Today (November 22), the National Health Commission issued the "Notice on Promoting Experience in the Construction of Graded Diagnosis and Treatment and Medical Consortium in Sanming City."

According to incomplete statistics from the "medical community", this is the Sanming experience has been promoted and learned after the Secretariat of the State Council Medical Reform Leading Group identified Sanming City as a national experience promotion base for deepening the reform of the medical and health system in February this year, and the Implementation Opinions of the State Council Leading Group for Deepening the Reform of the Medical and Health System in October this year.

The "Notice" summarizes the seven major experiences of Sanming City in the construction of tiered diagnosis and treatment and medical alliances, involving government responsibilities, operating mechanisms, medical insurance settlement, multi-point practice, talent training, and development of traditional Chinese medicine:

■On the one hand, strengthen the guarantee responsibility, and the investment in basic construction of public hospitals that comply with regional health plans, large-scale equipment purchase, key discipline development, public health services, etc. is the government responsible, and the fiscal investment has increased significantly. Debts that meet the regulations before the reform in 2012 are included in the unified management of local government debt, and the principal and interest shall be borne by governments at all levels; on the other hand, strengthen management responsibilities, scientifically plan the layout scale of medical institutions, and strictly prohibit the construction of public hospitals from borrowing.

■Close-type urban medical groups, close-type county medical communities implement counties and villages, and highly unified management of people, finance and property, realize the sharing of medical resources and information, and form a community with management, responsibilities, services and interests with close-type medical alliances as the carrier. At the same time, standardize the internal management of medical alliances, adhere to the "six unifications" of rules and regulations, technical specifications, personnel training, business guidance, quality control management, and work assessment.

■The leading unit of the medical alliance coordinates the use of medical insurance funds and public health funds, implements the "total payment, over-expenditure will not be compensated, and surplus will be retained" system of medical insurance funds, and adopts the "one group, one budget, and two determinations" mechanism (form a close medical alliance; determines the total budget of medical insurance funds for medical alliances, and no longer refines the total control indicators of various medical institutions; determines the medical service income of the medical insurance fund surplus part into the medical alliance, and determines the health promotion funds to be included in the cost of medical institutions). At the same time, the medical insurance policies of all districts and counties in the city can independently choose medical alliances across the city, and "money follows people".

■ Actively implement the multi-point practice policy of medical personnel within the medical alliance. Medical personnel practice in medical institutions at all levels within the medical alliance without undergoing changes in practice locations and filing procedures for practicing institutions; at the same time, relying on the county-level medical and health service technology platform, telemedicine services within the medical alliance are carried out to achieve resource sharing and mutual recognition of results.

■Relying on the leading units of the medical alliance, we will carry out recruitment and targeted entrusted training of primary medical and health talents, and entrusted medical schools to targeted training localized full-time college-level medical students. The municipal finance will fully pay the tuition fee of 6,600 yuan per year for students to study in school; counties and districts will allow independent adjustment of the professional title ratio of grassroots medical and health institutions, and units will be allowed to hire individual professional and technical personnel with outstanding performance; health technicians who have worked at the grassroots level for a long time will be directly appointed after obtaining the corresponding technical qualifications, and will not be subject to the number of senior professional titles.

■Construct a coordinated operation management model of medical and prevention, establish six coordinated operation mechanisms: personnel team, service projects, resources, work, training, and assessment; based on the implementation of family doctor contract services, grassroots staff such as medical, disease control, and streets, jointly participate, achieve full coverage of health screening, and on this basis, carry out disease spectrum analysis of common, frequent and major diseases, actively intervene in key groups in the jurisdiction, and explore the implementation of the "one disease, five prescription" system for medical care, exercise, diet, psychology and vaccine.

■ Establish a leading group for the construction of the National Traditional Chinese Medicine Development Comprehensive Reform Pilot Zone with the head of the municipal government as the group leader, comprehensively strengthen the construction of the traditional Chinese medicine service network system, give full play to the leading role of municipal traditional Chinese medicine hospitals, strengthen the county-level traditional Chinese medicine service network, and achieve full coverage of grassroots traditional Chinese medicine clinics; specially set up traditional Chinese medicine syndrome differentiation and treatment fees, traditional Chinese medicine decoction service fees, increase the price of traditional Chinese medicine diagnosis and treatment services, implement 80% medical insurance reimbursement of traditional Chinese medicine decoctions and 24 traditional Chinese medicine non-drug therapy medical insurance zero-deductible reimbursement policies.

The "Notice" also mentions that traditional Chinese medicine hospitals should be supported to take the lead in establishing medical alliances, and socially run medical institutions and clinics (including traditional Chinese medicine clinics) should be encouraged to join medical alliances on the principle of voluntary basis. Socially run medical institutions with the conditions can also take the lead in establishing medical alliances.

All localities should explore the reform of total medical insurance fund payment for close-knit medical alliances, establish a mechanism of "total payment, strengthen supervision and assessment, retain balances, and reasonable over-spending" and implement continuous calculation of medical insurance within the medical alliance; unify the catalog of chronic diseases within the medical alliance, and gradually establish a long-term prescription system for patients to use drugs; reasonably determine the salary level and total performance salary of public hospitals at all levels within the medical alliance, reasonably determine the proportion of personnel expenditure to public hospital business expenditure, and optimize the salary structure.

In addition, the "Notice" also requires the leading units of medical alliances to actively use selected pharmaceutical consumables for centralized procurement, guide primary medical institutions to follow up, improve the matching of drug consumables for use, strengthen the guidance on product replacement, and use products with appropriate prices.
Chapter completed!