Report card for the first anniversary of Beijing’s medical reform： 12 million primary patients increased.

What is the effect of medical reform for one year? On April 20, Beijing released the "medical reform report card": 210 million outpatient and emergency visits were completed, and 3.9 million discharged patients were treated in an orderly manner; There was a net increase of more than 12 million person-times in primary medical treatment; The average length of stay in tertiary hospitals decreased by 0.7 days … … "The overall situation is stable and orderly, with positive changes, in line with expectations and good response." Lei Haichao, Party Secretary and Director of the Municipal Health Planning Commission, gave comments.

Outpatient and emergency volume

Third-level hospitals reduced the number of primary hospitals increased.

Hierarchical pricing of medical service fees, differentiated medical insurance reimbursement policies and the construction of medical associations have greatly promoted graded diagnosis and treatment.

Over the past year since the reform, the number of outpatient and emergency consultations in tertiary hospitals has decreased by 11.9% compared with the previous year, while the number of outpatient and emergency consultations in secondary hospitals has remained basically the same. The cumulative number of outpatient and emergency consultations in primary hospitals and primary health care institutions has reached nearly 80 million, a net increase of more than 12 million over the previous year, with an increase of 16.1%. The number of consultations in some community health service institutions has increased by about 25% to 30%. Some common diseases have been gradually diverted to grass-roots institutions, which has reversed the situation that the amount of diagnosis and treatment at grass-roots level has declined or wandered for more than a decade, and the overcrowding of large hospitals has been alleviated.

The number of emergency visits by the deputy director and chief physician of the hospital decreased by 9.7% and 25.5% respectively, making it more rational for patients to choose experts to see doctors, alleviating the difficulty of seeing experts, and the limited resources of experts and famous doctors can better serve critically ill patients and prolong the communication time between doctors and patients.

While outpatients and emergency patients are diverted to grass-roots institutions, inpatient medical services are concentrated in tertiary hospitals. Over the past year since the reform, the number of discharges from tertiary hospitals has reached 3.2 million, an increase of 2.7%; The average length of stay was 8.6 days, a decrease of 0.7 days compared with the previous year, and the advantages of hospitalization service in tertiary hospitals were more obvious.

Medical expenses

Save more than 6 billion yuan a year.

The new compensation mechanism of medical institutions has begun to play an effective role. The old compensation mechanism that public medical institutions rely on drug income no longer exists.

The newly established medical service fee can replace the original registration fee, medical treatment fee and drug bonus income in the fourth week after the reform is initiated. When the total income of medical institutions is basically stable, the structure is optimized and the gold content is improved. Compared with before the reform, the disposable income of medical institutions is generally in a good trend, and the new compensation mechanism effectively supports the smooth operation of medical institutions.

Over the past year, the increase of medical expenses has declined. The city’s medical expenses only increased by about 5%, which is the lowest year since 2000. Medical institutions have saved more than 6 billion yuan in medical expenses. The total amount of drugs purchased in sunshine was 62.4 billion yuan, saving 5.51 billion yuan in drug expenses. Only one measure of drugs purchased in sunshine reduced the overall drug price by 8.8%. The proportion of drugs in secondary and tertiary hospitals in the city decreased by 9 percentage points.

Medical insurance assistance

Reduce personal burden by nearly 60 million yuan

The city will include all 435 medical services that meet the requirements in the scope of medical insurance reimbursement; Open up the difference in the scope of reimbursement of medical insurance drugs between community hospitals and large hospitals. Targeted implementation of the reform method of paying the hospitalization medical expenses of mental patients according to the fixed bed day, reducing the burden of special people, and the personal burden of urban and rural medical insurance patients is generally stable. Taking the basic medical insurance for urban workers as an example, as of April 7 this year, the medical insurance fund has increased its special expenditure by 2.28 billion yuan and reduced its personal burden by nearly 60 million yuan.

People in need have also received effective assistance. The proportion of outpatient assistance and hospitalization assistance for social assistance objects was adjusted from 70% to 80%, the annual ceiling line of outpatient assistance was adjusted from 4,000 yuan to 6,000 yuan, and the annual ceiling line of hospitalization assistance was adjusted from 40,000 yuan to 60,000 yuan; The proportion of major disease relief was adjusted from 75% to 85%, and the annual relief ceiling line was adjusted from 80,000 yuan to 120,000 yuan. The per capita burden of social assistance objects such as outpatient service, hospitalization and major disease assistance policies has been reduced by about 30%.

Medical institutions in this city have achieved results in improving medical services. Promote the appointment service to shorten the appointment time to less than one hour; Strengthen in-hospital hierarchical referral, and the number of well-known expert teams has reached 113.

The 261 community health service centers in the city implemented the service mode of "diagnosis first, settlement later", and reduced the medical service fee for the elderly over 60 by 26.65 million person-times. Patients with chronic diseases such as hypertension and diabetes can use 105 kinds of commonly used drugs in the community, and prescribe more than 40,000 "two-month long prescriptions" to save the cost of medical treatment for patients.

Hot spot response　　

How do community hospitals attract patients?

Lei Haichao: To make the graded diagnosis and treatment system develop deeply and persistently, we must further improve the ability of grassroots services.

