习大大指示:这是医改重中之重!

2016-09-09 司徒阳明 赛柏蓝

昨天(9月8日),国家卫计委召开新闻发布会,明确表态要推广地方经验,在如此鲜明的旗帜下,国家卫计委又推出了三个新典型:四川、陕西延安,河南郑州。 这三个地方共同的特点就是分级诊疗。现在分级诊疗很多人还是不太关注,司徒君天天关注政策,实在觉得这个政策对未来市场影响太重要,恨不得天天说,但是关注度还是不高。毕竟,分级诊疗才开始执行,从大医院、基层医疗机构的执行来看,很多人还是不太看好基层

昨天(9月8日),国家卫计委召开新闻发布会,明确表态要推广地方经验,在如此鲜明的旗帜下,国家卫计委又推出了三个新典型:四川、陕西延安,河南郑州。

 

这三个地方共同的特点就是分级诊疗。现在分级诊疗很多人还是不太关注,司徒君天天关注政策,实在觉得这个政策对未来市场影响太重要,恨不得天天说,但是关注度还是不高。毕竟,分级诊疗才开始执行,从大医院、基层医疗机构的执行来看,很多人还是不太看好基层市场。但是各位亲,没有长远考虑,如何迎战未来市场?我相信,对行业的熟悉,对医药产业未来看好,仍是很多人仍然坚守医药战线的原因。

 

闲话少说,而这次,国家卫计委在确定推广分级诊疗城市名单后,又召开新闻发布会,推出了分级诊疗的典型。在此力推分级诊疗。

 

习大大重点关注,医改的第一项任务

 

虽然仍然是卫计委在行动,但是必须注意的是,这绝对不会是一个部委的事情!为什么?

 

我们来看看国家卫生计生委体改司(国务院医改办)副司长姚建红的这段话:

 

前段时间中央开了全国卫生与健康大会,习近平总书记在会上对医改工作也做了重要指示。医改要建成五个制度,第一个是分级诊疗制度第二是现代医药管理制度,第三是全民医保制度,第四是药品供应保障制度,第五是综合监管制度。习总书记在这次会上把分级诊疗作为医改当中的第一项任务,放在最重要的位置。

 

 所以,分级诊疗不是卫计委力推,而是国家主席最关注的一项政策,放在第一位的一项政策,未来,分级诊疗有可能会不落实吗?而据此前赛柏蓝和微友们分享的内容,此次大会国家主席、国务院总理发表重要讲话,七大常委悉数出席,各部部长、各省省长、省委书记,各省重要部门的负责人都到场,不仅仅是传达精神,第二天的分组会议讨论的是如何落实的问题,在这种情况下,分级诊疗目标的实现并非是不可能。

 

地方经验以后要备加关注

 

此外,在经验接受之后,姚建红还特意提到三明,说三明市的经验在全国得到了很多的推广和总结。重点又提到了从地方经验到国家经验,然后再进一步推广。可见,在分级诊疗特别受重视的情况下,这三个地方的经验也特别值得关注。

 

让我们再来复习下分级诊疗的目标:2017年,也就是明年是个关键的时间节点,医疗卫生机构分工协作机制基本形成,优质医疗资源有序有效下沉,体现在核心的任务量要求是基层医疗卫生机构建设达标率≥95%,基层医疗卫生机构诊疗量占总诊疗量比例≥65%;其中慢性病下沉是比较重要的。

 

到2020年,分级诊疗服务能力全面提升,保障机制逐步健全,布局合理、规模适当、层级优化、职责明晰、功能完善、富有效率的医疗服务体系基本构建,基层首诊、双向转诊、急慢分治、上下联动的分级诊疗模式逐步形成,基本建立符合国情的分级诊疗制度。

 

和医药相关的两大亮点

 

所以,时间紧迫,卫计委分享的这三个典型,都是加大了对基层的投入,那么和医药相关的有什么亮点呢?

