IntroductionLanguage
Let the medical insurance fund work better!
A few days ago, the Guangdong Provincial Medical Security Bureau released the “Guangdong Provincial Designated Tertiary Medical Institutions Medical Insurance and Medical Service Evaluation Report (2021)” (hereinafter referred to as: “Report”), which comprehensively evaluates the province’s tertiary medical insurance designated points. It is the first time in China to evaluate, rank, and publish the medical services of TCM medical institutions. The evaluation results may be linked to the medical insurance payment policy to promote the high-quality development of designated medical institutions, which is of great significance to improving the level of medical security in Guangdong Province.
It is reported that the scope of this evaluation is 137 tertiary designated comprehensive medical institutions in the province except military hospitals, specialized hospitals and other tertiary designated comprehensive medical institutions. institutions and 45 tertiary designated TCM medical institutions.
No.1
Comprehensive Multi-Dimensional Ranking< /strong>
Zhongshan No.1 Hospital and Provincial Hospital of Traditional Chinese Medicine ranked first
Ranking in 8 dimensions< /strong>
The “Report” establishes5 first-level indicators, 13 second-level indicators and 50 third-level indicators, including policy norms, medical insurance quality, medical services, medical insurance operations, and sustainable development. The index evaluation system collected a total of 15.61 million front pages of medical records, 364 reports from medical insurance departments and medical institutions, 121,000 questionnaires for medical staff, 117,000 questionnaires for outpatients, and 73,000 questionnaires for inpatients. Provincial Medical Insurance Bureau and Provincial Academy of Medical Sciences successively organized more than 20 experts in medical insurance, medical and other fields to carry out 4 rounds of professional quality control to ensure the credibility of the evaluation process and results.
The evaluation report comprehensively presents the status quo of medical insurance and medical services in designated medical institutions and the strategic purchase of medical insurance funds, and provides an overall assessment of the medical insurance and medical services of designated tertiary medical institutions, policies and policies. Standardization, medical insurance quality, medical service, medical insurance operation, sustainable development, case mix index (CMI), and medical insurance capability index are ranked in 8 dimensions.
The “Report” ranks the designated third-level comprehensive medical institutions and designated third-level traditional Chinese medicine medical institutions respectively. Among the top 10 comprehensive medical institutions, 6 are located in Guangzhou, 2 are located in Shenzhen, and 1 are each in Meizhou and Foshan. The First Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial People’s Hospital, Nanfang Hospital of Southern Medical University, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, and Zhujiang Hospital of Southern Medical University ranked the top 5 in the total score.
5 cities with no medical institutions on the list
Top 50 in the total score Among the comprehensive medical institutions, 15 are concentrated in Guangzhou City, and no institutions in Heyuan City, Shanwei City, Chaozhou City, and Zhanjiang City are on the list.
Among the top 10 TCM medical institutions, 4 are in Guangzhou, 2 are in Foshan, 1 are each in Zhongshan, Shenzhen, Shaoguan and Yunfu. Guangdong Provincial Hospital of Traditional Chinese Medicine, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Foshan Traditional Chinese Medicine Hospital, Guangzhou Panyu District Traditional Chinese Medicine Hospital, and Zhongshan Traditional Chinese Medicine Hospital ranked the top 5 in the total score.
Chaozhou City, Jieyang City, Shanwei City, Zhaoqing City, Zhanjiang City’s TCM medical institutions rank among the top three designated TCM medical institutions in Guangdong Province Missed out of 30.
No.2
Evaluation results or related to Medicare payment Linked
“The development of medical service evaluation is an innovative measure in the reform of the medical security field in Guangdong Province. The publication of the medical service evaluation report and ranking is the first time in China.” Guangdong Xiao Xue, secretary of the party group and director of the Provincial Medical Insurance Bureau, said at the press conference.
Yu Xueqing, President of Guangdong Academy of Medical Sciences, introduced that the report comprehensively presented the current situation of medical insurance and medical services in designated medical institutions and the strategic purchase of medical insurance funds. The total score, medical insurance ability index and other 8 dimensions are ranked, and 50 three-level indicators such as the proportion of drugs in the medical insurance catalogue, the proportion of medical staff with senior professional titles, and the proportion of patients with specific diseases in outpatient clinics are deeply analyzed, and targeted policy recommendations.
Han Huidong, Director of the Medical Service Management Division of the Guangdong Provincial Medical Insurance Bureau, introduced that in the next step, the Guangdong Provincial Medical Insurance Bureau will gradually increase the number of specialized hospitals including the Maternity and Child Health Hospital. and guide local medical insurance bureaus to evaluate medical institutions at or below the second level, striving to achieve full coverage of the medical insurance and medical service evaluation of designated medical institutions in the province; we are exploring the establishment of a link between the evaluation results and medical insurance payment, unannounced inspections, etc., improve the enthusiasm of medical institutions to participate in the evaluation; will continue to improve the evaluation index system of medical insurance and medical services, carry out evaluation work on a regular basis, and create a “Guangdong model” for medical insurance and medical service evaluation.
No.3
Report Highlights at a Glance
According to the service capabilities of medical institutions, the report divides medical institutions into 4 categories to analyze the evaluation results of various three-level indicators:
Teaching and provincial hospitals: medical institutions affiliated to the index of medical schools in ministries, provinces and cities and provincial medical institutions; Only one hospital;
County and district hospitals: prefecture-level non-central hospitals or third-class hospitals other than the First People’s Hospital, and county- and district-level third-class hospitals;
County and district hospitals ( Level 3): tertiary hospitals that are not in the top three at the prefecture, county and district levels.
