Problems and suggestions on the construction of public health system and the reform of medical system
—— Excerpts from the communication seminar on "Prevention and Control of Epidemic Situation in COVID-19 and Promoting Healthy China Action" (1)
Guangming. com (Reporter Wu Pengfei) Recently, a communication seminar on "COVID-19 Epidemic Prevention and Control and Promoting Healthy China Action" was held, which was jointly sponsored by the Organizing Committee of (Yanqi Lake) Healthy Development Forum, Guangming. com, China Health Management Association, China Minsheng Bank Research Institute and Beijing Reform and Development Research Association. Experts and scholars from China Academy of Social Sciences, Central Party School (National School of Administration), Peking University, Tsinghua University, China Renmin University and other institutions attended. The theme of this seminar was
Jian Chen, Executive Director of Health Development Forum (Yanqi Lake)It is said that the old saying goes, "Go to the hospital to cure the country, and then save people." The ancients believed that the principles of governing the country and governing the body were interlinked, and the theory of governing the country with medicine reflected the feelings of ancient doctors about home and country. The sudden outbreak has affected China and even the whole world. Epidemic prevention and control is actually a big test of the national governance system and governance capacity, with both experience and lessons. Since its establishment, (Yanqi Lake) Healthy Development Forum has taken the promotion of Healthy China as its own responsibility. The experts who participated in the discussion of "Public Health System Construction and Medical System Reform" were Tian Xueyuan, the chief expert of (Yanqi Lake) Health Development Forum, Song Xiaowu, former president of china society of economic reform, Liu Wanling, vice president of china society of economic reform, Huang Jianhui, president of China Minsheng Bank Research Institute, and Jiang Huicheng, chairman of Hainan Cancer Hospital.
People-oriented: Thinking and Decision-making Choice of Deepening Medical and Health Reform
Tian Xueyuan, Chief Expert of Health Development Forum (Yanqi Lake) and Member of Chinese Academy of Social Sciences.
To sum up this fight against epidemic disease, the most fundamental lesson is that we should always stick to the people-oriented position and stick to and practice the ideological line of seeking truth from facts. This time, the CPC Central Committee and relevant departments adopted reasonable suggestions including Academician Zhong Nanshan and Academician Li Lanjuan, and decisively took the most severe measures to turn the tide, stop the epidemic from spreading and usher in a better situation in the whole country.
First, actively promote the reform of rational and effective allocation of medical resources
Medical reform has been carried out for many years, and many achievements have been made, but it is still not ideal. The main point is that there is no reasonable and effective allocation of medical resources, especially high-quality medical resources, according to market demand. Therefore, when the epidemic strikes, prevention, control, treatment, etc. are caught in a dilemma that is hard to cope with effectively.
1. Expand and rationally distribute comprehensive 3A hospitals.
First of all, in the first-tier cities such as Beijing, Guangzhou and Shenzhen, the top three hospitals will be expanded in scale. Secondly, to speed up and improve the construction of third-class hospitals in second-tier cities such as provincial party committees, big cities can take the lead. Thirdly, gradually expand to prefecture-level cities. First, we must adhere to high standards in the construction of top three hospitals. The second is to buy time. Strive to form a network distribution pattern of the top three hospitals in China in a relatively short period of time, such as three to five years, and make it a comprehensive medical and treatment center and backbone with reasonable distribution throughout the country.
2. Establish a medical group led by a well-known and specialized hospital.
For example, if Beijing Xuanwu (Brain), Tongren (Eye), Fuwai (Chest) and Jishuitan (Bone) Hospital take the lead, corresponding branches of provinces, autonomous regions and municipalities directly under the Central Government will be established. The lead hospital is mainly responsible for scientific and technological research and development, technical guidance, personnel training, regular rounds and other services. The local authorities are mainly responsible for hospital construction, administrative management and overall business operation. The group takes the state-owned as the main body, and can also adopt the joint-stock system and joint-stock cooperative system with the state-owned as the main body.
3. Encourage the coordinated development of private and joint-venture small and medium-sized hospitals.
This is the microcirculation system of the medical network system, and it is an extension and supplement of the state-owned backbone medical network, which is indispensable. It is necessary to form a medical grid structure that complements large, medium and small scales and combines state, collective and individual ownership.