 

1,互联网+,这是热门词汇,现在我们也看到越来越多的医药公司,例如九州通,这些大公司开始介入互联网平台和医院建立起合作关系。此次卫计委推出的典型上,比如,四川也在借助互联网发力。

 

四川省 “搭建一个平台,成立两个中心,构建三项制度”。一个平台就是在全国率先建成“健康四川”便民服务云平台,接入350家医院,导入7000万份健康档案、4000万份新农合档案,每月提供90余万个号源。两个中心就是建立了四川省互联网医疗管理指导中心,设立了四川大学华西医院和省人民医院两家省级互联网医疗中心。三项制度就是建立了备案制度、CA认证制度和患者实名预约及就诊记录保存制度。去年9月以来,全省网上预约挂号495.3万人次,线上支付179.6万人次,检查检验结果查询334.7万人次,远程会诊、影像和心电诊断82.7万人次,慢性病管理服务13.2万人次。 

 

所以,远程诊疗、慢病管理,这都是互联网方面可切入的亮点。做这类品种的企业可以借助互联网很好的切入这个市场。

 

2,医联体,如果说互联网可以把一个市、省的医疗需求整合到一个平台后,那么医联体对于医院来讲就是落实分级诊疗的重要方式。延安市、牟中县都是这方面的典型。

 

延安市以延安大学附属医院为总医院,吸纳市县公立医院为分院,组建了延安医疗集团。与2014年相比,2015年总医院的门诊人次、出院人次和手术例数分别降低了12.9%、6.52%和10.3%。2016年第一季度门诊人次比上年同期降低了9.8%。

 

牟中县的3家县级公立医院分别和13家乡级医疗机构建立对口帮扶、协同发展合作关系,共建协作病区,建立双向转诊绿色通道,为患者提供高效快捷的转诊服务。乡级医疗机构向县级医疗机构转诊的病人近1.3万余例,县级医疗机构下转病人3150例。

 


下面是国家卫计委新闻发布会全文(有删节)。

 时 间:2016年9月9日

地 点:西直门办公区2号楼1层新闻发布厅

主持人:宋树立  国家卫生计生委宣传司副司长 
嘉 宾:姚建红 国家卫生计生委体改司(国务院医改办)副司长 
    杜 波 四川省卫生计生委副主任 
    赵 璟 陕西省延安市政府副市长 
    潘开名 河南省郑州市中牟县县长


宋树立: 


各位媒体朋友,欢迎大家来参加我们9月份的例行新闻发布会。不久前召开的全国卫生与健康大会强调,当前,医疗卫生体制改革已经进入深水区,到了啃硬骨头的攻坚期。要加快把党的十八届三中全会确定的医药卫生体制改革任务落到实处,着力推进五项基本医药卫生制度建设,努力在分级诊疗制度、现代医院管理制度、全民医保制度、药品供应保障制度、综合监管制度5项基本医疗卫生制度建设上取得突破。 


今天我们就请来了四位嘉宾,向大家来介绍各地和全国医改方面的亮点和成效。下面我向大家介绍我们请到的嘉宾:国家卫生计生委体改司(国务院医改办)副司长姚建红,四川省卫生计生委副主任杜波,陕西省延安市政府副市长赵璟,河南省郑州市中牟县县长潘开名。 


下面首先请杜波副主任介绍四川省的医改进展。


各位媒体朋友,大家上午好。首先,感谢国家卫生计生委、国务院医改办给我们搭建这样一个平台,向各位新闻媒体朋友介绍四川省“分级诊疗改革、卫生人才队伍建设、互联网+医疗健康服务”的推进情况。 

 

一、全省全域实施分级诊疗制度 


全省医疗服务出现了四个可喜变化:一是城市大医院“看病难”开始缓解。省市级大型医疗机构门(急)诊量较分级诊疗实施前同比降低了8个百分点,出院人次增长幅度降低了7.88个百分点。二是基层“守门人”作用逐渐恢复。全省县域内就诊率已达到87.72%。三是医疗费用过快上涨得到遏制。省市大型医院门诊次均费用、县级医疗机构和社区卫生服务中心住院次均费用上涨趋势出现了逆转,分别下降0.17%、0.78%、4.74%。四是新农合医保基金运行安全稳定。新农合住院实际补偿比提高0.5个百分点,达到63.5%。 


