Health Planning Commission: 21 provinces have met the 90% much disease | see | health care _ news

Original title: Health Planning Committee: assessment said that 21 provinces have met the 90% ill patients out of the province

News for the 12 session of the national people's Congress meeting held on March 8 at 15 o'clock press conference, State health and family planning Commission Li bin, MA xiaowei, Deputy Director and Deputy Director Wang Peian "implementation of a comprehensive two-child policy" issues related to answer Chinese and foreign journalists ' questions.

Chengdu TV Reporter: Director Li also referred specifically to a big hospital doctors more grass-roots down, I noticed that this year's Government work report also specifically mentioned in the pilot cities to carry out classification of diagnosis and treatment about 70%, Li bin, Director of 70% pilot mainly in which province? Grading diagnosis and treatment in the city at present what difficulties have been encountered and difficulties? Next health diagnosis and treatment planning Commission will take measures to promote the grade to allow more production in small towns, people will be able to watch at home? Thank you.

Nancy: in this year's Government work report, the Prime Minister put forward major tasks of one item, 70% rank clinic pilot cities. I think this 70% includes comprehensive reform pilot provinces, including pilot cities. Last year, we have undertaken a public hospital reform with pilot programs in 100 cities, this year we will expand to 200 cities. In this regard, last night I saw a material, a large analysis of the data, I'd like to introduce you, and then there are some issues to answer Mr MA xiaowei.

Bin: I yesterday night see of material is Tsinghua University National Hospital Management Institute and Beijing public health information center carried out of a third party evaluation assessment, on 29 a province 593 by hospital 40.5 million discharged patients of big data analysis, this sample is enough big of, through on they medical records of Home data analysis and site of assessment, General proposed has such some welcome of changes, I with everyone said about. Flat growth in a tertiary University Hospital Clinic, overcrowding and the siphon phenomenon tends to ease the annual outpatient visits increased by only 3.4%, 3.7% hospital services decline, suggesting a change in hospital services. Second grade Clinic began to take shape, 21 provinces did 90% patients out of province, 75% patients at the city's Hospital, within the County attendance rates enhanced, some counties have been at or near the 90%. Absorb the primarily patients from other provinces are concentrated in Beijing, Shanghai, Guangdong, Sichuan, Jiangsu, go to our medical resources distribution, had a more straightforward reference. Patients are from outside Beijing in North China, northeast of patients, patient is the Yangtze River in Shanghai, Guangdong South China around, of course, you know West of Sichuan, southwest of this, making our next step to speed up the establishment of a regional medical center, including enhancing the capacity of medical services in some areas. Now, basic enough hardware, mainly connotation promotion, consistent with our overall demand for China's economic and social development. We have to elevate the content, improve the quality and level, including integration of Beijing, Tianjin and Hebei to promote quality medical resources distribution, like the Beijing children's Hospital in this area with the head, they organized a children's hospital service network, makes this medical situation has been greatly improved.

Nancy: we specifically where he opened a national conference last year. In addition, like Henan, itself has a population of more than 100 million, the fuwai hospital in Beijing has come to Henan, of cardiovascular disease treatment center is under construction in East China, this piece can be radiated. Next, the northeast to strengthen capacity-building in regional medical center, Northwest of this layout and capacity-building should be strengthened, including places like in Shaanxi, the layout makes the past structural contradictions can be resolved gradually.

Nancy: some of the following specific issues, Comrade Xiao Wei give you answer, I told everyone last night to see the data. Also add a few words, the third positive changes, national per capita hospital costs fell 1.4%, although it's not much, but the trend is good, average length of 9.6 days continue to shorten, which lessened the burden of the masses. Third-party grass-roots research of Beijing Normal University, per capita of township hospital and drug 6.1% and 7.1%, urban community health center by 2.1% and 5.2%, this is what I saw last night's big data analysis results.

Ma xiaowei: Director Li has made it very clear. It should be said that this round of reform of one of the most important initiatives is the graded system of diagnosis and treatment is proposed. In 2009, the start of the new round of health reform, put forward the "basic health services for all" such a goal.

