year's "Government Work Report" proposed to "deepen the public-welfare oriented public hospital reform", "improve the drug price formation mechanism", "improve the basic medical insurance financing and treatment adjustment mechanism"... To alleviate the "high cost of seeing a doctor", the policy is making efforts.

Seeing a doctor is more comfortable

Improve medical experience and enhance patient experience

At present, the people have a higher demand for health, not only to see the disease, see the disease well, but also to see the doctor more comfortable, more considerate service. Therefore, it is necessary to further deepen reform, take improving the people's experience of seeing a doctor as the starting point, strengthen institutional cohesion, open up the blocked points, crack the difficulties, and optimize the whole process of medical treatment.

——Allowing patients to make appointments at their fingertips.

"In the past, registration was like 'grab a ticket', now you can make an accurate appointment with your mobile phone, and even check items can be made at one time, which is really easy!" Li Tingting, a doctor at Zhengzhou Central Hospital affiliated to Zhengzhou University in Henan province, completed the whole process of booking from registration to inspection by mobile phone operation in just 10 minutes.

"Forgot your health insurance card? Just brush your face!" In the outpatient hall, the guiding nurse is guiding an elderly person to register using the face recognition function of the self-service machine.

"Our hospital has launched nine kinds of appointment methods, including phone, wechat, APP, self-service machines, etc., and supports various authentication methods such as ID card, medical insurance card and face recognition." Wei Haiying, director of the outpatient office of Zhengzhou Central Hospital affiliated to Zhengzhou University, said that for the elderly, the hospital also retains telephone reservations and on-site manual services, and volunteers teach self-service machine operation by hand.

——Let patients "one-stop" to complete the medical treatment process.

"With a 'one-stop' service center, you can rest assured that your family will see a doctor by yourself." Not long ago, Uncle Zhang, an 80-year-old resident of Kunming, Yunnan Province, came to the First Affiliated Hospital of Kunming Medical University for medical treatment because of knee pain. With the enthusiastic help of the service center staff, he successfully completed all the medical procedures in only one hour.

In order to optimize outpatient services, Yunnan has built "one-stop" service centers in public hospitals at all levels in the province to improve patients' medical experience. In the First Affiliated Hospital of Kunming Medical University, the "one-stop" service center integrates the resources of outpatient, inpatient, medical insurance, financial and other departments, and can realize the "one-stop" business of consultation, consultation, appointment, medical insurance, hospitalization, complaint acceptance and other services. The center also opens a green channel for the elderly over 80 years old and arranges special personnel to accompany them to medical treatment.

——Making it easier to reimburse medical treatment in different places.

      From the "round trip" to the local "brush face settlement", the cross-province medical settlement has quietly changed the life of Li Zengan, a retired teacher in Shijiazhuang, Hebei province.

Travel to Beijing, see a doctor, treatment, before and after pad a lot of money; A week later, I had to go back to Beijing to make copies of medical records, get receipts, and then submit them to the local medical insurance department for reimbursement. Talking about the rush to seek medical treatment, Lao Li suppressed a word: "annoying!"

…………

Travel to Beijing, see a doctor, treatment, before and after pad a lot of money; A week later, I had to go back to Beijing to make copies of medical records, get receipts, and then submit them to the local medical insurance department for reimbursement. Talking about the rush to seek medical treatment, Lao Li suppressed a word: "annoying!"

"It's different now. You can just swipe your face and get reimbursed." Li Zengan said. Thanks to the expansion of the scope of direct settlement of cross-provincial medical treatment, covering more than 600,000 fixed-point medical machines