4. Scientifically promote the reform of integrated traditional Chinese and western medicine
The combination of traditional Chinese and western medicine is a controversial topic for a long time. However, its role in the contemporary fight against malaria, influenza, SARS and COVID-19 has been confirmed by practice. Although it is not clear what the meridians of traditional Chinese medicine are, their functions in disease prevention, treatment and rehabilitation are obvious and objective. We should take the test of practice as the standard, seek common ground while reserving differences, learn from each other’s strengths and make up for each other’s shortcomings, and develop in a coordinated way. On this basis, it is summarized, accumulated and refined into a relatively systematic theory centered on anti-epidemic, disease prevention and treatment, and promotes the integration of traditional Chinese and western medicine into a new stage.
Second, deepen the reform of the public health system
Whether the epidemic situation including Covid-19 can be effectively prevented and controlled, as mentioned above, the medical system, system and affordability are the first to bear the brunt. However, the prevention and control of epidemic diseases is not only a medical matter. The prevention, treatment and rehabilitation of major infectious diseases involve monitoring, evaluation, policies, systems, supply, security, publicity, social coordination and many other aspects, and more belong to the public health system. In this sense, the Covid-19 epidemic is a severe test for the public health system.
The essence of public health can be expressed as a scientific and social public system to prevent diseases and promote people’s health through monitoring and evaluation, policies and systems, guarantees and actions. In short, it is the science of disease prevention and control and its social public system. The following suggestions are put forward for the reform of public health system:
1. Reform and improve the epidemic monitoring and evaluation system.
There are some prominent contradictions and problems in the existing epidemic monitoring and evaluation system, especially which department is responsible, who is responsible for monitoring and evaluation and information release. For example, the National Health and Wellness Committee has institutions such as the Bureau of Disease Control and Prevention and the Health and Wellness Supervision Center. In addition, there is China Center for Disease Control and Prevention (China CDC), and corresponding branches have been set up in various provinces, autonomous regions and municipalities directly under the Central Government. These organizations are responsible for the prevention and control of diseases, especially epidemic diseases, with the aim of creating a healthy environment and promoting people’s health. However, in the face of the epidemic examination, such institutional setup has some problems, such as overlapping institutions, overlapping functions, low efficiency, and even delaying fighters, ineffective command, mutual blame and so on, which need to be changed and reformed urgently.
To this end, first of all, clarify the responsible institutions for epidemic monitoring and evaluation. It is suggested that the National Health and Wellness Committee should assume the overall responsibility and set up a National Epidemiology Steering Committee composed of a deputy director, principals of relevant departments and relevant well-known experts. The steering committee is responsible for the review, approval and release of epidemic diseases, especially major infectious diseases. Secondly, at the same time, the National Epidemiology Administration was established, which was subordinate to the State Council, and its daily work was managed by National Health Commission. The National Epidemiology Administration is mainly responsible for monitoring and evaluating epidemic diseases, especially major infectious diseases, presenting epidemic reports and submitting them to the National Health Commission Epidemiology Steering Committee for review, approval and release.
2. Formulate laws and policies to deal with epidemic diseases.
It is necessary to strengthen the legal construction of epidemic prevention and control and introduce the Epidemic Prevention and Control Law as soon as possible. "Epidemic Prevention and Control Law" should embody the purpose of people-oriented and people’s health as the center. The provisions should absorb the common norms of the international community and proceed from the reality of China, which is a common law and regulation that is generally applicable to the prevention and control of various epidemics. At the same time, we should leave room to formulate national or local supplementary laws and regulations and corresponding policies according to the specific conditions of different epidemic diseases.
3. Accelerate the construction of epidemic emergency facilities and logistics support.
This sudden large-scale outbreak of the COVID-19 epidemic has caused medical and public health facilities, such as hospitals and sickbeds; The supply of materials such as masks and disinfectant is in short supply, which is quite scarce. After the epidemic, it is necessary to evaluate the consumption and demand of facilities and materials, and draw up a balance list of supply and demand of materials according to the actual material consumption of the number of cases, deaths and severe cases finally diagnosed during the epidemic. Taking this as a reference, the demand forecast of epidemic emergency facilities, high, medium and low logistics support is made, which provides a plan for coping with future epidemic logistics support.
