How to deepen the ＂focus＂ of medical reform and make the medical service system from ＂having＂ to ＂excellent＂？

Xinhua News Agency, Jinan, July 30thQuestion: How to deepen the "focus" of medical reform and make the medical service system from "having" to "excellent"?

Xinhua News Agency reporters Dong Ruifeng and Li Zhihao

China’s average life expectancy has increased to 78.2 years, and it has built the largest basic medical security network in the world, and its main health indicators are in the forefront of middle-and high-income countries … For more than a decade, China has continuously deepened the reform of the medical and health system, and made efforts to solve the problem of people’s difficulty and expensive medical treatment.

At present, what are the key tasks for deepening medical reform? In what areas are ordinary people expected to continue to enhance their sense of gain? At the 2023 National Experience Promotion Conference on Deepening Medical Reform and China Health Development Conference held in Jinan, Shandong Province from July 29th to 30th, many industry experts took stock of the list of previous medical reforms and looked forward to the next stage "road map".

Can there be more quality medical services at home?

Promoting "serious illness can be solved in this province, common diseases can be solved in cities and counties, and headaches and brain fever can be solved in towns and villages" is an important goal of deepening medical reform.

At present, China has identified 125 national regional medical center construction projects, and the medical service "highland" covers all provinces with weak resources. In 2021, the first batch of inter-provincial medical treatment for related specialties of national regional medical centers decreased by 9.3% compared with 2019.

"The national regional medical center has basically completed the planning and layout, and the next step is to promote the establishment of a management system and operational mechanism that is compatible with it." Zhu Hongbiao, a first-class inspector of the System Reform Department of the National Health and Wellness Commission, said.

Balanced layout of high-quality medical resources, the level of diagnosis and treatment at the grassroots level is also constantly improving. By the end of 2022, 87.71% of county hospitals in China had reached the basic standard of medical service capacity, and more than 30,000 township hospitals and community health service centers had reached the standard of service capacity.

Zhu Hongbiao said that in the future, we will continue to plan and build provincial regional medical centers, continuously improve the medical level of cities and counties, strengthen the capacity building of community and rural medical and health services, improve the system and mechanism for promoting graded diagnosis and treatment, and promote the inheritance and innovation of Chinese medicine.

Focusing on the long-term, it is necessary to deepen the reform of public hospitals oriented to public welfare and develop and strengthen the medical and health team in order to let the people enjoy more high-quality medical services at their doorstep.

Previously, the national public hospitals have cancelled the addition of drugs and medical consumables respectively. How to consolidate the public welfare foundation of public hospitals, at the same time, ensure the source of salary of public hospital staff and mobilize the enthusiasm of medical staff has become an urgent task. "The next step is to continuously consolidate and improve the new operating mechanism." Zhu Hongbiao said.

How to reduce the burden of individual self-payment of ordinary people?

According to the latest funding standard of basic medical insurance for urban and rural residents in 2023, the per capita financial subsidy standard is 640 yuan per person per year. Ten years ago, this standard was 280 yuan.

Statistics show that in recent years, China’s government health expenditure and social health expenditure have continued to increase, and the proportion of personal health expenditure in total health expenditure has continued to drop to 27.7%.

"But the money that some ordinary people actually took out of their pockets for medical treatment did not feel significantly reduced." Xu Shuqiang, dean of China Hospital Development Research Institute of Shanghai Jiaotong University, said that an important reason is that the expenses beyond the reimbursement scope of basic medical insurance are still heavy.

On the one hand, we must continue to solve the problem of expensive medical treatment, on the other hand, the price of medical services is low, and some medical institutions have losses. How to solve the problem?

Not long ago, with the consent of the State Council, the National Health and Wellness Commission and other six departments jointly issued "Key Tasks for Deepening the Reform of Medical and Health System in the Second Half of 2023", which clearly proposed to promote the orderly connection of multi-level medical security.

Shanghai launched customized commercial medical insurance "Huhuibao" based on the rule of "employees in this city voluntarily use the surplus funds of medical insurance personal accounts over the years to purchase commercial medical insurance". In 2021, the number of insured people reached 7.39 million, and by the end of 2022, the accumulated compensation was 790 million yuan, which became an effective supplement to basic medical insurance and helped people to "reduce the burden" of seeing a doctor.

On the basis of realizing the full coverage of long-term care insurance for employees, Shandong Province started the pilot project of long-term care insurance for residents in 2022. At present, the number of long-term care insurance participants in the province has reached 41.12 million, ranking first in the country, which better meets the long-term care needs of severely disabled people.

Xu Shuqiang believes that deepening medical reform should not only make people spend less and less money from their own pockets, but also promote the development of public hospitals. We can consider more reform measures in which medical expenses are paid by third parties. While continuing to play the basic role of medical insurance fund, we will actively promote the development of inclusive commercial medical insurance, commercial health insurance and long-term care insurance.

How to "use good medicine" and "supply good medicine"

At present, a new round of medical insurance drug list adjustment is under way, focusing on children’s drugs and drugs for rare diseases.

In recent years, with the implementation of many measures, such as medical insurance drug catalogue access negotiation and centralized quantity procurement, 341 new drugs have been included in the catalogue at suitable prices, and the average price of centralized drugs has been reduced by more than 50%, saving about 300 billion yuan.

According to Jin Chunlin, director of the Shanghai Health and Healthy Development Research Center, the preparatory work for centralized procurement is more adequate, the scheme design is more rigorous, and the drugs and medical consumables that benefit the people are more abundant.

According to the data of the National Medical Insurance Bureau, centralized purchasing not only promotes the price reduction of drugs, but also makes the proportion of original drugs and drugs evaluated by the consistency of generic quality and efficacy exceed 90%, and the accessibility of high-quality drugs is greatly improved.

Support drug R&D and innovation, regularly carry out centralized procurement of drugs and medical consumables, strengthen drug supply guarantee and quality supervision … Focus on reform and innovation in the medical field, and a series of key tasks will be continuously promoted in the second half of this year to ensure "good supply of drugs" and "good use of drugs".

The relevant person in charge of the Department of Restructuring of the National Health and Wellness Commission said that this year, all provinces will be instructed to carry out centralized procurement of drugs and consumables at least once, and it is required to achieve a total of 450 drugs collected at the national and provincial levels before the end of the year.

In addition, it is understood that promoting the coordination and integration of medical care and prevention, promoting the reform of disease prevention and control system, and improving the capacity of public health services will also be important contents of deepening medical reform in the next stage, and a series of guiding documents are expected to be issued this year.