State and municipal people’s governments, provincial committees, offices, departments and bureaus:
"Yunnan Medical and Health Service System Planning (2016-2020)" has been agreed by the provincial people’s government and is hereby issued to you, please implement it carefully.
General Office of Yunnan Provincial People’s Government
October 22, 2016
(This piece is publicly released)
Planning of Medical and Health Service System in Yunnan Province
(2016-2020)
In order to further optimize and rationally allocate medical and health resources, improve the quality and efficiency of medical and health services in our province, and provide better health protection for the demonstration area of national unity and progress, the vanguard of ecological civilization construction, and the construction of radiation centers facing South Asia and Southeast Asia, this plan is formulated according to the spirit of the Notice of the General Office of the State Council on Printing and Distributing the Outline of the National Medical and Health Service System Planning (2015-2020) (No.14 of the State Council [2015]) and the actual situation of our province.
Chapter 1 Planning Background
Section 1 Basic Status Quo
First, the current situation of medical and health resources
With the great attention of governments at all levels, after years of development, our province has basically established a medical and health service system covering urban and rural areas, which consists of hospitals, primary medical and health institutions and professional public health institutions. Medical and health resources are increasing year by year. Compared with 2010, the number of medical and health institutions at all levels increased from 22,888 to 24,186 in 2015, the number of beds in medical and health institutions per thousand permanent residents increased from 3.41 to 5.01, the number of practicing (assistant) doctors increased from 1.38 to 1.68, the number of registered nurses increased from 1.07 to 1.97, and the number of professional public health personnel increased from 0.44.
Second, the utilization of medical and health resources
In 2015, compared with 2010, the total number of patients in medical institutions in the province increased from 176.1324 million to 228.3867 million, with an average annual growth rate of 5.93%. The number of inpatients increased from 4.836 million to 7.4485 million, with an average annual growth rate of 10.80%. In 2015, the number of patients in hospitals and primary health care institutions accounted for 38.60% and 57.63% respectively, of which public hospitals were the main ones, accounting for 83.06% of the total number of patients in hospitals. The utilization rate of hospital beds in medical institutions in the province was 76.23%, and the average hospitalization day was 8.18 days.
Third, the level of health
The average life expectancy of the province’s population is expected to increase from 69.5 years in 2010 to 73.6 years in 2015, and the maternal mortality rate will drop from 37.27/100,000 in 2010 to 23.63/100,000 in 2015. The infant mortality rate and the mortality rate of children under five will drop from 12.24‰ and 15.31‰ in 2010 to 8.7‰ and 15.31 ‰ respectively.
Main problems in the second quarter
First, the total amount of medical and health resources is insufficient and the quality is not high.
There is still a big gap between the quantity and quality of medical and health resources in our province and the health needs of people of all ethnic groups. At the end of 2015, the number of beds in medical and health institutions, the number of licensed (assistant) doctors, the number of registered nurses and the number of professional public health personnel per thousand permanent residents in the province were lower than the national average. Health human resources are particularly scarce. From 2010 to 2015, the average annual growth rate of practicing (assistant) doctors per thousand permanent residents was only 3.84%, which was much lower than the growth rate of the number of patients. The academic qualifications and professional titles of health technicians are generally low. In 2015, only 28.84% of health technicians had a bachelor’s degree or above, and the sub-high and above titles only accounted for 6.41% of health technicians. 27.4% of maternal and child health care institutions in the province are still unable to carry out hospital delivery.
Two, the uneven distribution of medical and health resources, unreasonable structure
The distribution of medical and health resources is uneven, and under-utilization and over-utilization of resources coexist. 93% provincial hospitals, 46% third-class first-class hospitals and 30% licensed (assistant) doctors and registered nurses are concentrated in Kunming. The development of different types of medical and health institutions is uneven. The characteristic advantages of traditional Chinese medicine (ethnic medicine) have not been fully exerted. In 2015, the number of specialized hospitals in the province only accounted for 19% of the total number of hospitals, and beds only accounted for 13% of the total number of hospital beds. The medical service capacity and medical service radiation capacity were not strong, and specialties such as pediatrics, mental health, rehabilitation, geriatrics, hospice care, maternal and child health care, and family planning were relatively lacking. There are still some problems in social hospitals, such as low level, obscure specialty features, weak talent base and low social recognition, which have not yet formed a pattern of mutual promotion and common development with public hospitals.
Three, the basic medical and health institutions have low management level and weak service ability.
The management level of township hospitals and village clinics is relatively low. The management of community health service institutions is backward and the service function is not perfect. There are some problems in primary medical and health institutions, such as "unable to go down, unable to stay, unable to use well" and low professional quality. It is difficult to improve the service level, and it is difficult for the service ability to undertake the basic functions of primary diagnosis and graded diagnosis and treatment. At the same time, the medical business of primary medical and health institutions has shrunk, and the proportion of beds in township hospitals and the number of people admitted to hospitals have declined.
Four, the development of health information construction lags behind, and the regional development is quite different.
The information infrastructure is poor, the investment in health informatization construction is insufficient, the standards are not uniform, the information utilization and personnel training are not in place. Medical and health institutions at all levels have different degrees of informatization construction, and information interconnection mechanism has not been established between institutions, and medical and health information services for the public are insufficient.
Five, the function orientation of public hospitals is unclear, and the division of labor and cooperation mechanism has not yet been established.
The functional orientation of public hospitals at all levels in the medical and health service system is unclear. The division of labor and cooperation mechanism between medical and health institutions has not yet been established, and the fragmentation of medical and health service system is more serious. The scale of some hospitals is too large, which reduces the management efficiency, increases the burden on patients, siphons off grassroots medical and health talents and patients, occupies the development space of grassroots medical and health institutions and social hospitals, and affects the improvement of the overall efficiency of the medical and health service system.
Section 3 Opportunities and Challenges
In the next five years, the construction of medical and health service system in our province will usher in many rare opportunities. The CPC Central Committee and the State Council attach great importance to the development of medical and health undertakings, give priority to people’s health, focus on popularizing healthy life, optimizing health services, improving health protection, building a healthy environment and developing health industries, accelerate the construction of a healthy China, and strive to ensure people’s health in an all-round and full-cycle manner. The provincial party committee and government regard the protection of people’s health as a major livelihood project, and vigorously promote the construction of healthy Yunnan, which provides a historic opportunity for our province to further improve the medical and health service system. Our province actively serves and integrates into the national "Belt and Road" construction, strives to become a radiation center for South Asia and Southeast Asia, and brings opportunities for medical and health undertakings to open up and develop for South Asia and Southeast Asia. The state has stepped up efforts to get rid of poverty and created policy opportunities for our province to speed up the development of medical and health undertakings. The rapid development and popularization of information technology has provided technical support for the innovation of medical and health service and management mode and the improvement of accessibility and convenience of medical and health services.
