Promote the reform of medical insurance payment methods, strengthen the medical insurance fund revenue and expenditure budget, establish composite payment methods such as payment based on disease type, payment per capita, and payment per service unit, and explore packaged payment per capita for patients with chronic diseases in primary medical and health institutions. Continue to improve related policies such as the coordination of resident medical insurance outpatient clinics. Improve differentiated medical insurance payment policies for medical institutions at different levels, appropriately increase the proportion of medical insurance payment in primary medical and health institutions, and continuously calculate the deductible for transferred inpatients who meet the regulations to promote the orderly flow of patients. Qualified primary medical and health institutions and chronic disease medical institutions will be included in the designated coverage of basic medical insurance in accordance with regulations. (4) Improve the price formation mechanism of medical services. Reasonably formulate and adjust medical service prices to form effective incentives and guidance for medical institutions to implement functional positioning and for patients to reasonably choose medical institutions. According to the overall level of price control, in accordance with the principles of total volume control, structural adjustment, ups and downs, and gradual implementation, on the basis of reducing the cost of drugs and medical consumables, and the price of inspection and treatment of large medical equipment, we will increase the value of the technical labor services of medical personnel. project price. Straighten out the relationship between medical service price comparisons and establish a dynamic adjustment mechanism for medical service prices.

(5) Establish and improve the benefit distribution mechanism. By reforming medical insurance payment methods and strengthening cost control, we will guide hospitals at level 2 and above to refer chronic disease patients with clear diagnoses and stable conditions, and proactively provide diagnosis and treatment services for patients with difficult and complex diseases. Improve the performance-based salary distribution mechanism in primary medical and health institutions to favor medical personnel who contract to provide services.

(6) Establish a division of labor and collaboration mechanism for medical and health institutions. Oriented by improving primary medical and health service capabilities, and using business, technology, management, assets, etc. as links, we will explore the establishment of various division of labor and collaboration models including medical consortia and counterpart support, and improve the management and operation mechanism. Higher-level hospitals provide priority admission, priority examination, priority hospitalization and other services to transferred patients. Encourage higher-level hospitals to issue drug treatment plans and implement treatment in lower-level hospitals or primary medical and health institutions. For critically ill patients and surgical patients who need hospitalization, smooth transfers between medical institutions at all levels can be achieved by formulating and implementing admission and discharge standards and two-way transfer principles. Primary medical and health institutions can collaborate with secondary hospitals and chronic disease medical institutions to provide elderly care, home care, community care, mutual care, home beds, medical rehabilitation and other services for patients with chronic diseases, geriatric diseases and other diseases. Give full play to the role of different host medical institutions in the division of labor and collaboration mechanism.

4. Organization and implementation

(1) Strengthen organizational leadership. The hierarchical diagnosis and treatment work involves a wide range of areas, has strong policy implications, is long-term and complex, and local governments and relevant departments at all levels must adhere to the principle of perseverance and perseverance, effectively strengthen organizational leadership, and incorporate it as a core task into deepening the medical and health system. Make an overall arrangement for the reform work, establish relevant coordination mechanisms, clarify the division of tasks, and study and formulate practical implementation plans based on local realities.

(2) Clarify department responsibilities. The health and family planning administrative departments (including the traditional Chinese medicine management department) should strengthen the supervision of the planning, establishment, approval and medical service activities of medical institutions, clarify the two-way referral system, optimize the referral process, and take the lead in formulating admission, discharge and two-way referrals for common diseases. standards, improve the payment policy of the new rural cooperative medical system, and guide relevant academic (associations) to formulate and improve the diagnosis and treatment guidelines and clinical pathways for related diseases. The development and reform (price) department must improve pharmaceutical pricing policies and implement hierarchical pricing measures. The human resources and social security departments should strengthen supervision, improve medical insurance payment policies, promote the reform of medical insurance payment methods, and improve the performance salary distribution mechanism. The financial department must implement financial subsidy policies. Other relevant departments must, in accordance with the division of responsibilities, issue supporting policies in a timely manner and ensure their implementation.

(3) Promote pilot projects steadily. Local governments at all levels must insist on proceeding from reality, adapting measures to local conditions, and promote hierarchical diagnosis and treatment pilot work in various forms. In 2015, all public hospital reform pilot cities and comprehensive medical reform pilot provinces will carry out hierarchical diagnosis and treatment pilots, and qualified provinces (autonomous regions and municipalities) are encouraged to increase hierarchical diagnosis and treatment pilot areas. Taking chronic diseases such as hypertension, diabetes, tumors, and cardiovascular and cerebrovascular diseases as breakthroughs, we will carry out pilot work on hierarchical diagnosis and treatment. In 2015, we will focus on pilot work on hierarchical diagnosis and treatment of hypertension and diabetes. Explore the hierarchical diagnosis and treatment and comprehensive patient management service models for chronic infectious diseases such as tuberculosis. The National Health and Family Planning Commission should work with relevant departments to guide the pilot work of hierarchical diagnosis and treatment, sum up experience in a timely manner and report progress.

(4) Strengthen publicity and guidance. Carry out policy training for administrative personnel and medical personnel, and regard the establishment of a hierarchical diagnosis and treatment system as an inevitable requirement to fulfill social responsibilities and promote career development, further unify thinking, gather professional knowledge, enhance initiative, and improve enthusiasm. Give full play to the role of public media, widely publicize disease prevention and treatment knowledge, encourage patients to establish scientific medical treatment concepts, improve scientific medical treatment capabilities, and rationally choose medical institutions. Strengthen publicity on the improvement of the service capabilities of primary medical and health institutions and hierarchical diagnosis and treatment, guide the public to increase their awareness and recognition of primary medical and health institutions and hierarchical diagnosis and treatment, change their medical concepts and habits, and choose the nearest and first-class primary medical and health institutions for treatment. .

Attachment: Assessment and Evaluation Criteria for Graded Diagnosis and Treatment Pilot Work

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