Medical network May 15 - the state council executive meeting on April 12, examined and approved the "about strengthening the construction of medical association and the development of guidance" (countries do hair [2017] no. 32), in 2017 launched a comprehensive pilot of couplet of various kinds of medical construction, all tertiary public hospital to participate in and play a leading role, comprehensive reform pilot provinces each cities and grading treatment pilot cities built at least one has obvious effect of medicine. 

 

This is an unignorable development opportunity for tertiary public hospitals. Around after a few years ago developed strictly control the scale of large public hospital expansion planning, the power of the development of large hospital from the court or the principal of "points" to lead the medical couplet of "face". 

 

The full launch of the medic: 

 

No. 32 has a timetable 

 

In fact, with hierarchical diagnosis and treatment of many times in recent years, many places have to medical couplet body as the breakthrough point, to build different levels, the collaboration mechanism of different categories of medical institution. According to the national health and family planning commission, deputy director of the state council reform Wang Hesheng, director of the office earlier, by the end of 2016, the country has more than 205 local city (city covers an area of more than 60.8% of the total) to carry out medical couplet of pilot, is now gradually formed a variety of effective model, showing the pilot work performance. 

 

According to the schedule of hair is given no. 32, 2017 to the basic structures of couplet of medical system framework, the comprehensive start construction experimental unit of couplet of various kinds of medical, tertiary public hospital to participate in and all play a role of leading, comprehensive reform pilot provinces each cities and grading treatment pilot cities built at least one has obvious effect of medicine. By 2020, we will comprehensively promote the establishment of the medical community and form a more comprehensive policy system for the medical community by summarizing the pilot experience. At that time, all secondary public hospitals and government-run community-level medical institutions are required to participate in the medical community. Between different levels and different categories of medical institutions to establish specific goals and responsibilities clear, fair and effective collaboration mechanism, establish their consistent leading mechanism, make of couplet of medical service, responsibility, interests and community management, regional medical resource sharing, to further enhance grass-roots service ability, promoted the formation of first option at the grass-roots level, two-way referral, acute slow partition, the upper and lower linkage of hierarchical diagnosis model. 

 

Big hospital decompression: 

 

How is the benefit split? 

 

For tertiary hospitals, in addition to play on at the grass-roots level to lead the medical couplet body of technical radiation and leading role, will also be gradually reduce common disease, frequently-occurring disease, the proportion of patients with chronic diseases in a stable condition. Contact also require implementation of tertiary hospital abolish all drugs within this year bonus, common diseases and chronic disease, to reduce the medicine proportion, reduce the pressure of medical institutions pharmacy pharmacy is beneficial. Admits there are 3 armour hospital management, compared with the "one size fits all" cancel outpatient pharmacy, guidance to the practice of grassroots medical institutions of the same medical couplet of subordinates, are more likely to get the patient's understanding and support. 

 

In order to improve the motivation of the three tertiary hospitals to separate common diseases, morbidity and chronic diseases, the cat-type medical association is clearly more ideal. Is seen as a typical representative of the shenzhen luohu medical group, rehabilitation medical group, zhenjiang city, jiangsu province, is a tertiary public hospital hospital led or business ability is strong, united community health service institutions, such as resource sharing and collaboration management mode. 

 

And at the end of last year the national health and family planning commission issued by the implementation of the medical association of the pilot construction guidance ", to the city to carry out the main modes of the construction of medical couplet body, also gives the "1 in tertiary hospitals as the lead unit, combined several city secondary hospital, rehabilitation hospitals, nursing homes and community health service center, construction of couplet of" 1 + X "medical" idea; It also puts forward that "the integrated management mode of medical association, financial and physical education in the area of the medical community should be promoted, and the medical association should be a community of common goals." 

 

However, the director general of the health and family planning commission, liang wannian, added that there are many ways to encourage the construction of a closely connected medical body, but not to do so. "All around service, responsibility, benefit and management four community. The medical construction of couplet of the most important thing is to the emphasis on the efficiency of a single medical institutions, to emphasize the overall efficiency of the whole medical service system. In the future, we evaluate evaluation to an area, a system that is the smallest unit of couplet of medical efficiency, effect and effectiveness, it is an important shift." 

