Sign about print and distribute to promote family doctor service guidance

The national health and family planning commission of the People's Republic of China

The 2016-06-06

The reform do hair [2016] no. 1

Provinces, autonomous regions and municipalities directly under the central government, xinjiang production and construction corps reform, health and family planning commission (bureau), the national development and reform commission, the department (bureau), fiscal affairs department (bureau), human resources and social security department (bureau), the administration of traditional Chinese medicine:

Health department, national health and family planning commission of the state council, national development and reform commission, the ministry of civil affairs, ministry of finance, human resources, social security and the state administration of traditional Chinese medicine of the signing of promoting family doctor service guidance "has passed the central comprehensively deepen reform leading group for consideration. Agreed to by the state council, is printed and distributed to you, please carefully around the implementation.

Reform of the state council for the national health and family planning commission

The national development and reform committee, ministry of civil affairs

The Treasury of human resources social barrier

The state administration of traditional Chinese medicine

On May 25, 2016

Signing of promoting the family doctor service guidance

Shift in basic medical and health service mode, implements the signing the family doctor service, strengthen the grassroots health service network functions, is an important task of deepening the reform of medical health system, is also under the new situation better protecting the health of the people's important way. In recent years, integrated with actual actively explore, at the grassroots level to carry out the practice mode and service mode reform pilot work, adopt various forms to promote signing service, positive progress has been made, the accumulated practical experience. To implement the "state council on establishing GPS guidance system" (guo fa [2011] no. 23) and the general office of the state council on promoting the construction of the grading system of guidance "(countries do hair [2015] no. 70) requirements, accelerate the signing the family doctor service, we put forward the following opinions.

First, general requirements

(a) the overall train of thought. According to the overall deployment of deepening the reform of medical health system and requirements, focus on the health of China construction, realize the goal of everyone will have access to basic medical and health services, in order to protecting the health of the people as the center, promote the medical and health work center of gravity down, resource sink, combined with the grassroots health institutions comprehensive reform and construction of GPS system, accelerate the family doctor service signing. Perfecting the contract service connotation, highlight combine traditional Chinese and western medicine, enhance the will of the masses actively signing; Establishing and perfecting the contract signing of intrinsic motivation and external support mechanism, arouse the enthusiasm of the family doctor to carry out the contract services; Encourage lead level 2 above hospitals and non-government medical institutions to participate in, improve service levels and coverage, signed first option at the grass-roots level to promote, hierarchical diagnosis and treatment, for the masses to provide comprehensive, continuous, synergy of the basic medical and health services, enhance people's feeling.

(2) the main goal. In 200, 2016 public hospital comprehensive reform pilot cities for signing the family doctor service, actively carry out pilot encourage other conditional area. Signing service way, content, focus on pay, evaluation, incentive mechanism and so on to achieve breakthrough, priority covering the elderly, maternal and children, disabled people, as well as chronic diseases such as hypertension, diabetes, tuberculosis and severe mental disorders, etc. Signed in 2017, the family doctor service coverage rate of 30% or more, key crowd signing service coverage rate of 60% or more. By 2020, strive for the signing services extended to the whole people, form the long-term stability of contract service relationship, basic realizing a complete coverage of signing the family doctor service system.

Second, the clear sign service main body

(3) the family doctor service for signing the first responsible person. Family doctor at the present stage mainly grassroots health institutions, including the registration of general practitioners (including assistant general practitioners and category general practitioners of traditional Chinese medicine), and have the ability to doctors in towns and townships, rural doctors and so on. Actively guide of public hospital doctors and intermediate above title of retirement clinicians, especially in internal medicine, gynecology, pediatrics, doctor of traditional Chinese medicine, etc., as a family doctor signed service at the grassroots level, grassroots health institutions through agreements to provide service for its space and ancillary services. Encourage eligible non-government medical institutions (including individual clinic offering signing service, and enjoy the same pay policy. With the development of GPS talent team, gradually formed to service team for a gp as the main body of the contract.

(4) a team contract service. Contract signing, in principle, shall take the service team. Family doctor team mainly by the family doctor, community nurses, public health physician assistant (including public health physician) etc, level 2 above hospitals should send doctors (including the category of traditional Chinese medicine doctor) to provide technical support and professional guidance. Gradually achieve every family doctor team is able to provide services of traditional Chinese medicine doctor or rural doctors, conditional area can absorb pharmacists, health management division, psychological consultant, club (righteousness), etc. To join the team. The family doctor is responsible for task allocation and management of team members. Grassroots medical and health institutions should clear the family doctor team work tasks, work flow, system specification and members of the division of duties, and regularly carry out performance appraisal. Other specialist and health technical personnel to work closely with the family physician team.

(5) to sign the service agreement. According to service radius and the population, reasonable division of contract signing responsibility area, residents or family voluntarily choose 1 gp team to sign the service agreement, a clear sign the service content, way, time limit and responsibility of both sides, rights, obligations and other related matters. After the expiry of the contract period is one year in principle, residents can choose other contract or family doctor team sign up. To encourage and guide the residents nearby contract, also can sign up to different regions, orderly competition mechanism.