At the same time, after years of rapid development, the downward pressure on the economy of our province continues to increase, and the growth of public finance budget revenue is weak, so the development of medical and health undertakings must adapt to the new normal; The new urbanization construction and the optimization and adjustment of the spatial layout of the whole province put forward new requirements for the medical and health service system architecture and resource allocation; With the aging of the population, it is estimated that by 2020, the population of our province will reach 49.1 million, of which the elderly population will reach 6.5 million, accounting for 13%. Geriatrics, rehabilitation and other fields are under great pressure; The major adjustment of birth policy will aggravate the contradiction between supply and demand in pediatrics, maternal and child health care, reproductive health and other fields; The incidence of chronic non-communicable diseases is rising, major infectious diseases have not been completely controlled, and sudden new infectious diseases and imported infectious diseases pose potential threats to the province, especially the border areas; The improvement of the medical security system will further release the medical service needs of people of all ethnic groups; Deepening the reform of medical and health system in an all-round way, and establishing and implementing graded diagnosis and treatment system have set new goals for optimizing the layout and allocation of medical and health resources.
Chapter II General Requirements
The first section guiding ideology
Comprehensively implement the spirit of the 18th National Congress of the Communist Party of China, the 3rd, 4th and 5th Plenary Sessions of the 18th Central Committee and the National Conference on Health and Wellness, thoroughly implement the series of important speeches by the Supreme Leader General Secretary and inspect the spirit of important speeches in Yunnan, closely focus on the "four comprehensive" strategic layout and the decision-making arrangements of the CPC Central Committee, the State Council and the provincial party committee and government, adhere to the concept of innovation, coordination, green, openness and shared development, and implement the new policy of health and wellness work in the new period, with the aim of improving the health level of people of all ethnic groups in the province.
Section 2 Basic Principles
First, demand-oriented, rational layout
Guided by health needs and solving people’s major health problems, with adjusting the layout, upgrading the energy level, and strengthening the shortcomings as the main line, we will develop moderately and orderly and strengthen the weak links. Strengthen the management of the whole industry and localization, make unified planning and layout of medical and health resources with different subordinate relations and ownership forms within the administrative area, and scientifically and reasonably determine the number, scale and layout of various medical and health institutions at all levels.
Second, government-led, multi-input
Strengthen the government’s responsibility for the planning, financing and supervision of basic, grass-roots and basic medical and health resources, and safeguard the public welfare of public medical and health care. Give play to the role of market mechanism, strengthen policy guidance, mobilize the enthusiasm and creativity of social forces, encourage and support the society to run medical services, so as to meet the people’s multi-level and diversified medical and health service needs.
Third, fairness and accessibility, improve efficiency
Focusing on the goal of ensuring the fairness and accessibility of basic medical and health services and benefiting the masses, we will promote the equalization of basic medical and health services in ethnic minority areas and concentrated contiguous poverty-stricken areas. Pay attention to the scientific and coordinated allocation and use of medical and health resources, give full play to the advantages of information technology, build a scientific, reasonable and convenient medical and health service system, improve efficiency, reduce costs, and achieve the unity of fairness and efficiency.
Fourth, people-oriented, innovative mechanism
Reform the development mode of public hospitals, rationally regulate the scale of public hospital resources, and build a people-oriented integrated service model. Strengthen the construction of talent team, improve the service level of primary medical and health institutions, and enhance the service capacity of public health institutions.
Five, according to local conditions, overall coordination
Fully consider the level of economic and social development, the number of people served, the service radius, the traffic situation and the current situation of medical and health resources, and formulate allocation standards by classification. Coordinate the allocation of urban and rural and regional resources, coordinate the current and long-term, coordinate prevention, medical care and rehabilitation, focus on the grassroots, take reform and innovation as the driving force, give priority to prevention, and pay equal attention to Chinese medicine (ethnic medicine) and western medicine, give play to the overall function of the medical and health service system, and promote balanced development.
Section III Overall Objectives
Optimize the allocation of medical and health resources, build an integrated medical and health service system that is compatible with the national economic and social development level of our province, matches the health needs of people of all ethnic groups, has a complete system, a clear division of labor, complementary functions, close cooperation and convenient access, and realizes that everyone enjoys basic medical and health services. By 2020, the number of beds in medical and health institutions per thousand permanent residents in the province will be controlled at 6.0, the number of licensed (assistant) doctors will reach 2.5, the number of registered nurses will reach 3.14, the number of professional public health personnel will reach 0.83, and the number of general practitioners per 10,000 permanent residents will reach 2 (see Table 1 for details). According to the strategy of "controlling development, moderately developing and accelerating development", the allocation standards of medical and health resources in different States and cities will be formulated, and the gap in the allocation of medical and health resources among States and cities will be gradually narrowed, and a "15-minute health service circle in dam area" and a "30-minute health service circle in mountain area" will be built, with the rate of medical treatment in the county reaching 90%, which will comprehensively improve the fairness and accessibility of basic medical and health services in the province.
Chapter III Layout of Medical and Health Service System
Section 1 Framework of Medical and Health Service System
The medical and health service system mainly includes hospitals, grass-roots medical and health institutions and professional public health institutions.
Hospitals are divided into public hospitals and social hospitals. Among them, public hospitals are divided into government-run hospitals (mainly divided into county-run hospitals, state-run hospitals, provincial-run hospitals and departmental hospitals according to their functional orientation) and other public hospitals (mainly including military hospitals, state-owned and collective enterprises and institutions, etc.). Below the county level are primary medical and health institutions, which are divided into two categories: public and social. Professional public health institutions are divided into government-run professional public health institutions and other professional public health institutions (mainly including professional public health institutions organized by state-owned and collective enterprises and institutions).