Ma xiaowei: what kind of health care system to implement "all"? How to solve our health care resources shortage, unreasonable distribution, quality resource shortage problem? Clearly let us use limited medical resources to solve the medical problems of 1.3 billion people. Difficult and expensive problems, core performance as the contradiction between supply and demand, serious illness disease flocked to large urban hospitals, patients also flock to big hospitals in rural areas of the city, which appeared empty hospitals overcrowded and small hospitals. Grading diagnosis and treatment are important measures to alleviate the difficulty and high cost, but also to ensure implementation of a treatment system for all, is the restructuring of the pattern of medical resources in China, but also the medical habits change. The success of this strategy will take time, but in a sense, classification date of diagnosis and treatment, is a success for the reform of public hospitals in China at the time.

Ma xiaowei: grading diagnosis there are four main characteristics: one is primary the first consultation, the second is two-way referral, three simultaneous up and down, four are acute and slow diagnosis. Key is primary the first consultation, we only see a doctor in the grass-roots level, then to the hospital in order to meet the medical order, also in line with international practices, country rating was not the international clinic, the doctor is in accordance with the level of medical institutions came, so that resources can be put to effective use. Common diseases and frequently-occurring diseases in primary health care institutions, once severe at higher medical institutions. We want to establish such a pattern of medical treatment, call for grass-roots consultation.

Ma xiaowei: thus, to satisfy diagnosed problem is the problem, human resources is a matter of policy, policy issues are two issues, one is the treatment, is a career problem. General practitioners in training of primary care doctors, some excellent doctors, go to the grass-roots, these two issues must be resolved. Treatment is the way we want to, one is the Government, five years before we have made great achievements, basic medical and health institutions of the Government operating funding, assistance funds to give a lot of input. Second, price reforms, and improved the primary doctor's consultation fee. Third, the Equalization of public health services, this year is 45 dollars per person, can be packaged to primary care doctors. Four is the pay-for-performance piece, a considerable portion of income as a performance-related pay, for assistance. From the perspective of general practitioners in Shanghai at the grass-roots, per capita income has reached 120,000 yuan, Beijing municipal personnel subsidies to add 30% the end of this year, all income used for primary care doctors, such a powerful solution to the primary doctor's treatment.

Ma xiaowei: second career problem, Shanghai is also being considered, we are also considering, professional evaluation problem brewing for primary care doctors, professional evaluation criteria physicians and major medical institutions separately, so that the future of his career. Grass-roots to develop essential drugs list, basic medicine and hospital medicine. At the end of this year, Beijing is ready to put grass-roots medical SOEs and three-tier drug list in hospital, medical doctor pharmacy of the people, especially the common diseases and frequently-occurring diseases, good medicine in large hospitals, you can go to the grass-roots to get the medicine, not even to big hospitals to take drugs.

Ma xiaowei: If patients have to go to the grass-roots policy, much is reimbursed at the grass-roots, in the above claim less. Read the disease at the grassroots level, upward referrals, cancel the pay line. Patients transferred from the top down, this lump sum the total income not included in the basic medical care for the grass-roots level, doctors have incentive to transfer patients, patients are motivated to go and solve the problem of primary first consultation and referral. Grass-roots first diagnosed problems broke, grading is expected to exceed the problem of diagnosis and treatment.

Ma xiaowei: last I to said a sentence, Lee Director just told, actually is four sentence words: to regional medical center for hand, to focus subject for support, solution regional separate of problem, don't are to North, and Shang, and wide doctor, all district are has medical center; to County Hospital construction for hand, solution urban and rural separate of problem, people sick not town, 90% can in County Hospital get solution; to disease species for hand, chronic diseases, and common, and disease, including acute of some disease, these disease separate, above hospital see urgent of, Following the hospital to see slower and hurry slowly apart; while addressing the separate issue. So with time, we mix a medical resources and policies in place, the medical pattern of our country is an orderly pattern, the distribution of health care resources is a reasonable distribution, health care expenditures can do it carefully, just right. Grading diagnosis and treatment system can be implemented, addressing medical issues can be raised to a new level.