下一步,我省将进一步健全分级诊疗的制度体系,以糖尿病高血压和结核病等慢性病为突破口,出台慢性病分级诊疗试点指导意见。完善全省“医疗作战区”制度,探索完善医疗联合体利益分配机制,促进医疗联合体资源流动。推动医保支付制度改革,建立以按病种付费为主,按人头付费、按服务单元付费等复合型付费方式。强化分级诊疗政策宣传,引导群众就近、优先选择基层医疗卫生机构就诊。

 

二、大力实施人才强卫工程 

  

三、纵深开展互联网+医疗健康服务 


医疗卫生事业需要插上科技的翅膀。借“互联网+”的东风,我们顺势而为,主要是“搭建一个平台,成立两个中心,构建三项制度”。一个平台就是在全国率先建成“健康四川”便民服务云平台,接入350家医院,导入7000万份健康档案、4000万份新农合档案,每月提供90余万个号源。两个中心就是建立了四川省互联网医疗管理指导中心,设立了四川大学华西医院和省人民医院两家省级互联网医疗中心。三项制度就是建立了备案制度、CA认证制度和患者实名预约及就诊记录保存制度。去年9月以来,全省网上预约挂号495.3万人次,线上支付179.6万人次,检查检验结果查询334.7万人次,远程会诊、影像和心电诊断82.7万人次,慢性病管理服务13.2万人次。 


下一步,我省将重点抓好三项工作。一是加快推进“三医”综合监管平台建设。对医疗机构、医务人员、医疗行为进行精准监管。二是加快推进居民健康卡普及应用。按照国务院关于2020年普及居民健康卡的统一部署,在已发1000多万张居民健康卡的基础上,进一步加大发卡力度,推进省内就医“一卡通”。三是加快推进大数据分析利用。强化健康医疗大数据关键技术研究,制订行业标准与规范。推动省级健康医疗大数据中心和云平台建设。 


在今后的工作中,我们将认真贯彻全国卫生与健康大会精神,结合省情,大胆探索,为深化医改、提高人民健康水平作出积极贡献。

  

宋树立: 谢谢杜主任。下面请陕西省延安市政府副市长赵璟给我们介绍延安的医改亮点。


赵璟: 


2013年12月,我市以延安大学附属医院为总医院,吸纳市县公立医院为分院,组建了延安医疗集团。集团理事会由市县政府、延安大学和有关部门组成,首批成员有延安大学附属医院及医学院、市第二人民医院和洛川、延长、志丹三家县医院,2015年又吸纳了宜川县医院。集团成立两年多来,在各级政府和医改部门的指导按支持下,经过集团成员的不懈努力,取得了明显成效。 


一是显著提升了分院的医疗服务水平。2014年以来,总医院累计向分院下派专家90多人次,帮助分院开展新业务73项,指导手术500余例。2015年4家县级分院总门诊人次较上年平均增长了13.3%,尤其是延长县分院服务能力提升最为明显,门诊人次、手术例数分别较上年增长了91.06%、23.26%;分院平均住院日、住院药占比、院外转诊率分别下降了0.4天、5.3%和12.3%。 


二是推动了大医院患者向基层回流。与2014年相比,2015年总医院的门诊人次、出院人次和手术例数分别降低了12.9%、6.52%和10.3%。2016年第一季度门诊人次比上年同期降低了9.8%。 2016-09-08 10:14:39 


三是促进了优质医疗服务向乡镇延伸。通过县级分院一体化管理重点镇卫生院,洛川、志丹四所重点镇卫生院2015年就诊人次较2014年分别增长了12.27%和15.35%。 


我们的主要做法是建立六项机制(略) 


延安医疗集团的组建运行,推动了优势医疗资源下沉,提升了县域医疗服务水平,为公立医院改革探索创造了经验,为城乡医疗服务一体化创设了机制和平台。下一步,我们将以深化改革、规范管理为重点,推动集团持续健康发展,让老百姓从医改中得到更多的实惠。 

  

宋树立: 下面请河南省郑州市中牟县县长潘开名给大家介绍中牟县的医改情况。


潘开名: 