At present, the more economical way is to increase investment, improve quality, taste and scale on the basis of new temporary hospitals, vaccines and other new drug production lines built during the epidemic period, and strive to achieve scale and modernization and become a logistics support base to deal with various new epidemics. After the hospital is completed, it can be put into use to make up for the difficulty of seeing a doctor and being hospitalized. The production of new drugs needs to be scientifically determined according to market demand, and a reasonable reserve should be maintained on the basis of meeting current demand.
The construction of public health system urgently needs to fill shortcomings and loopholes.
Song Xiaowu, former deputy director of the State Council Northeast Office and former president of china society of economic reform.
Since the fight against SARS virus in 2003, China has made great achievements in the construction of public health system, and achieved remarkable results in preventing and resisting H1N1 in 2009 and H7N9 and avian influenza in 2013. However, we should also see that the COVID-19 epidemic has exposed some shortcomings in the public health and medical service system, which is worth summing up and thinking about.
First, there is a shortage of relevant professionals in the construction of public health system. According to national statistical data, the proportion of health personnel in CDC has dropped from 2.53% in 2009 to 1.53% at present, and the absolute number of people engaged in public health has dropped. In recent years, the country has put forward the development strategy of healthy China, and defined the guiding ideology of public health with prevention as the priority, but the actual situation shows that there is still a lack of corresponding implementation mechanism. For example, the cultivation and growth of public health talents should be a priority for the government to increase investment.
Second, after the SARS epidemic in 2003, the state invested a lot of manpower and material resources to establish a direct online reporting system for legal infectious diseases. This system has played an active role in preventing the spread of several major epidemic diseases. However, in the early days of the outbreak of Covid-19, the online direct reporting system of infectious diseases failed for a time, and the public health and epidemic prevention system failed to play its due role in the early days. This lesson needs to be earnestly summed up and remembered in a realistic way, and the causes of the artificial expansion of the epidemic need to be deeply reflected.
Third, patients and hospital doctors must be the first to find infectious diseases. How to organically combine social public opinion with the release of major epidemics through formal channels is a big problem that needs to be discussed. How to strictly control the reporting and publishing procedures of major epidemics, and properly handle the direct response of front-line doctors and the general public to epidemics is a major issue that needs to be addressed and studied in the construction of public health and epidemic prevention system. The construction of public health system should be coordinated with the reform of medical institutions. First, because the public health system is largely based on medical institutions. For example, medical treatment in the public health system, including infectious disease specialist hospitals, infectious disease wards in general hospitals, specialist prevention and control institutions, emergency departments of hospitals, pre-hospital first aid institutions and treatment institutions for occupational poisoning and nuclear radiation, are mostly related to hospitals and closely related to hospitals. Therefore, the construction of public health system can not be separated from the system reform and career development of medical institutions. Second, the jobs between the public health system and the medical service system are highly interchangeable and replaceable, and the mobility of medical staff between the two systems is very large. If the system connection between the two systems is not smooth and the operation mechanism is not harmonious, for example, the income distribution gap of medical staff at the same level is too large, which will lead to the unreasonable flow of medical staff. Therefore, in practical work, the construction of public health system cannot be promoted independently from the reform of medical institutions, and the two must be promoted in a coordinated manner.
In addition, it is worth noting that we can’t use special measures in public health emergencies to measure the way of medical service provision under normal circumstances. The public health service system is closely related to the new medical service system, and there are also significant differences. Public health and epidemic prevention is the responsibility of governments all over the world. The government plays an unshirkable role in public health, but it does not deny the role of non-public medical institutions in providing daily medical services to residents.
Eight countermeasures to promote the reform of medical and health system and mechanism
Huang Jianhui, Dean of China Minsheng Bank Research Institute
The public health shortcomings exposed by the COVID-19 epidemic have aroused widespread concern among the general public about the shortcomings of the current medical and health system and mechanism. We should respond to people’s concerns and accelerate the construction of public health system and the reform of medical system.
First, straighten out the relationship between the government and the market, and promote the implementation of the medical reform policy as a whole.
Promote the improvement of legislation and provide legal guarantee for the reform of medical and health system. Based on the Basic Medical and Health Law of People’s Republic of China (PRC), we will revise and improve the Social Insurance Law, the Law on Prevention and Treatment of Infectious Diseases, the Law on Traditional Chinese Medicine, the Regulations on Prevention and Treatment of Medical Disputes and other laws and regulations, and strengthen supervision according to law to increase the cost of violating laws and regulations.
