The three-year review of the new medical reform: public-private reform requires top-level design

In 2011, it was the year of “Closing the Officials” in the “Medical and Health System Reform Recent Implementation Plan (2009-2011)”. What are the problems in the new round of medical reform in the past three years?

Basic health insurance:

Should increase the level of compensation

Authoritative figures: In 2011, the number of people in urban and rural areas participating in the country reached 1.295 billion, and the population coverage rate was 95%, basically achieving universal health insurance; the three maximum levels of payment for medical insurance (urban worker medical insurance, urban residents medical insurance, and new rural cooperative medical care) reached the corresponding population years. The average income is more than 6 times and not less than 50,000 yuan.

[People's Voices] Liu Deli, Siming Town, Sheyang County, Jiangsu Province hopes that the new rural cooperative medical system “can further increase the reimbursement rate and reimburse the province or even the whole country for networking”.

[Expert Review] Hu Shanlian, Director of the Shanghai Municipal Health Development Research Center: We must see nearly ten times the difference between the three levels of health care coverage. The total amount of funds raised is low, and the ability to resist risks is still relatively weak. The average medical burden of individuals It is still more than 30%, and hospital and outpatient expenses are still increasing in recent years. During the “Twelfth Five-Year Plan” period, basic medical insurance should shift from “expanding the scope” to “enhancing quality” and exploring the establishment of a major disease protection mechanism.

Basic medicine system:

"Short legs" must be remedied

Authoritative figures China has initially established a national basic drug system, and the price of basic drugs has dropped by 16.9% before the implementation of the system. In 2011, more than 50,000 grass-roots medical and health institutions run by the government were all equipped with basic drugs and sold at a zero rate, ending the “remedy for medicine” history, and drug prices fell by an average of about 30%.

[People’s voices] Li Shuijin, a resident of Meiling Town, Wanli District, Nanchang City, Jiangxi Province, said: “Salvia Miltiorrhiza tablets selling at 1.65 yuan in health clinics are often out of stock. I have to buy a bottle of 3.5 yuan from a pharmacy.”

In addition to basic drug outages, the 2000% profit rate “defective drug” incident and the need for prostaglandins for heart surgery, hemophilia B-helpers, and “Nine factors” out-of-stock phenomenon have all been exposed to some extent. The "short legs" of basic drugs in directory setup, tender procurement, etc. Wang Hui, president of the Meiling Township Center Health Center, said: “If the pharmaceutical companies stop production because they are not profitable, eventually the people will not receive any benefits.”

[Expert Review] Hu Shanlian: A salient issue in the reform of the basic drug system is that the list of essential drugs formulated in 2009 cannot meet the needs of medicines everywhere and needs to be dynamically adjusted; a reasonable and scientific pricing mechanism must also be established to ensure the quality and supply of essential drugs.

Xu Yong, Director of the Sheyang County Health Department in Jiangsu Province: It is necessary to ensure that the operating expenses of the compensation for the primary health care institutions are fully paid, otherwise the basic drug system will be difficult to sustain or even go to waste.

Primary health care system:

After the village doctor lacks people

Authoritative figures: The central government has supported the construction of 2,233 county-level hospitals, more than 6,200 center township hospitals, and more than 25,000 village clinics. The villages have basically completed health rooms and townships have health centers.

[People’s voices] Qian Baozhu, dean of Yangma Township Hospital, Sheyang County, Jiangsu Province: There are no graduates of supplementary medicine for many years. "Reporter's investigation found that some villages in villages and village clinics lacked people.

[Expert Comments] Hu Shanlian: At present, China has not established a family doctor system, nor has it really achieved the goal of community (primary level) first diagnosis, graded medical treatment, and two-way referral. The patient is still in disorder. Strengthening the training of general practitioners (family) doctors, from "strong ribs and bones" to "comprehensive development" is the direction of the reform of basic medical institutions in the "Twelfth Five-Year Plan".

Basic public health:

Investment should avoid "walking"

Authoritative figures In 2011, the per capita basic public health service funding standards in most provinces reached or exceeded 25 yuan. As of the end of September 2011, the number of standardized electronic filers reached 433 million, 67.73 million people under 15 years of age were compensated for hepatitis B vaccine free of charge, and 10.4 million poor cataract patients were operated on.

[People's Aspirations] Xu Yong pointed out that the most prominent problems in advancing basic public health services are: the project has many funds, many projects cannot be sustained, and the quality of project implementation needs to be improved. For example, the rate of establishment of health records in some localities is high, but most of them have never been used and have become “dead”.

[Expert Review] Hu Shanlian: Increasing per capita public health expenditure does not necessarily require equal increase in the type and quantity of services. What is more important is to improve the quality and standards of existing service projects to ensure that public health services are implemented and implemented. When it comes to effectiveness, it can't "walk through the field."

public hospital:

System and mechanism reforms need to be broken

[Targets] The reform of public hospitals was gradually pushed forward in 2011; reform of public hospital management systems, operational mechanisms, and regulatory mechanisms; and promotion of public hospitals' compensation mechanism reforms.

[authority figures] By 2011, a total of 17 national-level and 37 provincial-level reform pilot cities for public hospitals have been identified.

[People’s voices] In recent years, public hospitals have spared no effort to carry out “improvement”. However, public hospitals have been repeatedly criticized for red bag rebates, unreasonable fees, and poor doctors’ attitudes.

[Experts comment] Yi Lihua, president of Wuxi Second Hospital, said that there is still a gap between the breakthrough in the reform of public hospitals and the solution to the “difficult to see a doctor”. Deepening the reform of public hospitals needs to solve the problem of top-level design. The most important thing is to clarify what the government should or should not manage.

Liu Yuanli, director of the China Program Department at Harvard University School of Public Health: The goal of encouraging medical personnel is far from being realized. Doctors still do not realize their value through their own labor. If only the interests of medical personnel are changed without actually touching the basic operation and compensation mechanism, the reform will eventually be difficult to continue. (Editor's note: On November 29, Li Keqiang, vice premier of the State Council and head of the State Council Leading Group for Deepening the Reform of the Medical and Health System, presided over the tenth plenary session of the State Council Leading Group for Deepening the Reform of the Medical and Health System, and requested the overall planning of the 12th Five-Year Plan for Health Care Reform. Planning will face up to the difficulty of reform and the systemic contradictions that will be exposed.