 

For tertiary hospitals, the extension is not limited to the area of the hospital. Countries do hair no. 32 has clearly pointed out that between the urban and rural to urban tertiary public hospital as the main unit, in the established relationship, based on the long-term stable partnerships through hosting area county hospital medical couplet body, a variety of forms, including tertiary public hospital to county-level hospitals in the management team and expert team. National and provincial public hospital in addition to the couplet of dependency in the medical, can establish cooperative relations with several medical couplet body to different regions, couplet of medical form a high-level, complementary advantages, develop innovative collaborative research, technology popularization promotion and personnel training, radiation to drive regional health service ability to ascend. 

 

But it is worth noting that the hair no. 32 will promote the couplet of medical health is put forward, to "encourage medical couplet of medical institutions in the administrative subordination relations and financial investment channels unchanged under the premise of overall staffing, compensation allocation, resource sharing and so on, forming high-quality medical resources through channels and mechanisms of up and down." 

 

"How the current interest is divided is the key to the real operation of the medic." It will be a big test for hospital executives involved in local medias to say how to balance the relationships at all levels. Yanzhou, shandong province area of traditional Chinese medicine hospital dean Kong Qingmin said, close medical couplet body in order to implement the orderly opens the door of hierarchical diagnosis and treatment, especially the health control under the condition of increasing cost pressure, the higher hospital under active patients, referral down into hospital integrated health care market, shunt patient, organization pressure effective means. 

 

Drug company extension prescription: 

 

Opportunities for slow disease 

 

If medical couplet body comprehensive advancement for large hospital is an opportunity to "be explored", then the main channels of hospital pharmaceutical companies, could impact at a deeper level. 

 

The first change is that the likelihood of a large hospital's prescribing habits to replicate within the same medical unit has risen sharply. Countries do hair no. 32 will give a clearer signal: exploring to establish unified inside couplet of medical drug bidding procurement, management platform, the formation of couplet of medical drugs prescription flow, in sharing and distribution mechanism. 

 

The drugs for chronic diseases are particularly acute. Since 2015 in Shanghai the first batch of pilot community health service comprehensive reform, the implementation of "prescription" community health service center of Shanghai pujiang revealed that the essence of which is aimed at different condition of medical needs, to the family doctor referred to superior medical institutions the signing of residents, such as for the continuation of the superior long-term medication orders to maintain treatment of a medical institution, when signing back to family doctor to see a doctor, family doctor can according to the higher authority hospital medication orders issued by the same drug. 

 

Similarly, and from 2012 the implementation of "three division condominium" couplet of the medical model of xiamen city, fujian province, the so-called "three" is big hospital specialist, grassroots organization family physicians and health management division. The model in order to better guide the patients to actively at the grass-roots level, or community health service center of hypoglycemic, commonly used antihypertensive drugs, and tertiary hospital drug varieties is consistent with "alignment" up and down; And to extend the prescribed dosage, the community can take four weeks of medication. The results were also significant, with the number of patients with diabetes and hypertension rising to 78.1%, 95.7 percent, from 40.7 percent to 72.6 percent as of 2016. 

 

Chronic diseases extended prescription pilot practice, also be incorporated into the guidance in the cure of couplet, no. 32 offered to "explore the signing of some chronic diseases patients provide no more than 2 months dose strengths party service; conditional place can, according to the requirements of two-way referral of patients go to a doctor, by extending the prescription, centralized distribution among primary and superior form of hospital medicine cohesion". 

 

In addition to the prescription of large hospitals, one form of the medical association, the inter-regional alliance, also gives medical companies a new layout. Such as HuaRen pharmaceutical announcement on April 19, the company is planning to a domestic medical networking platform company signed a strategic cooperation agreement, surrounding the kidney disease diagnosis and treatment, relying on the abdomen through business sales channel resources, build medical couplet body, kidney disease classification diagnosis model for the formation of upper and lower linkage to lay the foundation. 

 

However, the researchers also point out that the so-called cross-regional form junior coalition, request medical institutions specialized resources according to different area, with a number of medical institutions by characteristic specialized technical strength to support, give full play to the national medical center, the national center for clinical medical research and collaborative network, with specialized cooperation as a link, several characteristic specialized subject to form a regional alliance, form a development mode, focus on improving the capacity of major disease treatment. "Some companies that have already cultivated and have a certain medical facility in the relevant field may benefit from it."