Responsible editor: Liu Debin SN222

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卫计委：21省份已做到90%大病患者不出省|看病难|医改_新闻资讯

　　原标题：卫计委：评估称21个省份已做到90%大病患者不出省

　　十二届全国人大四次会议新闻中心3月8日15时举行记者会，国家卫生和计划生育委员会主任李斌、副主任马晓伟和副主任王培安就“实施全面两孩政策”的相关问题回答中外记者的提问。

　　成都电视台记者：刚刚李主任也专门提到了要大医院好医生多向基层下沉，我注意到今年的政府工作报告当中也专门提到在70%左右的地市来开展分级诊疗试点，请问李斌主任，这70%的试点主要分布在哪些省份？目前在地市开展分级诊疗当中遇到了哪些难点和困难？下一步卫计委会采取哪些措施来推进分级诊疗，让更多小城镇生产在地市的老百姓在家门口就能看好病？谢谢。

　　李斌：总理在今年的政府工作报告中提出的重大任务中就有一项，70%的城市要进行分级诊疗的试点。我想，这70%就包括综合改革的试点省，包括试点城市。去年我们已经在100个城市开展了公立医院改革试点，今年要扩大到200个城市。在这方面，昨天晚上我刚刚看到一个材料，一个大数据的分析，我想把情况跟大家介绍一下，然后还有一些问题请马晓伟先生来回答。

　　李斌：我昨天晚上看到的材料是清华大学国家医院管理研究所和北京公共卫生信息中心开展的一个第三方评价评估，对29个省593所医院4050万出院病人的大数据分析，这个样本是够大的，通过对他们病案的首页数据分析和现场的评估，大体上提出了这样一些可喜的变化，我跟大家说一下。一是三级大医院诊疗量增长平缓，人满为患和虹吸的现象趋于缓解，全年门诊量只增长了3.4%，住院服务量下降3.7%，这表明大医院的服务总量发生了一个变化。二是分级诊疗初见端倪，21个省做到了90%的大病患者不出省，75%的患者选择在本市的医院住院治疗，县域内就诊率也进一步提升，有的县已经达到或接近了90%。吸收外省患者多的主要是集中在北京、上海、广东、四川、江苏，这样就给为我们调整医疗资源布局，有了一个比较直观的参考。北京外面来的病人主要是华北、东北的病人，上海是长江流域的病人，广东当然是华南周边了，四川大家知道有华西，西南这一片，使得我们下一步要加快建立区域的医疗诊疗中心，包括要提高有些地区的医疗服务的能力。现在看，硬件基本够了，主要是内涵提升，符合我们整体对中国经济社会发展的要求。我们要提升内涵，提高质量和水平，包括利用京津冀一体化来促进优质医疗资源的分布，像北京儿童医院在这方面带了头，他们主动组织了一个儿童医院的服务网络，也使得这方面的医疗状况有了很大的改观。

　　李斌：我们去年专门在那里开了一个全国的现场会。另外，像河南，本身就有一亿多的人口，北京的阜外医院已经进入到河南，正在建设华东的心血管病治疗中心，这一块就能够辐射出去。下一步，东北要加强区域的医疗诊治中心能力的建设，西北要加强这种布局和能力的建设，包括像在陕西等地方，通过布局，使得过去结构性的矛盾能够逐步得以解决。

　　李斌：下面的一些具体问题，晓伟同志再给大家回答，我就把昨天晚上看到的大数据跟大家说一下。还补充一句，第三个可喜变化，全国人均住院总费用下降1.4%，虽然还不多，但是趋势是好的，平均住院日9.6天继续缩短，这也相对减轻群众的负担。北师大第三方基层的调研，乡镇卫生院人均住院和药费下降6.1%和7.1%，城市社区卫生中心下降了2.1%和5.2%，这是我昨天晚上看到的大数据的分析结果。

　　马晓伟：李主任已经讲得很清楚了。应该说，这一轮医改一个最重大的举措就是分级诊疗制度的提出。2009年，新一轮医改开始，明确提出了“人人享有基本医疗卫生服务”这样一个奋斗目标。