Fill in the shortcomings of public health management and form a development model of "paying equal attention to prevention and treatment". Improve the management level of CDC and strengthen its powers and responsibilities. The central government will directly lead and conduct vertical management to improve the emergency management ability of public health emergencies.
Transform government functions. Promote "separation of management and administration" and "separation of government affairs" to improve the operational efficiency and service level of the medical service supply system; We will improve the coordinated promotion mechanism of medical care, medical insurance and medicine, and completely get rid of "supplementing medicine with medicine".
Promote the supply-side reform in the field of drug production and circulation, and improve the drug supply guarantee system. Take multiple measures to accelerate the realization of a "full coverage, basic protection, multi-level and sustainable" medical security system. With the goal of "making the whole people enjoy fair and accessible health services", we will continue to improve and optimize the basic medical security system for all; Give full play to the supplementary role of commercial medical insurance; Effectively safeguard the safety of medical insurance funds and improve the efficiency of fund use.
Two, to share the fruits of economic development as the guide, increase financial investment in health care.
Gradually increase the proportion of medical and health financial expenditure. Clear the target of medical and health financial expenditure that is compatible with the level of economic development, and realize a moderate increase in the proportion of health expenditure in financial expenditure.
Promote the rational use of financial funds. Increase investment in public health, innovative research and development, and medical and health education; Increase the input of resources in rural areas, grassroots areas and poverty-stricken areas in the central and western regions; Subsidize public hospitals to reduce medical expenses, and subsidize medical insurance to reduce residents’ direct medical expenses.
Third, focus on strengthening the construction of a public medical system covering urban and rural areas and the whole people, and strive to reform the management system and mechanism.
Promote the establishment of a public medical system covering urban and rural areas and the whole people. Accelerate the optimal allocation of medical resources at regional, urban and rural levels; Improve the graded diagnosis and treatment system of "first diagnosis at the grass-roots level, two-way referral, rapid and slow division and treatment, and linkage from top to bottom".
Promote the reform of the management system of public hospitals. Change the current situation of direct control of public hospitals by health authorities; Strengthen the functions of health administrative departments and market supervision; Clarify the relationship between the government and the party group of public hospitals and the corporate governance structure of public hospitals.
Improve the management mechanism of modern public hospitals. Establish a performance appraisal mechanism oriented to public welfare and operational efficiency, and a "patient-centered" service mechanism; Strengthen budget management and cost accounting mechanism; Gradually implement the filing system for public hospitals.
Fourth, promote diversified, high-quality and efficient supply and demand matching
Speed up opening to the outside world and actively develop private hospitals; Accelerate opening to the outside world and actively introduce foreign-funded hospitals.
Fifth, actively deploy digital Internet medical care
Be good at digital service process and introduce digital medical technology. Establish an Internet grading diagnosis and treatment platform and promote online appointment; Use cloud computing, big data, artificial intelligence and other technologies for monitoring and analysis, health management, technology research and development, emergency management, etc.
Promote online diagnosis and treatment of "internet plus". Online follow-up visits for some common diseases and chronic diseases; Carry out telemedicine, health consultation and health management services; Establish a network medical science popularization platform to improve residents’ self-health management ability.
Six, effectively protect the legitimate rights and interests of medical personnel.
Gradually increase the average salary level of medical staff, take medical skills, patient satisfaction, clinical performance or the actual contribution of research to the clinic as the leading assessment indicators, and promote the legalization, rationalization and sunshine of medical staff’s income; Strengthen the protection of rights and interests and publicity and guidance to improve the professional dignity of medical staff.
Seven, for the purpose of improving patient satisfaction, the establishment of medical and health consumer rights protection bureau.
Set up health care consumer rights protection bureaus within health care committees at all levels, improve consumer rights protection mechanisms and measures in the field of health care, organize the acceptance, investigation and mediation of complaints about health care consumption, and carry out supervision, inspection, education and consultation.
8. Strengthen international cooperation in the field of medical and health care and practice building a community of human destiny.