Section 2 Hospital Planning and Setting-up
First, public hospitals
(A) functional positioning
As the main body of the medical service system, public hospitals must adhere to the maintenance of public welfare, give full play to the backbone role in the provision of basic medical services, the diagnosis and treatment of critical and difficult diseases, undertake the tasks of personnel training, medical research and medical teaching in medical and health institutions, and undertake the tasks of public health services, emergency medical rescue, foreign aid, national defense and health mobilization, supporting agriculture, supporting the border and supporting the community specified by the law and the government. County-run hospitals are mainly responsible for the diagnosis and treatment of common and frequently-occurring diseases, emergency rescue and referral of difficult diseases, training and guiding staff of primary medical and health institutions, undertaking corresponding public health services and emergency medical rescue, etc. They are an important carrier for the government to provide basic medical and health services to residents in county-level areas.
State-run hospitals mainly provide comprehensive or specialized medical services representing the high level of the region to residents in state-level administrative areas, accept referrals from lower-level hospitals, and undertake personnel training and certain scientific research tasks as well as corresponding public health and emergency medical rescue tasks.
Provincial hospitals mainly provide diagnosis and treatment of critical and difficult diseases and specialized medical services to the states and cities within the provincial administrative region, accept referrals from lower-level hospitals, and undertake personnel training, medical research and corresponding public health and emergency medical rescue tasks.
(2) Institutional setup
Various types of public hospitals are set up scientifically in various regions according to local urbanization, population distribution, geographical transportation, disease spectrum and other factors, and the number and scale of public general hospitals are reasonably controlled. For specialized medical services with large demand, corresponding specialized hospitals are set up according to specific conditions.
According to the number of permanent residents in county-level administrative regions, in principle, each county-level administrative region is set up with one county-run general hospital and one county-run traditional Chinese medicine hospital (including traditional Chinese medicine, integrated traditional Chinese and western medicine and ethnic medicine, the same below). The county that lacks TCM resources and unconditionally sets up TCM hospitals should set up TCM or ethnic medicine rooms in county-run general hospitals, with the number of beds not less than 10%. National autonomous county-level administrative regions give priority to the establishment of national medical hospitals. County-run general hospitals must set up psychiatric departments and infectious diseases departments. Counties with a population of more than 500,000 can appropriately increase the number of public hospitals.
In the prefecture-level administrative regions, according to the number of permanent residents, the service radius is generally about 50 kilometers per 1 million-2 million population, and 1-2 prefecture-level general hospitals (including traditional Chinese medicine hospitals) are set up, which can be appropriately relaxed in sparsely populated areas. In accordance with the principle of "reasonable layout, clear positioning and prominent focus", all prefectures and cities should set up at least one general hospital run by prefectures and cities and one hospital of traditional Chinese medicine, and encourage other existing general hospitals to develop into specialized hospitals for children, obstetrics and gynecology, oncology, stomatology, rehabilitation, psychosis, infectious diseases, senile diseases and hospice care as needed. Cities that have not set up specialized psychiatric hospitals and infectious diseases hospitals must set up psychiatric departments and infectious diseases departments in general hospitals in cities.
In provincial administrative regions, according to the number of permanent residents, 1-2 provincial-run general hospitals are planned for every 10 million people, and provincial-run specialized hospitals for children, obstetrics and gynecology, oncology, cardiovascular disease, mental illness, infectious diseases, occupational diseases, stomatology, rehabilitation, etc. (including traditional Chinese medicine specialized hospitals) are planned according to needs. Through exchanges and cooperation, innovation and development, we will continuously improve the level of medical services and the strength of medical scientific research, and build provincial hospitals into medical highlands based in Yunnan and facing South Asia and Southeast Asia.
Second, the society runs hospitals
Running a hospital by the society is an indispensable part of the medical and health service system and an effective way to meet the people’s multi-level and diversified medical service needs. Social-run hospitals can provide basic medical services, high-end services or services in short supply such as rehabilitation and elderly care, and form an orderly competition and supplement with public hospitals.
By 2020, planning space will be reserved for social hospitals according to no less than 1.5 beds per 1,000 permanent residents, and the setting of diagnosis and treatment subjects and the configuration space of large medical equipment will be reserved simultaneously. Guide the development of social hospitals to a high level and scale, encourage social hospitals to upgrade infrastructure construction, and develop professional hospital management groups. Support the society to run hospitals with large medical equipment.
Improve supporting policies, and encourage and guide social capital to set up medical institutions on the premise of meeting the planned total amount and structure. Speed up the examination and approval procedures, and approve hospitals run by the society with corresponding qualifications in accordance with the regulations, simplify the examination and approval process and improve the examination and approval efficiency. Relax the requirements for service areas, and all areas that are not explicitly prohibited by laws and regulations can be opened to social capital. Give priority to supporting the establishment of non-profit medical institutions. Promote doctors to practice more, strengthen business cooperation between public hospitals and community-run hospitals, improve clinical level and academic status, support community-run hospitals to be included in the designated scope of medical insurance, improve planning layout and land security, optimize investment and financing guidance policies, improve fiscal and taxation price policies, and implement market-adjusted prices for medical services in community-run hospitals. Strengthen industry supervision to ensure medical quality and safety.
Section III Planning and Setting of Grassroots Medical and Health Institutions
First, the functional orientation
The main duties of primary medical and health institutions are to provide basic public health services such as prevention, health care, health education, family planning, diagnosis and treatment services for common diseases and frequently-occurring diseases, and rehabilitation and nursing services for some diseases, and to refer common diseases, frequently-occurring diseases and critical and difficult patients beyond their own service capacity to hospitals. Grass-roots medical and health institutions mainly include township hospitals, community health service centers (stations), village clinics, outpatient departments, infirmary (offices) and so on. Township hospitals and community health service centers are responsible for providing basic public health services, comprehensive services such as diagnosis, treatment, nursing and rehabilitation of common and frequently-occurring diseases, and entrusted by county-level health and family planning administrative departments to undertake public health management within their administrative areas, and are responsible for comprehensive management, technical guidance and training of rural doctors in village clinics and community health service stations. Township hospitals are divided into central township hospitals and general township hospitals. In addition to the service functions of general township hospitals, central township hospitals should also carry out common operations, focus on strengthening medical service capabilities and undertake technical guidance for general township hospitals in surrounding areas. Village clinics and community health service stations, under the unified management and guidance of township hospitals and community health service centers, undertake basic public health services for people in administrative villages and neighborhood committees, and carry out primary diagnosis, treatment and rehabilitation of common and frequently-occurring diseases. The basic medical and health institutions such as the infirmary and outpatient department (institute) within the unit are responsible for the basic public health and basic medical services of the unit or the functional community.Other out-patient departments, clinics and other grassroots medical and health institutions provide relevant medical and health services according to the health needs of residents. The government can subsidize the services it provides by purchasing services.
