Guyuan City is the only comprehensively impoverished city in Ningxia and is the main battlefield for targeted poverty alleviation and targeted poverty alleviation in the region. The Guyuan Municipal Party Committee and Municipal Government, under the unified arrangements of the country and the autonomous region, regard health poverty alleviation as targeted poverty alleviation. , an important starting point for targeted poverty alleviation, closely focus on the key links of "affording medical treatment, getting good medical treatment, getting medical treatment, and getting less sick" for the poor people, unite our efforts, work hard, and prevent the people from becoming poor due to illness to the greatest extent , return to poverty due to illness.
1. Work progress
(1) Basic work status. According to statistics from the poverty alleviation department in 2018, at the beginning of 2014, there were 395,000 registered poor people in the city, with a poverty incidence rate of 31.8%. After years of poverty alleviation, there were 27,000 households with 96,000 remaining poor at the end of 2017, of which 6,056 households were impoverished due to illness, accounting for 22.5% of the poor population. In 2017, 2,931 people from 752 households returned to poverty, of which 496 households returned to poverty due to illness, accounting for 66% of the population returning to poverty. As of May 2018, there were still 18,592 poor patients in need of treatment in our city, accounting for 39.4% of the region's total.
(2) Carry out convenient services. We have formulated three work measures: first diagnosis and treatment, then payment, one-stop medical treatment, and one-stop reimbursement. We have implemented the "six one, two push, five understanding" working methods, and established a green channel for the treatment of poor patients and a patrol and follow-up system. . Establish health records for poor people and implement dynamic management.
Promote family doctor contract services, and the health record establishment rate and contract service rate of the poor population have reached 100%; compile health manuals, issue "medical service discount certificates for poor patients", and promote health knowledge and poverty alleviation policies to allow The poor people have a clear understanding of their health status, disease conditions, treatment costs, persons responsible for insurance coverage, and the reasons for poverty. Comprehensively carry out "one-stop" settlement of hospitalization expenses for poor patients, especially the introduction of third-party payment for financial guarantee funds, and realize the service requirement of "no meeting, immediate processing, and at most one trip" for settlement of expenses for medical patients and medical institutions; Carry out "Internet + medical health". Some counties and districts in our city have made full use of the "Internet + Family Doctor Service Platform" to gradually solve the problem of people's difficulty in seeing a doctor.
(3) Improve and improve the guarantee mechanism.
First, strictly implement the government’s medical coverage policy for poor patients in rural areas of the autonomous region. With financial subsidies from the autonomous region and matching local finances, the government has established a medical assistance fund. In accordance with the principle of insurance first, assistance second, and then assistance, through an eight-fold guarantee policy system such as medical insurance reimbursement for urban and rural residents, civil medical assistance, and government medical assistance, the poverty alleviation fund is provided. Patients achieve the goal of not less than 90% of the actual reimbursement ratio of hospitalization medical expenses within the year or the cumulative out-of-pocket expenses for hospitalization in the year not exceeding 5,000 yuan, benefiting 188,000 rural poor people.
The second is to formulate inclusive medical policies for rural residents. Introduce a commercial health insurance mechanism for ordinary rural residents suffering from diseases, establish a method whereby rural residents make personal contributions, with appropriate government subsidies and commercial insurance companies bear risks. Commercial health critical illness insurance is purchased to improve the level of medical security and benefit 1.079 million ordinary rural residents. people.
The third is to establish a supplementary medical insurance system for serious and serious diseases. All urban employees and urban and rural residents who participate in the city's basic medical insurance will be protected from diseases that seriously endanger life and health and require high treatment costs. The number of reimbursable major and serious diseases has been expanded to 36, covering 1.312 million people in the city. ?
(4) Healthy poverty alleviation has achieved results
Our city has established a medical security system for different groups of people, launched various convenient services, and adopted "targeted treatment" measures to solve the problems caused by diseases. The problem of poverty returning to poverty due to illness. Phased results have been achieved.
1. Work innovation results. In actual work, we have explored the idea of ??entrusting third-party management of government guarantee funds for health poverty alleviation (using commercial insurance companies' agencies, personnel and payment processes to achieve the settlement of medical expenses for medical patients and medical institutions. "Do it immediately without meeting, at most "One trip" service requirements) and the "Internet + medical and health" model have better solved the problem of rural poor people being able to afford medical treatment, getting good medical treatment, and getting less sick, and have been implemented throughout the region. Promote communication. After an evaluation in 2017 and an assessment in 2018, the National Health Commission determined that Pengyang County in our city was an “advanced county for health poverty alleviation (demonstration county)” in the country; Pengyang County’s application of “Internet + medical health” to assist health poverty alleviation work was approved by the Vice President of the State Council. Prime Minister Comrade Sun Chunlan’s affirmation.
2. The effectiveness of precise treatment. In 2017, our city's government approved 12,553 poor patients, including 1,802 patients with serious diseases (319 people diagnosed with 9 major diseases), 1,229 patients with serious diseases, and 9,522 patients with chronic diseases. As of the end of 2017, 12,459 people had been treated according to the "three batches" classification, with a treatment rate of 99.25%, including 1,768 people with serious diseases treated intensively (309 people with 9 serious diseases, a treatment rate of 96.87%.), with a treatment rate of 98.1%; 1,207 people with serious diseases were treated, with a treatment rate of 98.2%; 9,484 people with chronic diseases were treated, with a treatment rate of 99.6%. As of the end of June 2018, 329,049 people with registered files and card registrations had been subject to disease verification, and *** approved the registration of files and cards. There were 24,369 patients, and the approval rate was 93.65%.