中牟县作为河南省县域综合医改和居民健康签约服务的双试点县,认真落实政府办医责任,以完善县域医疗服务体系为保障,以加强基层人才队伍为支撑,以重点专科建设为着力点,以区域医疗联合为抓手,以城乡居民健康签约服务为突破口,扎实开展县域综合医改,统筹推进分级诊疗制度建设,取得初步成效。 


一、大投入、夯基础,构建县域医疗卫生服务大格局。


二、强保障、建队伍,破除基层医疗服务能力薄弱瓶颈。


三、增优势、补短板,大数据精准发力专科建设。……通过大数据分析,基本锁定“两多一重”的病种,这“两多”是外转病人多、医保基金外流多;“一重”是群众就医负担重。重点加强“两多一重”的学科建设,主要为重症医学、血液透析、介入、肿瘤等专科建设水平,留住了部分外转患者,实现了群众就近就医,减轻了群众就医的负担。


四、抓龙头、促联动,建立完善上联下带的分工协作机制。全面推行“县带乡”、“乡管村”的县域医疗联合管理模式,促进专业公共卫生机构、基层医疗机构和医院的有机衔接。3家县级公立医院分别和13家乡级医疗机构建立对口帮扶、协同发展合作关系,共建协作病区,建立双向转诊绿色通道,为患者提供高效快捷的转诊服务。乡级医疗机构向县级医疗机构转诊的病人近1.3万余例,县级医疗机构下转病人3150例。同时,积极整合医疗资源,建立远程会诊、影像诊断等九大县域医疗卫生中心,基本实现县域内医疗数据集中管理和资源共享,让患者在基层就能享受到县级医院专家的服务。


五、建网格、分层级,扎实开展居民健康签约服务。

通过以上“具体化、可操作、真落实”的有利举措,使我县医疗服务能力大幅提升,县级公立医院龙头作用、乡级的纽带作用和村卫生室的守门作用得到发挥,人才短缺等瓶颈问题得到缓解,群众分享到了医改红利,初步构建了定位明确、分工协作的新型县域医疗卫生服务体系,有效缓解了群众看病难、看病贵的问题。 

   

宋树立:下面我们国务院医改办姚建红副司长也到了现场,请姚司长解说一下从国家层面怎么看待这些地方做出的符合自己特色的大胆的探索和他们的成效?如何在过深水区和啃硬骨头方面,有哪些打算? 


姚建红:宋司长和三位地方领导讲的核心就是六个字,推广地方经验。推广地方经验,我们认为有三个方面的重要作用,一是可以有利于减少改革成本。经验是个非常好的老师,大家学习经验以后,能够非常有利的减少改革成本。二是有利于放大改革成效。少走点弯路,可以更好地惠及人民群众,也可以更好地调动医务人员的积极性,也可以更好地实现党和政府得民心的很好的目标。三是有利于凝集改革共识。我们推广、培育和总结地方的成熟经验,能够使得大家在争议声中获得更多的认识。我觉得推广地方经验有三方面的重要作用。 


这轮医改是2009年3月份启动的,至今已经过去了七年多的时间,新一轮医改以来,特别是党的十八大以来,我们各个地区、各个有关部门,按照党中央、国务院的重要决策部署,扎实推进改革任务,在各方面都做出很多探索。今天我们请了三个地方,应该说在选择方面,有省一级代表,有市一级代表,有县一级代表,都具有很好的代表性。为充分发挥地方经验对我们整个国家全局改革的示范、突破和带动作用,在过去几年当中,我们做了几个方面的工作:


一是尊重地方首创精神。我们经常讲一句话,要坚持顶层设计和基层探索相结合,我们很多经验都是来自于基层,成熟于基层。中央机关的最重要的任务是把经验上升到国家政策,很好地总结、提炼和发扬。可以非常肯定地说,地方是推进改革的重要力量,近年来,我们各个地方主动性和创造性不断增强,重点难点问题逐步突破,涌现出一批敢啃硬骨头、勇于探索创新的典型地区,这些地方针对改革的重点领域和关键环节,统筹推进解决体制机制改革问题的一些思路、办法和措施,也摸索出了一些切实有效的路径和做法。刚才三位地方的领导都做了很好的介绍,大家也知道今年2月22日,中央深改组专门听取了三明市医改情况汇报,三明市的经验在全国得到了很好的推广和总结。 