Second, the institutional setup
Township hospitals and community health service centers shall be set up according to the administrative divisions of townships and sub-district offices or a certain service population. By 2020, a township health center run by the government will be well established in each township, and a community health service center run by the government will be set up within the scope of each street office or according to the plan for every 30,000-100,000 residents. Comprehensively improve the service capacity and level of community health service centers and township hospitals. Considering urbanization, geographical location, population concentration and other factors, about one-third of township hospitals are selected to improve their service capacity and level, and central township hospitals are built. Reasonably determine the number and layout of village clinics and community health service stations, and reasonably set them according to the coverage of township hospitals and community health service centers, service radius, service population and other factors. In principle, each administrative village should set up a village clinic and each community should set up a community health service station. The establishment of individual clinics and other primary medical and health institutions is not limited by the planning and layout, and the management mode of market regulation is implemented.
Section 4 Planning and Setting of Professional Public Health Institutions
First, the functional orientation
Professional public health institutions are institutions that provide professional public health services (mainly including disease prevention and control, comprehensive supervision and law enforcement of health and family planning, health education, maternal and child health care, mental health, first aid, blood collection and supply, food safety risk monitoring and evaluation and standard management, family planning, birth defect prevention, etc.) within their administrative areas, and undertake corresponding management work. Professional public health institutions mainly include disease prevention and control institutions, health education institutions, health and family planning comprehensive supervision and law enforcement institutions, maternal and child health care family planning service institutions, mental health professional institutions, emergency centers (stations), blood stations, etc., which are organized by the government in principle.
The main duties of county-run professional public health institutions are: to undertake professional public health tasks, corresponding business management, information submission and other work within the administrative area, and to provide technical guidance, personnel training, supervision and assessment on public health work of medical and health institutions within the administrative area, and to complete the mandatory tasks assigned by superiors.
The main responsibilities of state-run professional public health institutions are: to undertake professional public health tasks and corresponding information management within the administrative area, and to carry out business guidance, personnel training, supervision and assessment for subordinate professional public health institutions, and to complete the mandatory tasks assigned by superiors.
The main responsibilities of provincial professional public health institutions are: undertaking professional public health tasks within the administrative area, carrying out regional business planning, scientific research and training, information management, technical support, business guidance, personnel training, supervision and assessment of subordinate professional public health institutions, and completing mandatory tasks assigned by superiors.
Second, the institutional setup
Professional public health institutions are set up reasonably according to the number of permanent residents, service scope, workload and other factors in the administrative area. Strengthen the integration of public health service resources in administrative areas and encourage the formation of comprehensive public health service centers; Strengthen the capacity building of disease prevention and control in border areas; Strengthen the capacity building of health education. According to administrative divisions and levels, there is only one similar professional public health institution in each administrative region at or above the county level in principle, and the government at or above the county level regulates the establishment of comprehensive supervision and law enforcement institutions for health and family planning according to their work responsibilities, which will undertake the task of comprehensive supervision and law enforcement for health and family planning.
Below the county level, community health service centers (stations), township hospitals (maternal and child health care and family planning service stations), village clinics and family planning service rooms undertake professional public health-related work. Integrate the maternal and child health care functions of township family planning technical service institutions and township hospitals. Village clinics and village family planning service rooms are reserved at the village level and shared.
In principle, there are one disease prevention and control, one comprehensive health and family planning supervision, and one maternal and child health care and family planning service institution within the county-level administrative region. At present, the specialized prevention and control institutions for leprosy and schistosomiasis are gradually integrated into the disease prevention and control center; There is an emergency center (station) and a blood bank attached to the county-run general hospital, and the location of the state government is not repeated.
One public health institution, including disease prevention and control, comprehensive supervision of health and family planning, maternal and child health care and family planning services, blood collection and supply, and one emergency center (station) are set up independently or relying on the state-run general hospital. Kunming will no longer set up emergency centers and blood centers repeatedly. All localities can integrate resources according to the actual situation. Within the provincial administrative region, one professional public health institution is set up, including disease prevention and control, health education, comprehensive supervision of health and family planning, maternal and child health care, scientific research of population and family planning, mental health, first aid, blood center and so on.
Within the scope of the province, the mental health service system and network will be established and improved on the basis of professional mental health institutions as the main body, psychiatric departments of general hospitals as the auxiliary, primary medical and health institutions and community rehabilitation institutions for mental illness.
Within the province, the prevention and control of infectious diseases in the province will be strengthened based on disease prevention and control institutions as the main body, infectious diseases specialist hospitals and general hospitals as the auxiliary, and primary medical and health institutions.
Within the scope of the province, with the provincial and municipal emergency centers as the leader, the county-run emergency center and the pre-hospital emergency network hospital jointly built a relatively complete emergency network. Strengthen the construction of emergency medical rescue bases in areas with frequent geological disasters, locations of large-scale petroleum refining and chemical projects, and areas along oil pipelines.
Section 5 Building a Regional Medical and Health Center
According to the development idea of "strengthening central Yunnan, invigorating the border areas, linking corridors, multi-point support and two-way opening", combined with the new urbanization construction plan, we will build six medical and health service areas in central Yunnan, western Yunnan, southeastern Yunnan, northwestern Yunnan, southwestern Yunnan and northeastern Yunnan. The medical and health service areas in central Yunnan include Kunming, Yuxi, Chuxiong and Qujing; The medical and health service areas in western Yunnan include Dali, Baoshan and Dehong; The medical and health service areas in southeastern Yunnan include Honghe and Wenshan; The medical and health service areas in northwest Yunnan include Lijiang, Diqing and Nujiang. The medical and health service areas in southwest Yunnan include Xishuangbanna, Pu ‘er and Lincang. The medical and health service area in northeast Yunnan includes Zhaotong. Coordinate high-quality medical and health resources in various regions, develop interactively, build regional medical and health centers, and improve the overall level of medical and health services in the province.
