Basic medical care is guaranteed by three lines, one, three, and three qualified lines In order to implement the decisions and arrangements of the Party Central Committee and the State Council to solve the outstanding problem of "two worries and three guarantees", according to the "State Council Leading Group for Poverty Alleviation and Development" issued Notice on the Guiding Opinions on Solving the Outstanding Issues of "Two Guarantees and Three Guarantees" (Guofafa [2019] No. 15), to promote comprehensive solutions to the outstanding issues of basic medical security, and to further promote the implementation of health poverty alleviation projects, the National Health and Health Commission, The National Development and Reform Commission, the Ministry of Finance, the National Medical Insurance Administration, the State Administration of Traditional Chinese Medicine and the State Council Poverty Alleviation Office jointly formulated the "Work Plan for Solving the Outstanding Problems of Basic Medical Care for the Poor". It is now printed and distributed to you (can be downloaded from the National Health Commission website), please implement it carefully. The work plan for solving the outstanding problem of ensuring basic medical care for the poor is to implement the decisions and arrangements of the Party Central Committee and the State Council to solve the outstanding problem of "two worries and three guarantees", and further promote the implementation of the health poverty alleviation project, with the capacity building of county hospitals, "county and township integration, rural areas The main focus is on the construction of an "integrated" mechanism and the standardization of rural medical and health institutions, comprehensively solving the outstanding problems of ensuring basic medical care for the poor, and ensuring that the task of health poverty alleviation is fully completed by 2020. Guarantee "Guiding Opinions on Outstanding Issues" and formulate this work plan. 1. Accurately grasp the standards and requirements for guaranteed basic medical care. Basic medical care for the poor mainly means that all poor people are included in the coverage of basic medical insurance, critical illness insurance and medical assistance. Common diseases and chronic diseases can be treated at the county and rural levels. Medical institutions provide timely diagnosis and treatment, and basic life is still guaranteed after serious or serious illness. Establish and improve the basic medical security system, strengthen the construction of county and rural medical and health institutions, equip qualified medical personnel, eliminate "blank spots" for personnel in rural and rural institutions, and ensure that poor people have places, doctors and institutional guarantees for medical treatment. The guidance work standards include: "three ones" for medical and health institutions, "three qualifications" for medical and health personnel, "three lines" of medical service capabilities, and full coverage of the medical security system (see the attachment for details). 2. Strengthen the capacity building of county hospitals (1) Increase support. Further increase investment support within the central budget and urge local governments to include county-level hospitals (including traditional Chinese medicine hospitals, the same below) in eligible poor counties (key counties for national poverty alleviation and development and counties in contiguous poverty-stricken areas, the same below) into the national health security Engineering support scope. All localities must fulfill their investment responsibilities, transform and improve county-level hospital facilities, and equip them with basic equipment to ensure the normal operation of county-level hospitals. (2) Strengthen counterpart assistance. Further clarify the assistance goals, tasks and assessment indicators for tertiary hospitals. Organize tertiary hospitals to increase assistance to deeply impoverished counties. Adopt a "group-type" support method and select management and technical personnel to serve as presidents or vice presidents, directors of nursing departments, and subject leaders of the supported hospitals. The support team should be no less than 5 people (traditional Chinese medicine hospitals can select 3 people). The batch of personnel shall work continuously for no less than 6 months. Help poverty-stricken county hospitals to strengthen the construction of clinical specialties for local disease spectrum, and improve the diagnosis and treatment capabilities of common diseases, frequently-occurring diseases and some critical and severe diseases in internal medicine, surgery, obstetrics and gynecology, pediatrics and emergency departments. (3) Promote telemedicine. Achieve full coverage of telemedicine in county-level hospitals in poor counties, expand service connotation, enrich service content, and effectively promote the sinking of high-quality medical resources through remote consultation, ward rounds, teaching, and training. Further standardize telemedicine services and gradually improve telemedicine charging and reimbursement policies. 3. Strengthen the construction of the mechanism of “county and township integration and rural integration” (4) Strengthen the training of county and rural personnel. Continue to carry out standardized training for general practitioners, training for assistant general practitioners, job transfer training, etc., and increase the training of free medical students directed to rural orders. Continue to recruit general practitioners for special posts in poverty-stricken areas and comprehensively solve the problem of lack of licensed doctors in township health centers. Encourage all localities to continue to carry out free medical student training for village clinics. Continue to carry out practical skills and appropriate technical training for rural doctors to improve their ability to diagnose and treat common and frequently-occurring diseases and provide traditional Chinese medicine services. (5) Coordinate the use of county health human resources. Encourage the implementation of "counties hire counties to manage townships" and "townships hire villages" to hire qualified medical personnel for township health centers and village clinics. Establish and improve a stubble selection and dispatching system to solve the problem of lack of qualified doctors in village clinics by selecting doctors from township health centers to carry out inspections and dispatch. Explore the province's non-poverty-stricken counties and county-level hospitals to provide counterpart support to township health centers in poverty-stricken areas, and regularly select doctors to practice in township health centers. (6) Promote the construction of county medical system. Where conditions permit, further carry out the construction of a compact county medical system, promote the unified operation of administrative management, medical services, information systems, etc. within the medical system, improve the overall performance of county medical and health services, and gradually use the total amount of regional medical insurance funds to control Instead of total control of specific medical institutions. 