(6) to encourage modular sign. To dock with the grassroots health institutions, strengthen hospital guide residents or family at the same time of signing with the family physician team, voluntary choice of a secondary hospital, a tertiary hospital, to establish the combination of "1 + 1 + 1" service mode, signing within the portfolio according to demand to choose medical institutions, and gradually transition to the first option at the grass-roots level; Outside combination visits shall be enforced by the family doctor referrals. Research to explore the floating population signing service pattern, promoting equal basic medical and health services.

Three, optimize signing service connotation

(7) clear sign service content. The family doctor team provide residents with agreed in the public health and basic medical and health management service. Basic medical services covering common disease and frequently-occurring disease diagnosis and treatment of traditional Chinese and western medicine, the path of the rational use of drugs and medical guidance and referrals, etc. Public health service covers the basic public health services and regulations of the state of other public health services. Shall, according to the service capacity and demand around the set contains basic medical and public health services, including the basic contract service content, to sign for all residents. Health management service mainly for residents health status and needs, to develop different types of individual contract service content, including health assessment, rehabilitation guidance, family sickbed services, home care, Chinese medicine "cure not ill" service, remote health monitoring, etc. At this stage should start first from focus groups and key diseases, determine the service content, and gradually expand the scope of services. Give full play to the traditional Chinese medicine's important role in the basic medical and preventive care, meet the residents' health demand diversification. Local health planning, management, human resources, social security, the financial department of traditional Chinese medicine should combine reality, affirmatory family doctor team service projects, the connotation, process and specification, standard.

Signing enhanced services (eight). Across to take a variety of measures, in medical treatment, referral, medicine, health care and other aspects of signing residents adopted a policy of differentiation, effective use of signing services in the boot. Family doctor team to take the initiative to improve the service mode, can be in accordance with the agreement signed for residents to provide full service, door-to-door service, traffic service, booking service, and other forms of service. By giving a percentage of hospital visit family doctor team, make an appointment, reserving beds, convenient signing residents priority in clinic and hospitalization. Level 2 above hospitals jinpenling district or designated docking family physician referral service department, build green referral channel for referral of patients. For signing with a chronic illness, as appropriate to extend a single dose. For the patients, according to the illness and the superior physician prescribed by the regulation of medical institutions. To give full play to the guiding role of medical insurance payment, implement differentiation to pay for health care policy, take to conform to the provisions of the continuous calculation of hospitalized patients with referral starting line, guide people to the clinic.

Four, and improve the mechanism of signing pay service charge

(9) reasonable signed a contract for service. Family doctor team provide residents with the signing of service agreement, according to a service charge of signing contract service number according to the years, by the medical insurance fund, for the basic public health services and signed share of paying for residents. Specific standards and family planning, human resources allocation proportion by local health departments and so on social security, finance, price according to the contract service content, signing residents structure and basic medical insurance fund and public health funding capacity factors such as determined through consultation. In accordance with medical assistance policy in accordance with the provisions, bailout. Contracted projects of basic public health services in the service fees from the basic public health services is listed in special funds.

(10) play a role of family doctor charged fees. Conditional region can explore residents will sign the outpatient service fund capitation payment to basic medical and health institutions or family doctor team, for the referral of patients to the hospital at the grassroots level by grassroots or family doctor team pay referral fees. Explore collaboration (such as medical association pattern of vertical cooperation total medicare pay, play the role of family doctors in the medical insurance payment control, reasonable guide the two-way referral, give play to the role of gatekeeper.

Other medical services fee (11) specification. Family doctor team to provide for the agreed service in the contract, except in accordance with the provisions, a service charge of signing and shall not charge other fees separately. Agreed to provide the medical and health services or signing to the residents to provide medical and health services, fees according to regulations.

Five incentive mechanism, establishing the contract signing

Perfect family doctor income distribution mechanism (12). Considering the social public welfare goal task completion, including contract service, performance appraisal, career development and so on factors, reasonably determine the grassroots health institutions performance salary amount, make the family doctor signing by providing high quality service and the reasonable raise the level of income, raise the activity to carry out the contract services. Grassroots medical institutions internal performance salary allocation may establish gp allowance, take to the personnel responsible for signing services clinical front line. Basic medical and health institutions to balance part reward fund can be extracted by the regulation. Level 2 above hospitals on the performance salary allocation to attending physician signing service. Conditional place may be passed to the corresponding evaluation gp team and participate in the signing service more than secondary hospital doctors give financial support to guide.