In the medical and health service area in central Yunnan, based on the construction of national and provincial clinical key specialties and clinical disciplines, relying on the provincial-run tertiary hospitals, we will introduce domestic high-quality medical and health resources to cooperate and build a provincial-level high-level medical and health center; Relying on Fuwai Cardiovascular Hospital, we will build a national cardiovascular disease diagnosis and treatment center and a provincial cardiovascular disease diagnosis and treatment training base for South Asia and Southeast Asia. Strive to build the provincial high-level medical and health center into a medical and health institution with beautiful environment, talented people, outstanding characteristics, excellent equipment, leading technology, rigorous academic research, innovation and advanced management, and provide efficient and high-quality diagnosis and treatment of critical and difficult diseases and specialized medical services for the whole province and neighboring countries, leading the improvement of the medical and health level of the whole province.
In the medical and health service areas of western Yunnan, southeastern Yunnan, northwestern Yunnan, southwestern Yunnan and northeastern Yunnan, regional medical and health centers in western Yunnan, southeastern Yunnan, northwestern Yunnan, southwestern Yunnan and northeastern Yunnan will be built through the construction of key clinical specialties and clinical disciplines jointly established by provincial and provincial cities, and relying on tertiary hospitals with strong technical capabilities and good service capabilities in the region to provide high-level medical and health services to the people in the region, and train and guide primary medical and health personnel in the region.
In the medical and health service areas of western Yunnan, northwest Yunnan, southwest Yunnan and central Yunnan, we will give full play to the traditional advantages of ethnic medicine, actively carry out ethnic medicine services and build ethnic medicine service centers such as Tibetan medicine, Dai medicine and Yi medicine, relying on existing ethnic hospitals such as Tibetan medicine hospitals, Dai medicine hospitals and Yi medicine hospitals.
Section 6 Division of Labor and Cooperation of Medical and Health Institutions
Establish and improve the division of labor and cooperation among public hospitals, professional public health institutions, grass-roots medical and health institutions and social hospitals, integrate the service functions of various medical and health institutions at all levels, and provide systematic, continuous and all-round medical and health services for the masses.
I. Combination of prevention and control
Professional public health institutions should strengthen guidance, training and assessment for public hospitals, primary medical and health institutions and social hospitals to carry out public health services, and establish cooperation mechanisms such as information sharing and interconnection. Clarify the responsibilities of professional public health institutions and medical institutions, and do a good job in the comprehensive prevention and treatment of chronic diseases such as hypertension, diabetes and cancer. General hospitals or specialized hospitals carry out diagnosis and treatment of key infectious diseases such as tuberculosis and AIDS, as well as patients with occupational diseases and mental diseases, and professional public health institutions are responsible for tracking and management. Provide women and children with life-cycle health care and clinical health services, and carry out comprehensive prevention and treatment of birth defects. Strengthen the coordination between maternal and child health care institutions and general hospitals, and focus on strengthening the referral and treatment of high-risk pregnant women and high-risk children. General hospitals and related specialized hospitals should rely on relevant departments and cooperate closely with professional public health institutions to undertake certain public health tasks within their administrative areas and provide operational guidance to primary medical and health institutions. Establish a compensation mechanism and a service purchase mechanism for medical institutions to undertake public health tasks. Strengthen the construction of public health service capacity of grassroots medical and health institutions to ensure that all public health tasks are in place.
Second, pay equal attention to Chinese and western medicine
Efforts will be made to promote the revitalization and development of Chinese medicine, adhere to the principle of paying equal attention to both Chinese and Western medicine, give full play to the unique advantages of Chinese medicine (ethnic medicine) in medical prevention and health care in our province, establish and improve the development mechanism of Chinese medicine (ethnic medicine), strengthen the team building of Chinese medicine (ethnic medicine), and improve the management system, inheritance and innovation system and service system of Chinese medicine (ethnic medicine). Use modern science and technology to strengthen the cooperation between Chinese and western medicine in disease prevention, clinical treatment and medical research, and promote the complementary and coordinated development of Chinese medicine (ethnic medicine) and western medicine. Increase the information support of traditional Chinese medicine (ethnic medicine) hospitals. In general hospitals, maternal and child health institutions and other non-Chinese medical and health institutions, Chinese medicine (ethnic medicine) departments are set up. Strengthen the construction of comprehensive service areas of traditional Chinese medicine (ethnic medicine) in township hospitals and community health service centers. Strengthen the development of ethnic medicine such as Tibetan medicine, Yi medicine and Dai medicine. Strive to realize the creative transformation and development of traditional Chinese medicine health preservation culture.
Third, up and down linkage
Establish and improve the graded diagnosis and treatment mode in line with the actual situation in our province, build a division of labor and cooperation mechanism between hospitals at different levels, hospitals and primary medical and health institutions, and continue medical institutions, improve the operation mechanism of networked urban and rural primary medical and health services, and gradually realize the diagnosis and treatment pattern of primary diagnosis, two-way referral, up-and-down linkage, and rapid and slow division. With the goal of forming a graded diagnosis and treatment order, we will actively explore scientific and effective medical associations and telemedicine and other graded diagnosis and treatment methods, and strive to improve the incentive mechanism of the reimbursement ratio of basic medical insurance for two-way graded diagnosis and treatment. Make full use of information technology to promote the disclosure of medical service information and the vertical flow of high-quality medical resources, and realize the information channel of sharing diagnosis and treatment information, developing telemedicine service and teaching and training between hospitals and primary medical and health institutions. Improve the service chain of treatment-rehabilitation-long-term care, develop and strengthen continuous medical institutions such as rehabilitation, elderly care, long-term care, chronic disease management, hospice care, establish a system of acute and slow treatment, and improve the utilization efficiency of medical resources in public hospitals.
Fourth, the combination of medical care and nursing
Combined with the unique advantages of natural conditions in our province, we will establish various types of combination models of medical care and nursing. Encourage all kinds of medical institutions to carry out pension services, support all kinds of pension institutions to load medical service functions, increase the number of resources to provide medical services for the elderly, and enhance the ability of general hospitals, traditional Chinese medicine hospitals, geriatric hospitals, rehabilitation hospitals, nursing homes, hospice care institutions and primary medical and health institutions to serve the elderly. From the aspects of common diseases, chronic diseases, rehabilitation nursing and health promotion, we will focus on strengthening the ability of primary medical and health institutions to provide diagnosis and treatment services for the elderly. Medical and health institutions have opened a green channel for the old-age care institutions to provide services such as medical rounds, health management, health consultation, appointment, emergency treatment, and Chinese medicine health care for the elderly, so as to ensure that the elderly can get timely and effective medical treatment. Conditional medical institutions set up in old-age care institutions can be used as post-rehabilitation nursing places for the elderly in hospitals (including traditional Chinese medicine hospitals). Encourage two or more general hospitals (including Chinese medicine hospitals) to carry out counterpart support and cooperation with old-age care institutions. We will integrate medical, rehabilitation, old-age care and nursing resources by building a medical and old-age care consortium, and provide the elderly with health and old-age care services that integrate hospitalization during treatment, rehabilitation care, stable life care and hospice care. Promote the extension of medical and health services to communities and families. Encourage social forces to set up institutions that combine medical care with nursing care.