According to this “Report Content”, medical institutions in Guangdong Province have the following characteristics and deficiencies.
Guangdong medical institutions have more “plateau” disciplines and less “peak” disciplines
The report shows that no matter the comprehensive medical institutions or the There are few top-notch “peak” disciplines and many “plateau” disciplines in TCM medical institutions, and the “peak” and “plateau” disciplines are mainly concentrated in teaching and provincial hospitals.
The report recommends that Guangdong continue to promote the construction ofThe layout of top medical centers with international influence, promote the construction of differentiated development of superior clinical specialty layout, promote the construction of high-level hospital layout in the Greater Bay Area; strengthen the high-level development plan of traditional Chinese medicine in the region. It is suggested that county-level hospitals and county-level hospitals (level 3) strengthen discipline construction, and jointly build more “plateau” disciplines through the construction of medical alliances.
County and district hospitals should formulate and improve Mente policies
Whether it is a comprehensive medical institution or a TCM medical institution, In the indicator of the proportion of patients with specific diseases in outpatient clinics, county and district hospitals (level 3) all performed poorly.
The report recommends that relevant departments should formulate and improve Mente policies, covering the access standards, clinical pathways, and treatment standards of Mente in various regions. Each medical institution should timely handle the Mente treatment for eligible Mente patients, and county-level hospitals and county-level hospitals (level 3) should appropriately consider increasing the number of Mente number sources and adjusting the frequency of visits by outpatient physicians in various specialties. The number of visits of Mente patients will further optimize the proportion of Mente patients.
Basic hospitals lack high-level medical talents
The report shows that high-level medical talents are mainly concentrated in teaching, provincial hospitals and municipal hospitals. In indicators such as the proportion of medical staff with senior professional titles and the proportion of medical staff with master’s and doctoral degrees, county and district hospitals (level 3) have obvious disadvantages.
The report recommends that county-level hospitals and county-level hospitals (level 3) should strengthen the construction of medical consortia, develop core medical technologies, and make good use of the local government’s support for high-end medical talents. The introduction of policies and measures to promote the introduction of highly educated talents; at the same time, policy support such as resettlement subsidies, scientific research start-up funds, housing security, children’s enrollment, and establishment are provided.
Comprehensive teaching, provincial hospitals should pay attention to the proportion of drugs in the medical insurance list
The report shows that in comprehensive medical institutions, , teaching and provincial hospitals did not perform well in the proportion of drugs in the medical insurance catalogue. Only 7 were in the excellent grade, 30 were good, 22 were average, and 41 needed improvement. Correspondingly, county-level hospitals performed the best, with 26 excellent, 19 good, 32 average, and 23 to be improved.
The report recommends that general medical institutions should correctly understand the meaning of the proportion of drugs in the medical insurance catalogue, and fully implement and complete relevant policies; In the process, the clinical value of the medicines on the medical insurance list should be brought into full play, and the clinical use of the medicines on the medical insurance list should not be influenced by reasons such as the limitation of the number of drugs on the medication list or the proportion of drugs. Clinicians are encouraged to use medical insurance as much as possible on the basis of ensuring the quality of medical care. Catalog of medicines.
It is worth noting that among TCM medical institutions, teaching and provincial hospitals performed the best in terms of the proportion of drugs in the medical insurance catalog, while municipal hospitals performed poorly.
Third-level general hospitals should improve service efficiency
Whether it is a general medical institution or a TCM medical institution, there are different levels of In general medical institutions, teaching and provincial hospitals performed poorly; in TCM medical institutions, county and district hospitals (level 3) performed poorly.
At the same time, in terms of time consumption index and cost consumption index, teaching in general medical institutions and provincial hospitals performed poorly.
The report recommends that relevant departments strengthen the supervision of indicators such as the average hospitalization days and the average cost of comprehensive medical institutions through various means, so as to promote comprehensive medical institutions to improve the level of medical diagnosis and treatment and reduce hospitalization. The average hospital stay of patients, reduce medical expenses and improve service efficiency.
No.4
Listed Medical Institutions< /p>
Guangdong Province designated tertiary comprehensive medical institutions (top ten in total score)
The First Affiliated Hospital of Sun Yat-sen University
Guangdong Provincial People’s Hospital
Southern Hospital of Southern Medical University
Sun Yat-sen Memorial Hospital of Sun Yat-sen University
Zhujiang Hospital of Southern Medical University
Shenzhen No. 2 People’s Hospital
The First Affiliated Hospital of Guangzhou Medical University
Shenzhen People’s Hospital
Meizhou People’s Hospital
The First People’s Hospital of Foshan Hospital
Guangdong Province designated tertiary TCM medical institutions (top ten in total score)
Guangdong TCM Hospital< /p>
The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
Foshan Traditional Chinese Medicine Hospital
Guangzhou Panyu District Traditional Chinese Medicine Hospital
Zhongshan Traditional Chinese Medicine Hospital< /p>
Guangdong Second Hospital of Traditional Chinese Medicine
Guangzhou University of Traditional Chinese Medicine Shunde Hospital
Shaoguan Traditional Chinese Medicine Hospital
Shenzhen Traditional Chinese Medicine Hospital
Yunfu Traditional Chinese Medicine Hospital
Source/ Comprehensive Health Guizhou, China Economic Net, Yangcheng Evening News, Nanfang Daily, Nanfang Plus, etc.
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