(13) improve comprehensive incentive policies. In preparation, staff employment, the title promotion, on-the-job training, awards, and other key aspects to the gp in directing, tilt, the outstanding staff included in the scope of talents introduction of preferential policies at all levels of the government, strengthens the professional attraction of gp, accelerate the construction of gp team, sign the service level of ascension. Continue to carry out the GPS work plan. Implement the human resources and social security ministry national health commission on further reform and perfect the grass-roots health appraisal work guidance of professional and technical personnel titles "(people club department is sent [2015] no. 94), setting up reasonable grassroots health institutions gp is high, the proportion of intermediate position, expand title promotion space, focus on contract signing examination excellent personnel. Will sign the service evaluation appraisal results, as an important factor of relevant personnel responsibility.it. Prominent family doctor and his team to the result, according to the regulations of the state, give praise, vigorously promote advanced typical. Expand training channels at home and abroad, establish and improve the second class above hospital doctors to the doctor at the grass-roots level to carry out the business guidance and family on a regular basis to clinical teaching base education system on a regular basis. To strengthen the family doctor and his team members of continuing medical education, improve the quality of contract signing.

Sixth, strengthen the signing service performance evaluation

Establish regular check mechanism (14). Local health planning, management, human resources of traditional Chinese medicine sign for social security, finance and other departments to improve service management specification. Establish a signing quantity and structure, service quality, the effect of health management, residents satisfaction, medical expenses control, contract signing as the core services such as proportion of residents basic medical evaluation index system, the regular of gp team to carry out the evaluation, the encourage family doctor represents, signing representatives of local residents, and social participation. The assessment results to the public in a timely manner, and with health care payment funds disbursed, basic public health services and distribution of team and individual performance. For the inspection result is unqualified, public opinion prominent family doctor team, set up a corresponding punishment mechanism.

(15) play a role of social supervision. Establish a signing residents as the main body of the feedback evaluation system, channels open to public scrutiny, feedback evaluation situation in a timely manner to the public, as an important basis and family doctor team performance appraisal residents choose family doctor team important reference. Considering the family doctor working strength, quality of service, etc., reasonable control the family doctor team signing service number.

Seven, strengthening the contract technical support service

(16) to strengthen technical support. Integration of the second class above hospital existing inspection, disinfection supply center, such as resources, open to the grassroots health institutions; Explore set up independent regional medical test mechanism, pathology, diagnosis, medical imaging inspection agencies, etc., realize the regional resources sharing, to provide technical support for the family doctor team. Strengthen the family doctor to sign service equipped with necessary facilities equipment, conditional place for family doctors with uniform dress, visits and equipment, transportation, etc. Grassroots medical institutions to the family doctor team to provide the necessary business and technical support.

(17) play a role of information support. Build perfect regional health information platform, the realization of residents' health records, electronic medical records, inspection reports and other information sharing and business collaboration. In telemedicine, instant messaging and other way, strengthen the second class above hospital physicians technical communication with the family doctor. Through a variety of ways, such as mobile client, set up the family doctor and signing residents of communication platform, for information consulting, interactive communication, patient feedback provide convenience, health management, etc. Active use of the mobile Internet, wearable equipment for signing treatment and waiting to remind residents to provide online booking report query, accurately capture to expend, diagnosis and treatment, drug delivery and health information collection, etc.

Eight, organize the implementation

Strengthen organizational leadership (18). To combine the actual, introduced in a timely manner to carry out the specific scheme of the family doctor to sign. Strengthen the leadership and the overall coordination, form the government leading, departments, the working mechanism of the whole society to participate in to ensure all tasks in place. Strengthen the family doctor to sign service and construction of public hospital reform, the grading system reform work of cohesion, forming superposition effect and reform the resultant force.

(19) to strengthen collaboration. Related departments should earnestly perform their duties, the resultant force to promote the family doctor signing service work. Development and reform (price) departments to actively support the family doctor services facilities equipped with signed, contract service price related work. Approved by the financial department to plan as a whole grassroots health institutions in all kinds of compensation funds, and establish quality and quantity and sign service link mechanism. Human resources and social security, health, family planning departments to establish and improve the beneficial to sign with the family doctor service classification diagnosis and treatment of insurance of primary medical treatment of pay policies, personnel policy. Family planning and management department of traditional Chinese medicine health sign we need to bear the family doctor service functions of organizing, coordinating, unified deployment of medical and health resources, strengthen the regulation of contract signing.

Strengthen supervision assessment (20). Health under the state council for signing jointly with relevant departments to promote the family doctor service work, seriously sum up experience, strengthening the supervision assessment, explore in third-party assessment. Around regularly investigation supervision mechanism should be established and timely solve the problems and difficulties, summarizes the typical experience and practice. Strengthen the family doctor to sign service related monitoring, evaluation, training, etc.

Do a good job in publicity (21). Should make full use of all kinds of information media, take many forms widely publicized signing the family doctor service policy and content, highlight the characteristics of convenient, benefiting the people and beneficial signing service. Publicity of advanced typical family doctors, enhance the professional sense of honor, to create a whole society to respect, trust, support, good atmosphere of signing the family doctor service.