At present, the number of patients in community medical institutions is increasing. In the future, we will consider setting up certain rehabilitation and long-term nursing beds in community health service centers according to the needs of residents.

We also need to train more pediatric graduates. By 2020, each community health service center must have at least one doctor who can carry out diagnosis and treatment of common and frequently-occurring diseases in pediatrics.

How to break the shortage of drugs in the community?

Lei Haichao: At present, some patients report that some drugs cannot be prescribed in community health service institutions, mainly because the space of community health service institutions is limited. At the same time, it is necessary to further explore the characteristics of drug use for patients who are diverted from tertiary hospitals and secondary hospitals to the grassroots level and optimize drug allocation. At the same time, explore and promote the innovation of pharmacy management mode in community medical institutions.

Will the diseases with long prescriptions be expanded?

Lei Haichao: This year, the city will study increasing the number of long prescription diseases in community health service institutions and adjusting the long prescription drug list in a timely manner, so as to truly solve the demand for drugs and medical treatment at the grassroots level.

Check how to run less.

Lei Haichao: In the future, information technology will be used to improve the diagnosis and treatment capabilities of community primary medical and health service institutions. For example, we are considering establishing consultation or diagnosis centers for inspection, pathology, imaging and electrocardiogram. Through the Internet+medical technology, patients can complete the corresponding examination at the grassroots level, and then transmit the relevant information to the secondary and tertiary hospitals to complete the diagnosis, so as to ensure and improve the quality of patients’ treatment at the grassroots level in the community.

Progress in medical reform　　

20% experts give priority to staying in the community.

Li Sufang, deputy director of the Municipal Development and Reform Commission, revealed that the next step will be to improve the quality of primary health care services, ensure that patients can see diseases in the community, get medicines, and be good gatekeepers of people’s health.

The city will continue to increase the training of primary medical service personnel, especially the training of general practitioners, introduce a number of talents in short supply, and enrich the front-line strength of primary medical service. Give full play to the role of medical associations hand in hand, and give priority to leaving 20% of the expert sources in large hospitals to community medical institutions as an important channel for making appointments for referral. In the future, the source of the secondary and tertiary hospitals in the medical association of this city will be open and inclined to the primary medical and health institutions, and the on-demand directional referral appointment will be realized in 2020. At the same time, encourage and guide doctors from large hospitals to visit the community, and improve the ability to guarantee primary drugs.

The city will continue to promote the adjustment of medical service prices. It will also improve the procurement mechanism of drugs and medical consumables, and further reduce the space of inflated prices of pharmaceutical consumables; Improve the supervision mechanism, promote the construction of the whole supervision mechanism of medical behavior, and promote the information disclosure of the price, average cost and drug use of pharmaceutical consumables in hospitals.

New things in medical reform　　

Century altar hospital opens special clinic in community.

After the medical reform, the Millennium Hospital opened a special clinic in the community to attract a large number of patients. For example, the clinic for lumbago and leg pain at Fuxingmen Community Station, the clinic for constipation at Ronghui Clinic and Lianhuachi Community Station; Cough clinics of ganjiakou Community Health Service Center and Wanshou Road Community Health Service Center, the governing units of the Medical Association.

"The demand for these clinics is very high, and our hospital regularly sends experts to the grassroots every week." Xu Jianli, president of the Millennium Monument Hospital, revealed that the hospital also organized experts to go to the community to make house calls, make rounds, teach and give health talks in a number of primary medical institutions. According to statistics, last year, experts made a total of 1517 visits to the grassroots, 156 rounds and 286 consultations. "Residents have enjoyed the diagnosis and treatment services of tertiary hospital experts in the community, achieving a high level of medical continuity." Xu Jianli said.

Xuanwu hospital reduced unreasonable drug costs by 3.157 million yuan.

During the implementation of medical reform, in order to ensure the safety and benefits of patients’ medication, xuanwu hospital adopted a prescription review pre-system to expand the scope of prescription review. Over the past year, through prescription review and rational drug use monitoring, as well as the implementation of prescription/doctor’s advice pre-audit system, the unreasonable drug costs for patients have been reduced by 3.157 million yuan, the average outpatient drug costs have decreased by more than 20 yuan year-on-year, and the average drug costs for discharged patients have decreased by 25.19% year-on-year.

The proportion of drugs in the Third Hospital of Beijing Medical University decreased by 14.7% compared with the previous year.

Since the medical reform, the Third Hospital of Beijing Medical University has launched a series of measures to control the increase of medical expenses, drug expenses and sanitary materials expenses and reduce the burden of medical expenses for patients. For example, in drug management, the hospital set up a list of key monitoring drugs based on evidence-based, combined with the special management of antibacterial drugs, tumor treatment drugs and auxiliary drugs, and further reduced the proportion of drugs by guiding rational drug use. In 2017, the proportion of drugs in this hospital was 32.39%, which was 14.7% lower than the previous year.

Chaoyang hospital

Shooting in the community

The diagnosis is in the top three

During the medical reform, Chaoyang Hospital established the first remote imaging diagnosis center in this city. The patient "shoots" in the community hospital nearby, and the experts in the radiology department of Chaoyang Hospital will read the film remotely through the Internet and complete the diagnosis report in time. At present, the hospital’s remote imaging diagnosis center can issue radiation diagnosis reports for 7 community health service centers in Chaoyang District.