V. Diversified development
Strengthen the coordinated development of social medical institutions and public medical and health institutions, and improve the overall efficiency of medical and health resources. Encourage social capital to invest in service areas that meet diverse needs. Encourage social capital to invest in establishing community health service institutions through various forms and channels. Encourage social forces to set up Chinese medicine specialized hospitals, rehabilitation hospitals, nursing homes (stations) and clinics for oral diseases, geriatric diseases and chronic diseases. Encourage social forces to give priority to the establishment of non-profit specialized hospitals of traditional Chinese medicine such as gynecology, pediatrics, orthopedics and anorectal diseases, and develop rehabilitation hospitals and nursing homes with Chinese medicine characteristics. There are no layout restrictions on the establishment planning of medical institutions and regional health development planning for Chinese medicine clinics and clinics that only provide traditional Chinese medicine services with social capital. Support qualified Chinese medicine professionals and technicians, especially famous old Chinese medicine practitioners to set up Chinese medicine clinics and clinics. Encourage pharmaceutical trading enterprises to hold traditional Chinese medicine clinic. Actively carry out more practice of doctors. Support social medical institutions to strengthen the construction of key disciplines, introduce and train talents, and enhance their academic status. Encourage and support social forces to participate in public health work, and strengthen technical guidance and supervision and management. Social forces should strengthen their own management, constantly strengthen their own capabilities, and work closely with professional public health institutions to ensure the smooth development of public health work.
Chapter IV Allocation of Medical and Health Resources
The first section configuration ideas
In view of the overall shortage of medical and health resources and the extreme shortage of health human resources in our province, we should control the growth rate of beds, improve service efficiency, speed up the construction of practicing (assistant) doctors, professional public health personnel and general practitioners, and rationally allocate registered nurses in accordance with the development idea of overall coordination.
In view of the uneven distribution of medical and health resources, according to the social and economic development, geographical traffic conditions, current situation of medical and health resources and the needs of regional medical and health center construction, 16 provinces and cities in the province are divided into: Kunming, the control development area; Moderately developed areas: Yuxi, Chuxiong, Honghe, Xishuangbanna and Dehong; Areas for accelerated development: Qujing, Baoshan, Zhaotong, Lijiang, Pu ‘er, lincang, Wenshan, Dali, Nujiang and Diqing.
According to the strategy of "controlling development, moderately developing and accelerating development", the allocation standard of medical and health resources in different regions is formulated, which requires controlling the development regions to promote structural adjustment, strengthen connotation construction, control the growth rate of all kinds of resources, guide the society to do fine medical work, encourage state-run hospitals and county-run hospitals to explore new service models, and gradually compress beds; Encourage moderately developed areas to improve efficiency, revitalize stocks, and rationally allocate and utilize various medical and health resources; Support to accelerate the development of areas to increase the construction of service supply capacity, and gradually narrow the gap in medical and health service capacity between various regions. Appropriate tilt will be given to the allocation of various resources in eight border States and cities, including Honghe Prefecture, Xishuangbanna Prefecture, Baoshan City, Pu ‘er City, lincang, Wenshan Prefecture, Dehong Prefecture and Nujiang Prefecture, so as to strengthen the medical and health services and disease prevention and control capabilities in border areas and provide health protection for the construction of a radiation center for South Asia and Southeast Asia.
Section 2 Allocation of Bed Resources
I. Structural configuration
By 2020, the total number of beds in medical and health institutions in the province will be controlled at about 295,000, the number of beds in medical and health institutions per 1,000 permanent residents will be controlled at 6.0, and the number of beds in public hospitals will be controlled at 3.25, including 1.94 hospitals run by counties, 0.88 hospitals run by cities and 0.33 hospitals run by provinces. There are 0.10 other public hospitals, 1.5 social hospitals and 1.25 primary medical and health institutions organized by state-owned and collective enterprises and institutions. The number of beds in Chinese medicine hospitals can be configured according to 0.55 beds per thousand permanent residents. Public specialized hospitals can be set up according to the proportion of 15% beds in public hospitals. If the number of beds in public hospitals per thousand permanent residents exceeds 3.25, in principle, the scale of public hospitals will no longer be expanded, and areas with conditions will be encouraged to optimize and adjust the excessive stock resources of public hospitals. The government has increased investment in areas and fields where medical and health service resources are short and social capital investment is insufficient to meet the basic medical and health service needs of the people. According to the basic tasks and functions undertaken, reasonably determine the size of beds in primary medical and health institutions, focusing on improving the quality of beds, improving the efficiency of use, and focusing on strengthening the combination of medical care, nursing and rehabilitation beds.
Second, the regional configuration
Considering the social economy, geographical location, service population, existing bed resources, bed utilization and other factors of each state and city, the bed allocation standards of each state and city are formulated according to the strategy of "controlling development, moderately developing and accelerating development" (see Table 3 for details).
Third, the monomer scale
Strictly control the bed size of public hospitals (single practice point). The number of beds in county-run comprehensive hospitals is generally about 500, and the number of beds in counties with a population of more than 500,000 can be appropriately increased. In principle, the number of beds in counties with a population of more than 1 million does not exceed 1,000; The number of beds in state-run general hospitals is generally about 800, and cities with a population of more than 3 million can be appropriately increased, in principle, not more than 1200; The number of beds in provincial and above general hospitals is generally about 1000, and in principle it is not more than 1500. General hospitals with more than 1,500 beds before 2015 shall not add any more beds. The size of beds in specialized hospitals is reasonably set according to actual needs.
Section III Allocation of Health Human Resources
The allocation of health human resources is adapted to the people’s health service demand, institutional function orientation and bed allocation. The distribution of medical and health talents in urban and rural areas and regions tends to be reasonable, and all kinds of talent teams develop in a coordinated manner. Strengthen the standardized training of general practitioners and residents, improve the coordination mechanism of medical education, and gradually establish and improve the general practitioner system. Promote the rational flow of medical personnel, optimize their allocation in the flow and give full play to their functions. Strengthen the construction of special capacity of public health personnel.
