China's primary medical institutions have nearly doubled the five-year increase in outpatient visits

Business Club April 11th News reporter recently learned from the Ministry of Health: In 2010, the number of outpatients at the National Community Health Service Center (stations) and township hospitals was 1.54 billion, accounting for 26.4% of the total number of outpatients in medical institutions, compared with 2005. The outpatient volume of the two types of institutions increased by 740 million person-times (an increase of 91%), and their share increased by 6.7 percentage points.

Since the new medical reform, the strength of grass-roots medical institutions has been greatly improved, which is conducive to solving the “deadlock” in which people are expensive and see a doctor. As for the situation of local primary hospitals, the reporter went to Beijing, Shanghai, Hubei, and Zhejiang to conduct on-site visits.

Beijing: Grass-roots attendance rate increased 7-fold in 5 years In 2010, Beijing's community health service institutions saw an ever-increasing number of patients per year. In 2010, it was 36.291 million passengers, an increase of 7.78% compared with 2009.

According to Mao Yu, deputy director of the Beijing Municipal Bureau of Health and spokesman of the Ministry of Health, with the continuous enhancement of community health service capabilities, the proportion of visits to primary care in Beijing has increased from 5% in 2006 to 42% now.

At present, the community health service network covering urban and rural areas in Beijing has taken shape. The city has built 327 community health service centers and 2,901 community health service stations (including 899 standardized village clinics). Basically, urban residents, suburban plains, and mountainous residents have reached the goal of providing access to medical and health services within 15, 20, and 30 minutes respectively. Two-level investment in urban areas is about 3 billion yuan to implement standardized allocation of basic equipment for community health service organizations.

Shanghai: Prescription Disappeared in the Community Reporters learned from the Shanghai Municipal Health Department that Shanghai's community clinics in 2010 were 73,422,300 person-times, up 14.9% year-on-year. The proportion of the community’s total number of outpatient and emergency departments also increased year by year. It accounted for 33.18% in 2006, 37.36% in 2009, and rose to 38.36% in 2010.

Since 1997, Shanghai has invested a total of 1.86 billion yuan in special funds, and has reconstructed 2,678 community health service agencies. In the layout of community health service organizations, it has achieved a “vertical orientation, horizontal orientation to borderline”. In the downtown area, citizens can find a community health service station within a 15-minute walk. In the rural center village or large natural village, there is a village clinic.

At the community health center, large prescriptions and major inspections are virtually eliminated. At present, Shanghai's community health service agencies have implemented the management of "separation between revenue and expenditure". Medical and health services have been paid by the government. In addition, since 2007, Shanghai has introduced the outpatient service fee reduction policy for community service centers, which has greatly reduced the burden on patients. According to statistics, the average outpatient emergency cost of Shanghai Community Health Service Center is 117.88 yuan, which is 40.30% lower than the average level of the secondary hospital.

According to relevant officials of the Shanghai Municipal Health Bureau, Shanghai will further strengthen the role of community health service institutions in the “basis” role of public health and basic medical services, speed up the training of community general medicine and public health personnel, and comprehensively improve the services of community health service agencies. The ability and technical level enable residents to obtain good basic public health and basic medical services in the community. At the same time, it explored the implementation of community family doctor system services, so that family doctors gradually became the "gatekeepers" of residents' health.

Hubei: Building a "15-minute Service Circle"

In recent years, many grassroots medical and health networks have been consolidated in various parts of Hubei, and the number of primary hospital visits has gradually increased. According to statistics, there were 1,182 township hospitals in Hubei Province in 2009. The total number of outpatient visits was 39,229,900, up by 12.86% over the previous year. There were 1,133 community hospitals, and the total number of outpatient visits was 163.321 million, and the total number of hospitalizations was 164,400. The utilization rate of beds increased by 20.51% over the previous year. In addition, the number of outpatient clinics in the village clinics in the province was 61,023,300 people, with an average of 2,724 visits per health room.

The relevant person in charge of the Hubei Provincial Health Department said that if we want to change the passive situation of “squeezing out to large hospitals,” we must establish basic hospitals and medical staff so that residents can come to the hospital with ease. It is understood that, in 2010, the entire province of Hubei implemented 1,740 grass-roots health construction projects with a planned total investment of 9.56 billion yuan. By the end of last year, 1,170 had been completed. 1,500 general practitioners from township hospitals were trained to recruit 40 practicing doctors for the province's no-practitioners or township hospitals in poor areas.

In 2011, Hubei Province strived to ensure that at least one county-level hospital in each county and county reached the level of standardization, township hospitals met the national construction standards, and 70% of the village clinics reached standardization. A total of 2,000 general practitioner training programs for township hospitals were organized to ensure that there were an average of more than 5 general practitioners in each township hospital. Promote the standardization and standardized management of community health service institutions and build a “15-minute service circle” for community health.

Zhejiang: At the grassroots level in more than half of patients, in 2010, the primary medical and health service institutions in Zhejiang Province accounted for 53% of the total number of gates and emergency departments of medical institutions.

In order to facilitate more convenient medical visits, Zhejiang Province has comprehensively strengthened the establishment of grassroots health service systems. It is understood that in 2010, the province has added 55 central government primary health projects, including 12 county-level hospitals and 43 township health centers (community health service centers), which have obtained central funding of 211 million yuan. The provincial financial arrangements are 80 million yuan to support the construction of township health centers in 120 undeveloped areas; arrangements are made for 15 million yuan to fulfill the “replacement by award” policy for the 8 counties (cities, districts) that have basically met the standards for the first batch of township health centers. Arrange 91,700,000 yuan to support the development of village clinics (community health service stations).

On the other hand, through the design of the system, comprehensive reforms of basic medical institutions are promoted, and government compensation mechanisms and performance pay systems are gradually established. In 2010, the provincial government arranged a total of 275 million yuan in grants for township health centers, 67 million yuan in subsidy funds for village clinics, and 747 million yuan in municipal and county-level financial subsidies, which basically ensured the normal operation of basic medical institutions under the new system.

Dr. Wang Guojing, deputy director of the Health Department of Zhejiang Province, told reporters that the biggest challenge faced by the “strong grassroots” in the two years since the implementation of the medical reform was how to further strengthen protection. The core is how to improve primary health care service capabilities and how to strengthen grassroots health personnel. At present, Zhejiang Province has increased financial input and comprehensively promoted the comprehensive reform of basic medical and health institutions to achieve the purpose of consolidating the basic level and ensuring basic protection.