After five years of nationwide medical reform, how are people’s lives going?

From the analysis of policy orientation in the past five years, we can see the country’s policy support for various medical fields and its determination to reform the pharmaceutical field. From a policy perspective, the reform of my country's medical institutions has the greatest impact on traditional fields such as hospitals, doctors, medical insurance, medical equipment, and drugs.

Taking the protection of people’s health and life safety as the starting point and goal, adhere to the basic path of overall planning and highlighting key points, highlight the goal orientation and problem orientation, and strengthen top-level design and overall planning , formulated and promoted the issuance of a number of major medical reform policy documents, and basically established the main framework of the basic medical and health system with Chinese characteristics. The integrity, systematicness and synergy of the medical reform have been significantly enhanced, and the medical reform has achieved significant phased results. After five years of reform and development, the problem of difficulty in seeing a doctor has been improved to a considerable extent, and the level of medical services and public health service capabilities have steadily improved.

First of all, a hierarchical diagnosis and treatment system is taking shape

With the goal of "first diagnosis at the grassroots level, two-way referral, rapid triage treatment, and linkage between upper and lower levels", Focusing on the construction of medical associations, telemedicine, and family doctor contract services, we will promote the sharing of high-quality medical resources and improve grassroots service capabilities. The Medical Association is an institutional means to empower primary care. It breaks through the vertical and horizontal barriers between various institutions, establishes a circulation mechanism for medical resources, and optimizes the allocation of medical resources. With the improvement and upgrading of telemedicine technology and the establishment of a family doctor system with high-quality medical resources, the health pass has moved forward, making family doctors the "health gatekeepers" of residents, from treating diseases to "treating diseases before they occur." , reduce the overall medical expenditure of society. Supporting policies have been continuously improved, the proportion of medical insurance reimbursement for primary-level outpatient clinics has been increased, the deductibles for referral patients have been continuously calculated, the long-term and extended-term policies have been implemented, and the drug connection between primary-level hospitals and higher-level hospitals has been strengthened.

Second, the construction of a modern hospital management system is steadily advancing

All public hospitals across the country have comprehensively promoted comprehensive reforms, completely abolished drug bonuses, gradually broken the profit-seeking mechanism, and adhered to the public welfare nature of public hospitals. The compensation of public hospitals has been changed from three channels: service charges, drug plus income, and government subsidies to two channels: service charges and government subsidies. Standardize medical service behavior, implement clinical path management, and establish follow-up monitoring of auxiliary medication, abnormal hospital medication, and high-value consumables. Adhere to the "linkage of three medical services", rationally allocate medical resources, and standardize drug prices. Fully mobilize the enthusiasm of medical staff from aspects such as salary, internship development space, and internship environment. At the same time, in the field of medical services, social capital is promoted to establish medical institutions, the conditions for Sino-foreign joint ventures and cooperative medical services are relaxed, the development of private clinics is promoted, and the efficiency of administrative approval of social medical services is improved.

Third, the national health insurance system is gradually improving

The number of people participating in basic medical insurance exceeds 1.3 billion. 1.177 billion urban residents and employees are covered by medical insurance, and 133 million people are covered by the new rural cooperative medical system. The insurance participation rate is stable at over 95%. The per capita financial subsidy standard of the basic medical insurance for urban and rural residents has been increased from 240 yuan to 490 yuan, and the reimbursement ratio of outpatient and hospitalization expenses within the scope of the policy has remained stable at around 50% and 70% respectively. The basic medical insurance system for urban and rural residents has been basically integrated, achieving unified coverage, financing policies, security benefits, medical insurance catalogues, designated management and fund management.

Promote direct settlement of medical expenses across provinces. There are 13,995 designated medical institutions in each province, and the cumulative direct settlement of medical expenses in each province is 1.063 million yuan. Medical expenses were 25.61 billion yuan, and the fund payment ratio was 58.6%. The critical illness insurance system achieves full coverage. The reimbursement ratio of medical expenses for patients with serious illnesses has increased by about 12 percentage points on average based on basic medical insurance, with more than 17 million people benefiting from it in the past five years. Medical assistance and emergency assistance for serious illnesses have been fully established, and commercial health insurance has developed rapidly.

The reform of medical insurance payment methods continues to advance, and most coordinating areas have reformed payment methods such as disease type, per capita, and service unit. More than 200 cities have implemented disease-based payment for more than 100 diseases, implemented disease diagnosis-related group payment pilot reforms (DRG), and implemented clinical pathway management to ensure medical quality and safety. The health poverty alleviation project has been carried out in depth, and the action plan of "centralized treatment of a number of serious diseases, contracted service management of a number of chronic diseases, and protection of a number of serious diseases" has been launched.

Fourth, the drug safety supply system is increasingly improving

In the field of pharmaceutical research and development, the "Pharmaceutical Industry Development Planning Guide" has been formulated to focus on industrial scale, technological innovation, product quality, and green development. , functional manufacturing, supply guarantee, organizational structure, internationalization and other aspects have put forward the development goals of my country's pharmaceutical industry during the "13th Five-Year Plan" period. Promote the reform of the process of drug production, distribution and use rights, and continuously improve the ability to ensure drug supply. A number of policies have been introduced to encourage the research and development of high-quality innovative drugs and medical devices, improve the quality of drug approval, solve the problem of registration backlog, promote the quality consistency evaluation of generic drugs, accelerate the approval of innovative drugs, and improve the technical guidelines for overseas clinical trial data of drugs.

Cancel government pricing for most drugs and establish a new market-led price formation mechanism. Implement zero tariffs on imported drugs, lower the purchase price of anti-cancer drugs, and launch national drug price negotiations.

Drug circulation is becoming increasingly standardized, and the "two-invoice system" for drug purchase and sales has been implemented in 11 pilot provinces and 200 pilot cities to promote transparency in price increases. The national essential medicine system has become more complete. The National Essential Medicine List has been published and distributed, with the number increasing from 520 to 685. It basically covers major clinical diseases and better meets basic medical and health needs. Complete the centralized procurement bidding for 31 types of drugs in 4+7 cities, reduce drug prices, reduce corporate transaction costs, and guide hospitals to standardize drug use.

Verb (abbreviation of verb) to accelerate reforms in medical-related fields

Promote the development of "Internet + medical and health", highlight the policy orientation of encouraging innovation, inclusiveness, and prudence, and promote the Internet and Integrated development of service fields such as medical care, public health, family doctor contracting, drug supply guarantee, medical safety settlement, medical education and science popularization, and artificial intelligence applications. At present, "Internet + medical and health" is showing a good trend of vigorous development. The introduction of new technologies has played a positive role in improving the level of medical services, reducing the price of medical services, and improving the accessibility of medical services.