First, the configuration of licensed (assistant) doctors and registered nurses
Considering the social economy, geographical location, service population, existing human resources, medical and health service demand and other factors of each state and city, according to the strategy of "controlling development, moderately developing and accelerating development", the allocation standards of licensed (assistant) doctors and registered nurses in each state and city are formulated.
By 2020, the number of licensed (assistant) doctors and registered nurses per thousand permanent residents in the province will reach 2.5 and 3.14 respectively, with a total of about 123,000 and 154,000 respectively (see Table 4 for the allocation guidelines). States and cities can make appropriate adjustments according to the changes of population, economic development level and medical service needs and demands in the region.
Second, the hospital staffing
Hospital staff should focus on the allocation of licensed (assistant) doctors and registered nurses, and allocate the number of licensed (assistant) doctors and registered nurses on the basis of residents’ health service demand and doctors’ standard workload, combined with factors such as serving population, economic situation and natural conditions. The doctor-nurse ratio is 1: 1.25, and the bed-nurse ratio of state-run and above hospitals is not less than 1: 0.6. Medical and health institutions undertaking clinical teaching, teaching practice, supporting grassroots units, foreign aid medical care, emergency rescue, medical research and other tasks may appropriately increase staffing. Hospitals that do not meet the standard of bed-to-nurse ratio are not allowed to expand the size of beds in principle.
Three, the basic medical and health institutions staffing
By 2020, the number of primary health workers per thousand permanent residents will reach more than 3.5; The number of rural doctors per thousand service population is not less than 1, and the number of administrative villages with scattered residence can be appropriately increased; Every village clinic has at least one village doctor practicing. Village clinics equipped with more than two village doctors should have one female village doctor, and at least one village doctor who can attend the Western Conference. There are 2 general practitioners per 10,000 permanent residents, and each township health center has 2 general practitioners. The general practitioner system has been initially established, and a unified and standardized general practitioner training model and a service model of "first diagnosis at the grassroots level" have basically been formed. General practitioners and urban and rural residents have basically established a relatively stable contract service relationship, which basically meets the basic medical and health service needs of the people.
Fourth, the staffing of professional public health institutions
By 2020, the number of public health personnel per thousand permanent residents will reach 0.83, and all kinds of public health personnel at all levels will meet the needs of work. In principle, the staff of the Center for Disease Control and Prevention shall be approved according to the proportion of resident population of 1.75/ 10,000, and the number of infectious diseases in high-incidence areas and remote areas may be appropriately increased. Among them, the proportion of professional and technical personnel in the total establishment shall not be less than 85%, and the proportion of health technical personnel shall not be less than 70%. Maternal and child health care and family planning institutions should be reasonably staffed according to the local service population, social needs, traffic conditions, regional health and family planning development plans and the functions and tasks undertaken. The proportion of health technicians in maternal and child health care and family planning service institutions shall not be less than 80% of the total number. Professional mental health institutions shall allocate public health personnel according to the population in the region and the mental health prevention and control tasks undertaken. Blood collection and supply institutions shall allocate health technical personnel according to the annual business volume of blood collection and supply. Emergency centers, health and family planning comprehensive supervision and law enforcement agencies should be staffed according to the service population and annual business volume.
Section IV Information Resource Allocation
To guide the construction of population health informatization in the whole province with the national health insurance informatization project, and effectively improve the application level of population health informatization business; With information benefiting the people as the goal and business and management requirements as the guidance, a practical, shared and safe population health information service network will be built in an all-round way. Accelerate the construction of population health information platforms at the provincial, city and county levels, integrate and improve six business application systems, including public health, family planning, medical services, medical security, drug management and comprehensive management, and connect three databases, namely, population information, electronic medical records and electronic health records of residents, build a big data center for population health in the whole province, and popularize the application of residents’ health cards. Study and formulate the standard system of population health information in our province and implement the safety guarantee system.
By 2020, an interconnected population health information service system in the whole province will be initially established, so as to realize the integration of all-in-one coverage of health and family planning, all-in-one health card for residents and government social resources, and establish a national health security information service mechanism with full population coverage, whole life process, equal emphasis on Chinese and Western medicine, and all-weather work; Strengthen the application of medical and health big data analysis based on residents’ electronic health records throughout their life cycle; Promote health and family planning business collaboration, information sharing and scientific decision-making.
Section 5 Allocation of Other Resources
I. Configuration of large-scale equipment
According to the functional orientation, medical technology level, subject development and people’s health needs, strengthen the allocation planning of large medical equipment. Adhere to resource sharing and ladder configuration, guide medical institutions to rationally allocate appropriate equipment, gradually improve the allocation level of domestic medical equipment, and reduce medical costs. Strictly control the unconventional and debt-borrowing equipment of public hospitals. Moderately relax the allocation conditions of social medical institutions, do not take the level of social medical institutions and the size of beds as the necessary preconditions for determining the allocation of large-scale equipment, focus on assessing the qualifications and technical service capabilities of institutional personnel, and reserve a certain allocation quota for large-scale equipment of social medical institutions. In order to control the unreasonable increase of medical expenses caused by large-scale medical equipment and ensure the safety of large-scale medical equipment, medical insurance reimbursement support and price charging license support are not allowed for large-scale medical equipment that has not been allowed. Support the development of professional medical inspection institutions and imaging institutions, and gradually establish a mechanism for sharing, sharing and co-management of large medical equipment. Encourage the establishment of regional medical imaging centers in central Yunnan, southeastern Yunnan, southwestern Yunnan and other areas with conditions, promote the establishment of a service model of "inspection by primary medical and health institutions and hospital diagnosis", and improve the service capacity of primary medical imaging inspection and inspection. According to the unified and standardized standard system, the inspection of medical institutions above the second level is open to all medical institutions, and the promotion is conditional.In the area to carry out centralized inspection and mutual recognition of inspection results. Large-scale medical equipment shall be classified and managed according to the items, and the specific configuration plan shall be formulated separately. Strictly implement the relevant provisions on the purchase and use of second-hand large-scale medical equipment by medical institutions. It is strictly forbidden to use the models that have been eliminated by the state.