Improve the international cooperation mechanism for dealing with major public health incidents and jointly safeguard world public health security; Strengthen international cooperation in pharmaceutical innovation and research and development; Promote the modernization of Chinese medicine industry, and continue to promote the integration of Chinese and Western medicine from the aspects of personnel training, theoretical research and clinical application.
Seize the new opportunity brought by the epidemic to medical insurance reform
Liu Wanling, Vice President of china society of economic reform.
Medical security has played an important role in fighting the epidemic, and it has also deepened our understanding of the importance and necessity of accelerating the construction of medical security system. We should seize the opportunity of medical security reform brought by this epidemic and speed up the improvement of our medical security system.
First, improve the medical treatment system during major epidemics.
In emergencies such as sudden epidemic, in order to ensure that patients can be treated as soon as possible, medical institutions should treat them first and then charge them, giving priority to saving patients’ lives. Explore the establishment of a medical fee exemption system for special groups and specific diseases. Improve the proportion of payment to primary medical institutions, ensure the demand for funds, and simplify the settlement method.
Second, establish a reasonable fund raising system
Fund is the basic guarantee for the operation of medical security. The level of medical security should adapt to the level of economic development. We should proceed from the reality of China’s national conditions, adhere to the reasonable burden of the state, units and individuals, not only ensure the basic medical care for employees, but also consider the affordability of finance and enterprises, and establish a financing mechanism that is suitable for the basic national conditions in the primary stage of socialism, matches the affordability of all parties, and coordinates with the basic health needs.
Third, improve the multi-level medical security system
In view of the insufficient imbalance in the development of medical security, we will speed up the establishment of a multi-level medical security system with basic medical insurance as the main body and medical assistance as the foundation, supplemented by medical insurance, commercial health insurance, charitable donations and medical mutual assistance. In particular, we should learn from foreign advanced experience, accelerate the development of commercial health insurance, and make it an important supplementary level of medical security.
Four, improve the medical insurance fund supervision mechanism
The medical insurance fund is the "life-saving money" of the people. Maintaining the security of the fund should be the primary task. Strengthen the establishment of a systematic and integrated comprehensive supervision system, establish and improve a strict management and supervision system, implement a strict accounting system, and give play to the role of supervision of medical insurance public service institutions, departmental coordination supervision, third-party supervision and social supervision. Innovate fund supervision methods, make full use of information technology, implement real-time dynamic intelligent monitoring of big data, and establish a normal mechanism for supervision and inspection. Improve the social supervision and incentive mechanism of medical security.
Vigorously promote the construction of public health emergency management system
Jiang Huicheng, Chairman of Hainan Provincial Cancer Hospital
In the process of epidemic prevention and control, the shortcomings and shortcomings of the public health emergency system were exposed. We should comprehensively improve the construction of public health and the capacity building of public health emergencies. Improve public health and medical service capabilities, speed up the improvement of major epidemic prevention and control systems and mechanisms in various regions, focus on the goal of "early detection, early reporting and early disposal", strengthen the information collection, analysis and utilization capabilities of disease control institutions at all levels, continuously strengthen the graded diagnosis and treatment mechanism, optimize the layout of public health resources, and strengthen grassroots infrastructure construction.
The first is to build an intelligent emergency system. It is suggested to accelerate the construction of "Internet+Medical" platform, make full use of digital technologies such as big data, cloud computing and informatization, improve the data interconnection between public health platform and medical institutions, and realize the intelligence, informatization and convenience of emergency system for public health emergencies. Improve the concept, means and technology of "smart health" throughout the construction of emergency system for public health emergencies, accelerate the construction of a moderately advanced, interconnected, safe, efficient, intelligent and green modern infrastructure system, create an intelligent emergency system, and continuously improve the modernization level of governance system and governance capacity.
The second is to improve the emergency material reserve system. Establish and improve relevant laws, regulations and rules and regulations around the material reserves for handling public health emergencies, so that there are laws and regulations for the management of materials for handling public health emergencies. The government reserve and enterprise reserve, non-governmental organization reserve and family reserve are adopted to carry out diversified emergency materials reserve for public health emergencies. In addition, we will improve the emergency material reserve system by building, rebuilding, leasing emergency material storage facilities and entrusting enterprises to purchase services.
Only by promoting the construction of public health emergency management system can we enhance our ability to deal with public health emergencies.