How can a health insurance reimbursement policy change the healthcare system? Over the years, Beijing has insisted that the medical insurance reimbursement ratio of community health service centers is higher than that of second- and third-level hospitals, encouraging residents to choose primary consultation, and accelerating the formation of consensus on graded diagnosis and treatment, primary diagnosis and community medical treatment. At the same time, the increase in the number of patients also brings greater challenges to grassroots services, and how to provide better diagnosis and treatment services for the public is a common proposition that community hospitals need to solve.

Where is the high medical insurance reimbursement for community hospitals?

In recent years, the National Health Insurance Administration has continuously expanded and improved the medical insurance catalogue, and encouraged the public to choose the first diagnosis at the grassroots level by adjusting the reimbursement ratio. According to data from the Beijing Municipal Health Commission, as of 2021, there are 2111,30 community health service centers (stations) in Beijing, which are basically within a <>-minute walk.

Chen Yingjun, director of the Majiapu Community Health Service Center in Fengtai District, Beijing, said that since the medical reform in 2017, Beijing medical insurance has encouraged residents to make their first diagnosis in the community through the implementation of differentiated reimbursement. For example, the proportion of outpatient reimbursement for urban medical insurance participants in community health service centers is 90%, which is higher than the outpatient reimbursement rate of hospitals (70%).

Wang Jiangjiang, director of the Liqiao Community Health Service Center in Beijing's Shunyi District, said that the center mainly serves urban and rural residents, whose medical insurance accounts for 60% of the number of medical visits. At present, the first consultation discount in the community is mainly reflected in three aspects.

First, the reimbursement ratio is different, with 55% reimbursed by urban and rural residents in community health service centers, while 50% reimbursement by secondary and tertiary hospitals; 90% of the medical insurance personnel of urban employees in community health service centers are reimbursed, while 70% is reimbursed at the second and third levels.

Second, the minimum payment line for urban and rural residents is different, with the starting line of 100 yuan for community health service centers and 550 yuan for secondary and tertiary hospitals.

Third, registration saves time and worry, the queue for medical treatment is short, and the community health service center registration is only 1 yuan, and it is free for the elderly.

After the community hospital reimbursed amlodipine besylate tablets for the treatment of hypertension, there were 1 tablets, and the course of treatment was nearly 57 month. For another example, if the first consultation of urban and rural residents' medical insurance is prescribed, 28,1 yuan is prescribed for Class A without self-payment drug fees, and after settlement according to medical insurance reimbursement, it will cost 1000 yuan in community hospitals and 505 yuan in secondary and tertiary hospitals, which can save more than 750 yuan.

What can you see in the "hospital on your doorstep"?

Community medical and health services are primary health services integrating prevention, health care, rehabilitation and health education. Community health service centers are considered to be "hospitals on the doorstep", mainly meeting the needs of surrounding residents for nearby medical treatment and dispensing medicines.

According to experts, the professional foundation of primary medical and health services is general medicine. Doctors need to grasp the overall situation of patients, carry out comprehensive health management, and coordinate the whole service, which is also the characteristics and comparative advantages of community medical care.

In the Majiapu Community Health Service Center, the visualized real-time health monitoring system, the dynamic circulation of the "drifting" smart blood pressure monitor, and the smart medicine cabinet that can realize contactless drug collection at the doorstep... A series of advanced equipment for the elderly service is eye-catching. Not only minor problems such as fish bones and inverted eyelashes can be treated in the community, but community health service centers can also provide medical services such as gastrointestinal endoscopy and CT examination.

"As a community hospital, if you want to retain the people, you have to always think about the people." Chen Yingjun said that community health service centers should provide the medical services that ordinary people need, so that ordinary people are "willing to come, stay and see well."

Thanks to the doctor's dispatch program, general practitioners at Majiapu Community Health Service Center can "learn from experience" from large hospitals, and the medical level of ophthalmology, otolaryngology, stomatology and other departments in community hospitals has been continuously improved.

At present, community hospitals are the closest clinical and prevention platforms to the people, and the management of chronic diseases has also become a prominent embodiment of the advantages of community medical care. Cao Donghong, deputy director of Liqiao Community Health Service Center, said that the drug list of chronic disease drugs in the center is wider than that of Shunyi District Hospital, because Liqiao Community Health Service Center connects three medical alliances: Shunyi District Hospital, District Hospital of Traditional Chinese Medicine and Airport Hospital, which can provide drugs including the list of chronic disease drugs of the third-class hospital.

In addition, community hospitals will reorganize the drug catalogue according to the needs of patients, and set up a general catalogue and a temporary procurement catalogue. The proportion of use of national essential drugs and national centralized procurement varieties of conventional lists is high, and patients' direct feeling is that drugs are cheap; After patients are consulted in secondary and tertiary hospitals, if they encounter drug shortage when they come to the community hospital, the community hospital will also register the lack of medicine and purchase point-to-point to solve the patient's medication problem.

Can it be "catched" after the increase in patients?

With the continuous improvement of community medical service capacity, more and more residents are choosing to be treated for the first time at the grassroots level. According to data from the Beijing Municipal Health Commission, since 2012, the number of consultations and treatments in community health service institutions in Beijing has increased by 86%, and the comprehensive satisfaction of residents with community health services has increased by 11 percentage points, reaching 2021% in 88.

"This year, the number of patients seeking medical treatment in community health service centers has increased significantly, and the number of outpatient visits in the first quarter increased by 17.27% year-on-year." Wang Jianjian said that the key to in-depth promotion of graded diagnosis and treatment lies in improving the level of grassroots medical and health care, to this end, they are focusing on on-the-job training and introducing expert outpatient clinics to strive to improve diagnosis and treatment capabilities.

At the Liqiao Community Health Service Center, Aunt Li, who came for treatment, told the reporter that she has high blood pressure, and although the community hospital can meet the needs of medication, if she has severe symptoms, she still needs to go to the secondary and tertiary hospitals.

She Ruifang, director of the Community Health Service Center of Xueyuan Road in Haidian District, said that due to the large number of schools in the jurisdiction, there was indeed a situation where it was inconvenient for children to see a doctor. "We 'prescribe the right medicine' and do the medical treatment that ordinary people can reach."

She Ruifang said that since 2021, with the support of Beijing's policy of vigorously developing community hospitals, the center has established pediatrics with appropriate technology of traditional Chinese medicine, trained two deputy chief physicians of pediatrics, and now there are 6 pediatricians in the department, which has played an important role in the high incidence of influenza A. "After making up for the shortcomings of the department, pediatric patients in large hospitals will now also be referred to community hospitals for treatment."

Many community doctors believe that to promote graded diagnosis and treatment, we cannot fully expect that the people will change their medical habits by relying on preferential medical insurance treatment, but also need to improve the level of primary medical care. Liu Lianxin, member of the National Committee of the Chinese People's Political Consultative Conference and secretary of the Party Committee of the First Affiliated Hospital of the University of Science and Technology of China, said that it is necessary to continuously improve the level of medical technology, effectively improve the medical experience of the masses, and take multiple measures to create a grassroots medical and health service system that is "willing to come, stay and see well".

Half-moon reporter: Chen Xu Xiake

(Half Moon Talks)