Among them, 2,803 patients with serious diseases, 2,706 patients with serious diseases, and 11,960 patients with chronic diseases were approved. A total of 5,436 patients with serious illnesses, 5,298 patients with serious illnesses, and 16,309 patients with chronic diseases have been treated. The average treatment rate is 74.11%.
3. Medical security effectiveness. The first is the effectiveness of government protection for rural poor patients in the city. In 2017, 5,572 poor hospitalized patients were accounted for, and 15.97 million yuan of critical illness insurance financial subsidy funds and government guarantee funds were reimbursed. Various reimbursements accounted for 93.2% of the total hospitalization expenses, and the average out-of-pocket payment for individual hospitalization was 963 yuan. The reimbursement ratio for hospitalization expenses for poor patients reaches the goal of no less than 90% required by the autonomous region, and the out-of-pocket expenses do not exceed the target of 5,000 yuan. The second is the effectiveness of the city’s policies to benefit urban and rural residents. In 2017, 171,600 urban and rural residents in the city were hospitalized, with total hospitalization expenses of 1,090.46 million yuan. The reimbursement ratio of critical illness insurance reached 8.68%, of which the reimbursement ratio of Guyuan preferential policy of critical illness insurance was 4.28%, and the reimbursement ratio of commercial health insurance was 13.49%. The number of other rural residents in our city who enjoyed the two policies reached 85,000, accounting for 49.5% of the total number of hospitalizations in 2017. The per capita reimbursement of Guyuan's preferential policy for critical illness insurance reached 269 yuan, and the per capita reimbursement of commercial health insurance's bottom-up reimbursement reached 848 yuan. The total reimbursement of the two items was 1,117 yuan per capita. The third is the effectiveness of the government in 2018. As of the end of June 2018, the city's Dong *** had reimbursed 3.5186 million yuan of government subsidy funds, and 3,230 people had benefited from the government's subsistence policy. The average personal out-of-pocket fund was 725 yuan, and the reimbursement ratio reached 91%.
4. Effectiveness in promoting poverty alleviation. Since the launch of health poverty alleviation, the city's residents' insurance participation rate has increased from 95.4% in 2014 to 98.2% in 2018, an increase of 2.8%. The average life expectancy is expected to be extended by 1.5 years in the five years. As of the end of June 2018, 3,849 households in our city had become poor due to illness among the people who had not been lifted out of poverty, and the poverty rate due to illness dropped to 7.66%. People's health concepts have undergone tremendous changes. Gradually, they have formed a lifestyle in which everyone pays attention to hygiene and pays attention to health. They can receive timely hospitalization for serious diseases, outpatient diagnosis and treatment of minor diseases, home contract management of chronic diseases, and early prevention of diseases, which has improved the quality of life. health awareness. ? 3. Current problems
(1) There is a shortage of medical resources in the city. The allocation of medical resources is lower than the national average, the academic structure of the medical team is unreasonable and low-level, there are few subject leaders and practical talents, the rural health team is unstable, and there is a shortage of general practitioners.
(2) The structure of health resources is unbalanced. The allocation of medical resources is unbalanced between urban and rural areas, and the total amount of medical and health resources at the rural and rural levels is seriously insufficient. The development of traditional Chinese and Western medicine is uneven, and the development of traditional Chinese medicine lags behind. The development of specialized hospitals is slow, especially in the fields of obstetrics and gynecology, pediatrics, and geriatrics, where service capabilities are relatively weak.
(3) There is still the problem of difficulty in seeking medical treatment. Medical assistance costs cannot be addressed. After poor patients receive medical treatment outside the city and are reimbursed by major illness assistance and government support, they have a large remaining medical expenses, transportation expenses, accommodation expenses, escort expenses, and food expenses; the expenses for drugs during the recovery period cannot be reimbursed; there is no policy support for outpatient expenses; and patients are referred up and down The problem of repeated "threshold fees" is difficult to solve; the situation of controlling the unreasonable increase in medical expenses is grim.
4. What are the next steps? (1) Implement the "Return to Six Disciplines" project for medical talents. The state has invested in setting up incentive funds to give heavy rewards to returning high-end medical talents and local medical workers who have made greater contributions, and to encourage and attract medical talents who are originally from abroad. Strive for the country to give Guyuan City policy preferences in college recruitment, training, employment placement and other aspects. ?
(2) Establish a characteristic medical team. Strive for the country to set up a special local medical service fund to support Guyuan City in cultivating and establishing excellent medical teams at all levels and build a medical treatment pattern in which "minor diseases are treated at the grassroots level, major diseases do not go out of the county, and difficult and complicated diseases do not go out of the city".
(3) Build high-end professional medical departments. Strive for state investment in the construction of the Department of Urology, Stroke Center, Orthopedics, General Surgery, and Ophthalmology of the Municipal People's Hospital, the Department of Internal Medicine, and the Spine Health Center of the Municipal Hospital of Traditional Chinese Medicine, and build 9 obstetrics and neonatal departments of the Municipal Maternal and Child Health and Family Planning Service Center (Municipal Children's Hospital). Key departments and advantageous departments have driven the city's medical diagnosis and treatment level and scientific research capabilities to improve, and achieved leapfrog development in the city's overall medical level. ?
(4) Increase the construction of basic medical equipment and medical conditions at the grassroots level. Strive for the state to provide preferential financial support to our city in developing the infrastructure of the "Internet + Medical and Health" project.
(5) Pay close attention to details and implement contract signing services. We will implement the management of chronic disease contracting services, achieve 100% contracting rate for registered poor patients, and achieve the contracting rate for general residents to meet national requirements, and implement one contracting case, one management case, and implement contracting services.