4. Strengthen the standardization construction of rural medical and health institutions (7) Eliminate “blank spots”. Promote local governments to implement their main responsibilities, increase investment, and in accordance with the principle of filling in the gap, fully complete the infrastructure construction of township hospitals and village clinics during the poverty alleviation period, and rationally allocate medical equipment in township hospitals and village clinics. Strengthen the construction of traditional Chinese medicine departments in township health centers and the allocation of traditional Chinese medicine equipment in village clinics. For newly formed administrative villages after poverty alleviation relocation, temporary medical points can be set up to provide services to the masses before the local government's water, electricity, network and other infrastructure construction is in place. 5. Strengthen comprehensive prevention and control of diseases in poverty-stricken areas (8) Comprehensively implement the three-year campaign for comprehensive prevention and control of key infectious diseases and endemic diseases. In accordance with the requirements of the "Three-Year Action Plan for Healthy Poverty Alleviation" (Guowei Finance Fa [2018] No. 38), comprehensive prevention and control of endemic diseases such as AIDS, tuberculosis, schistosomiasis, hydatid disease and Kashin-Beck disease, and classification of symptomatic patients treatment. 6. Safeguard Measures (9) Clarify the division of responsibilities. Adhere to the management system in which the central government coordinates overall planning, provinces take overall responsibility, and cities and counties take charge of implementation. The central department is responsible for the top-level design of health poverty alleviation policies, improves working mechanisms, and clarifies responsibilities and requirements; local governments are responsible for formulating policies, clarifying standards, and promoting the implementation of poverty alleviation policies based on the actual situation of local poverty alleviation. implement. The health administrative department takes the lead in implementing health poverty alleviation, strengthening county and rural medical and health service capacity building, and carrying out classified treatment. The poverty alleviation department is responsible for incorporating health poverty alleviation into the overall deployment and work assessment of poverty alleviation. The medical insurance department is responsible for implementing medical security poverty alleviation and including the poor population in The coverage of the medical security system, development reform and finance departments are responsible for strengthening the investment guarantee for health poverty alleviation. (10) Formulate implementation plan. All localities should formulate specific work standards and implementation plans based on actual conditions and in accordance with the principles that can solve practical problems, are generally recognized by the poor people, and are quantifiable, achievable, and assessable, carry out inspections against the standards, find out the bottom line, establish ledgers, and clarify the time table, roadmap, and report local specific work standards and investigation results to the National Health Commission and the National Medical Insurance Bureau before the end of July 2019. In principle, all parts of the province will no longer formulate separate standards. (11) Increase investment support. The central government coordinates existing funding channels in the health field, and when allocating health transfer payment funds, appropriately favors the "three districts and three states" and other deeply impoverished areas. Provincial and municipal finance should provide preferential support to solve the outstanding problems of ensuring basic medical care. County-level finance must implement subsidies for township health centers and rural doctors in accordance with regulations. For village clinics that serve a small population and are insufficient to maintain normal operation according to existing channels and subsidy standards, county-level finance will provide appropriate subsidies. Poverty-stricken counties should make full use of existing policies and support qualified projects that solve outstanding problems in ensuring basic medical care. Poverty alleviation cooperation between the east and west, counterpart assistance, and targeted poverty alleviation should support solving the outstanding problems of ensuring basic medical care in poverty-stricken areas. Encourage various public welfare funds, enterprises and other social forces to support the capacity building of medical and health institutions in poverty-stricken areas. Attachment: Working standards for ensuring basic medical care 1. Guaranteeing the accessibility of basic medical care (1) "Three Ones" for medical and health institutions. 1. Each poverty-stricken county should build a county-level public hospital (including a traditional Chinese medicine hospital) with corresponding functional rooms, facilities and equipment. In poor counties that are close to or affiliated with municipal administrative districts, if municipal public hospitals can meet the needs, separate county-level hospitals may not be established based on local realities. 2. Each township should build a government-run health center with corresponding functional rooms, facilities and equipment, and be able to undertake the responsibilities of diagnosis and treatment of common and frequently-occurring diseases, preliminary on-site first aid and referral of acute and critical patients. 3. Each administrative village will build a clinic with corresponding functional rooms, facilities and equipment, capable of providing basic medical and health services. Administrative villages with smaller populations or smaller areas can jointly set up village clinics with adjacent administrative villages. The administrative villages where township health centers are located do not need to set up village clinics. (2) "Three Qualifications" for medical technicians. 1. Each county hospital has at least one qualified practicing physician in each professional department. 2. Each township health center has at least one qualified practicing (assistant) physician or general practitioner. 3. Each village clinic has at least one qualified rural doctor or practicing (assistant) physician. (3) “Three lines” of medical service capabilities. 1. A poverty-stricken county with a permanent population of more than 100,000 has a county hospital (traditional Chinese medicine hospital) that has reached the medical service capacity of a second-level hospital. 2. Township health centers with a permanent population of more than 10,000 people meet the requirements of the "Township Health Center Management Measures (Trial)" (Wei Nong Wei Fa [2011] No. 61). 3. Administrative village clinics with a permanent population of more than 800 people must meet the requirements of the "Village Clinic Management Measures (Trial)" (Guo Wei Grassroots Issue [2014] No. 33). 2. Ensure full coverage of the medical security system. All rural registered poor people will be covered by basic medical insurance, critical illness insurance, and medical assistance.