二是将地方经验升华为国家政策。地方经验探索完了以后,是要用起来,实现叠加效应。应该说地方经验是我们国家制定政策的重要参考依据。如果大家看新闻,8月30日,中央深改组第27次会议通过了一个重要文件,这个文件的名字是《关于进一步推广深化医药卫生体制改革经验的若干意见》,这个文件推广地方的成熟经验。我们在今年制定“十三五”医改规划的一些重要的医改文件过程当中,也吸收了三明市和很多地方的经验,我们兵马未动,粮草先行。写文件过程当中,总是先分析地方的很多做法,这些做法能够对我们有很好的借鉴和启示意义,在这方面我们做了大量工作。


三是传播地方典型经验。一方面组织专家力量,另一方面要求地方组织专家,总结和提炼地方典型经验,同时采取多种方式,推广我们的成熟经验。 


四是组织学习和应用好经验。国家卫计委和国务院医改办通过多方式,交流改革经验,使各个地方深刻认识到推广经验的重要意义,深入领会各个地方的好的改革思路、步骤和方法,也鼓励各个地方将改革经验结合自身实际进一步推广下去,也保证党中央、国务院的决策部署在各个地方能够落地生根,产生实效。 


下一步,我们将会同有关部门落实中央深改组第二十七次会议精神,这次会议通过了《关于进一步推广深化医药卫生体制改革经验的若干意见》的文件,文件下发以后,我们将组织有关部门和有关地方认真学习文件、贯彻文件,也希望我们各个地方能够进一步加强探索和创新,我们也将密切跟踪各个地方的进展情况,宣传好、应用好各个地方鲜活的实践样本和进展成效,让他们更好地得到传播效益。谢谢大家。

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    2016-09-13 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

    0

  2. 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    2016-09-11 doctorJiangchao

    继续学习

    0

  3. 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authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Sep 09 12:29:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114958, encodeId=1fa91149586d, content=四川、陕西延安,河南郑州。, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Fri Sep 09 10:33:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114959, encodeId=cd4a114959a6, content=第一个是分级诊疗制度,第二是现代医药管理制度,第三是全民医保制度,第四是药品供应保障制度,第五是综合监管制, beContent=null, 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    2016-09-11 doctorJiangchao

    继续关注

    0

  4. 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    2016-09-11 tidiq
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    2016-09-09 舒心和人

    初衷是好的,关键看执行力度够不够

    0

  6. 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authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Sep 09 12:29:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114958, encodeId=1fa91149586d, content=四川、陕西延安,河南郑州。, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Fri Sep 09 10:33:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114959, encodeId=cd4a114959a6, content=第一个是分级诊疗制度,第二是现代医药管理制度,第三是全民医保制度,第四是药品供应保障制度,第五是综合监管制, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Fri Sep 09 10:33:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114960, encodeId=badb11496032, content=、全省全域实施分级诊疗制度, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfdY7yem1P7bRvOP6z0jKsBoYR8ezfAricY7meQWcte7LRJsWHVn0CnPJg2JuQmevR0DoFmmEib5QLD2kNESBESQT/0, createdBy=59191706502, createdName=医路开来, createdTime=Fri Sep 09 10:33:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114913, encodeId=47e3114913f6, content=习大大,好样的, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/12/17/3872cad7a53dc9dcbd08202fb6313cf4.jpg, createdBy=2cb71609450, createdName=KO229256262, createdTime=Fri Sep 09 10:11:00 CST 2016, time=2016-09-09, status=1, ipAttribution=)]
    2016-09-09 ylzr123

    新的思维,新的思路,要多宣传才能迅速推广。

    0

  7. 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    2016-09-09 医路开来

    四川、陕西延安,河南郑州。

    0

  8. 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    2016-09-09 医路开来

    第一个是分级诊疗制度,第二是现代医药管理制度,第三是全民医保制度,第四是药品供应保障制度,第五是综合监管制

    0

  9. 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    2016-09-09 医路开来

    、全省全域实施分级诊疗制度

    0

  10. 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    2016-09-09 KO229256262

    习大大,好样的

    0

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