　　马晓伟：用一个什么样的医疗体制来落实“人人享有”呢？怎样解决我国医疗资源总量不足、分布不合理、优质资源匮乏的问题呢？显然就让我们用有限的医疗资源解决13亿人的看病就医问题。看病难、看病贵的问题，核心表现为供需矛盾，大病小病涌向城市大医院，城市农村患者也涌向大医院，这样就出现大医院人满为患、小医院门可罗雀。所以分级诊疗是缓解看病难、看病贵的重要措施，也是落实人人享有的一个就医体制的保证，是对我国医疗资源格局的重新调整，也是对就医习惯的改变。所以这项战略举措的成功需要一定的时间，但是从某种意义上讲，分级诊疗实施之日，乃为我国公立医院改革成功之时。

　　马晓伟：分级诊疗主要特点有四个：一是基层首诊，二是双向转诊，三是上下联动，四是急慢分诊。关键是基层首诊，大家只有在基层看病，再到大医院看病，才符合就医的次序，也才符合国际惯例，国际上没有不分级诊疗的国家，看病都是按照医疗机构级别来看病的，这样资源才能得到有效的利用。常见病、多发病在基层医疗机构，一旦重症在上级医疗机构。我们要建立这样一个就医的格局，就要求实现基层首诊。

　　马晓伟：因此说，解决基层首诊问题是人才问题，人才问题是政策问题，政策问题是两个问题，一个是待遇问题，一个是职业前途问题。基层医生培养的全科医生，有些优秀医生到基层去，必须解决这两个问题。待遇问题我们是这样想的，一个是政府投入，我们在前五年已然取得了很大的成绩，政府对基层医疗卫生机构运营经费、人员经费给予了很大的投入。二是价格改革，提高了基层医生的诊疗费。三是公共卫生服务均等化，今年是人均45块钱，可以打包给基层医生。四是绩效工资这一块，有相当一部分收入作为绩效工资，用于人员经费。从上海全科医生在基层的情况看，人均收入达到了12万元，北京市今年年底给人员补助经费再增加30%，全部用于基层医生的收入，这样有力地解决基层医生的待遇问题。

　　马晓伟：第二个是职业前途问题，上海市也正在考虑，我们也在考虑，酝酿基层医生的职称评定问题，把基层医生的职称评定标准和大型医疗机构分开，这样使他有职业发展的前途。基层要拓展基本药物目录，使基层用药和大医院用药基本相当。北京市在今年年底就准备把基层药品目录和三级医院药品目录并轨，这样老百姓就医看病取药，尤其是常见病、多发病，大医院开好药了，就可以到基层取药，不要再到大医院取药。

　　马晓伟：要让患者有愿意去基层的政策，就是在基层报销得多，在上面报销得少。在基层看完病，往上转诊，取消起付线。病人从上面往下转，这个医疗收入不计入基层的基本医疗总额包干，医生也有积极性来接转病人，患者也有积极性往上去，解决基层首诊和上下转诊的问题。基层首诊的问题突破了，分级诊疗的问题就有望突破。

　　马晓伟：最后我要说一句，李主任刚才讲，实际上是四句话：以区域医疗中心为抓手，以重点学科为支撑，解决区域分开的问题，不要都到北、上、广看病，各个区都有医疗中心；以县医院建设为抓手，解决城乡分开的问题，老百姓得病不进城，90%能够在县医院得到解决；以病种为抓手，慢性病、常见病、多发病，包括急性的一些疾病，这些病分开，上面医院看急的，下面医院看慢的，实行急慢分开；同时解决上下分开的问题。这样假以时日，我们把医疗资源调配好，把政策到位，我们国家的就医格局就是个有序的格局，医疗资源的分布就是个合理的分布，医保费用的支出就能够做到精打细算，用得恰到好处。所以分级诊疗制度能够实施，我国解决看病就医问题就能够提高到一个新的水平。

责任编辑：刘德宾 SN222

文章关键词：
看病难 医改

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