Second, the technical configuration
According to the demand of medical and health services, the functional orientation of medical and health institutions, disease spectrum, difficult and critical diseases, etc., the medical and health technology is rationally allocated. The establishment of medical technology clinical application evaluation management system, the clinical application of medical technology for the record management. Focusing on common diseases and health problems, we will strengthen the research and development, popularization and application of appropriate medical technologies, and strengthen the popularization and application of traditional Chinese medicine (ethnic medicine) technology. Build 50 provincial clinical key disciplines and 20 Chinese medicine key disciplines, form superior disciplines with Yunnan characteristics, and promote the overall level of disease diagnosis and treatment and the comprehensive competitiveness of hospitals. We will implement 300 provincial-level key clinical specialty construction projects and 200 provincial-level key clinical specialty cultivation projects, and build a number of key clinical specialty groups with radiation and demonstration functions to solve the problems of diagnosis and treatment of difficult, critical and specialized diseases for the masses. Strive to build 1-3 national regional medical diagnosis and treatment centers by 2020, and 40 specialties will meet the national standards of key clinical specialties, and the ability to treat difficult and critical diseases will be significantly improved. Strengthen the system construction of county-level medical institutions and the capacity building with talents and technology as the core, realize the rule of law, standardization, refinement and informatization of hospital management, and achieve the basic requirements of the state for comprehensive medical services. Each township health center and community health service center should build at least one clinical key department to achieve the goal of "common diseases do not leave the countryside and serious diseases basically do not leave the county". Strengthen the allocation of pre-hospital emergency transport equipment and the construction of pre-hospital emergency capacity in ethnic minority areas and remote areas.
Third, the allocation of funds
Strengthen the government’s investment responsibility for basic, grass-roots and basic medical and health resources, safeguard the public welfare of public medical and health services, and effectively ensure the funds for public health services and primary health services. The newly increased medical and health investment should focus on public health, primary health care, traditional Chinese medicine (ethnic medicine) and other key areas. Reform the way of financial subsidies and establish a mechanism linking financial subsidies with performance appraisal results. Provincial, state and municipal finance will give preferential support to areas and regional medical and health centers where medical and health services are lagging behind, and increase support for health services in poverty-stricken areas.
Chapter V Safeguard Measures
Section 1 Strengthening organizational leadership
First, strengthen leadership
The planning of medical and health service system is an important means for the government to carry out macro-control on health undertakings. It is necessary to strengthen the leadership of regional health planning, put regional health planning on the important agenda, include it in the government’s work objectives and assessment objectives, and establish an accountability system. Governments at all levels should make overall consideration of the development needs of medical and health institutions in the overall land use planning and urban and rural planning, rationally arrange land supply, and give priority to ensuring the land for non-profit medical institutions.
Second, rationally divide the responsibilities of governments at all levels
The people’s governments of prefectures and cities are responsible for studying and compiling the regional health planning and the establishment planning of medical institutions, and organizing their implementation. It is necessary to focus on the planning of hospitals and professional public health institutions at the prefecture level and below, refine the bed allocation standards to counties, and make overall plans for the establishment of various medical and health institutions at all levels in the city according to the principle of territoriality. The county-level government shall be responsible for the establishment of county-run hospitals, professional public health institutions and primary medical and health institutions in the region in accordance with the requirements of the regional health planning and medical institution establishment planning of the city where it is located.
Third, clarify the responsibilities of relevant departments
Departments of health and family planning, development and reform, finance, urban and rural planning, human resources and social security, institutional establishment and Chinese medicine management should conscientiously perform their duties and promote regional health planning in a coordinated manner. In terms of health and family planning, formulate regional health planning and medical institution setting planning and make dynamic adjustments in a timely manner; In terms of development and reform, we will carry out capital construction management for new reconstruction and expansion projects according to the plan, and actively strive for central construction funds in accordance with capital construction procedures; In terms of price, promote the reform of medical service price; In terms of finance, it is necessary to implement relevant funds in accordance with the government’s health investment policy, and pay attention to the principle of paying equal attention to both Chinese and western medicine; In terms of urban and rural planning and management, construction land should be approved in accordance with the urban and rural planning approved according to law; In terms of institutional establishment, it is necessary to coordinate the establishment of public medical and health institutions according to relevant regulations and standards; In terms of social security, we should speed up the reform of medical insurance payment system; Other relevant departments should carry out their duties and do a good job in relevant work.
Section 2 Innovating System and Mechanism
Deepen the reform of medical and health system and create favorable conditions for the implementation of medical and health service system planning. The main content of this plan is the allocation of medical and health resources. The overall deployment of deepening medical reform during the "Thirteenth Five-Year Plan" period will be arranged by the medical and health system reform plan. In the process of implementation, it is necessary to make a good connection with relevant plans. It is necessary to establish and improve the government’s health input mechanism and clarify the leading position of the government in providing public health and basic medical services. Effectively implement the investment policy for public and social non-profit medical and health institutions. Reasonably divide the responsibility of governments at all levels for medical and health investment. Deepen the comprehensive reform of primary medical and health institutions, improve the operational mechanism of networked urban and rural primary medical and health services, and improve service quality and efficiency; Accelerate the reform of public hospitals, establish a reasonable compensation mechanism, a scientific performance evaluation mechanism and a personnel compensation system that adapts to the characteristics of the industry, and promote the separation of management and administration, politics and medicine. Scientifically establish a dynamic adjustment system for performance pay in professional public health institutions, and allow grassroots public health institutions to extract a certain proportion from the balance of income and expenditure as an incentive performance pay increment, which will be included in the overall management of performance pay. Accelerate the development of serious illness insurance and commercial health insurance for urban and rural residents, and establish and improve a multi-level medical security system with basic medical insurance as the main body. Reform the medical insurance payment method and establish a more reasonable medical insurance payment mechanism. Strengthen the supervision of the whole medical and health industry. We will implement various forms of medical practice insurance such as medical liability insurance and medical accident insurance, and accelerate the development of third-party mediation mechanisms such as people’s mediation of medical disputes.Improve the medical dispute handling mechanism.
Section III Intensifying the Adjustment of Resources
According to the principle of "strictly planning increment and scientifically adjusting stock", the number and layout of public hospitals in the region are reasonably determined, and various measures are taken to promote the layout and structural optimization of public hospitals. Reasonably control the bed size, construction standards and large-scale equipment configuration of public hospitals, and prohibit borrowing for construction and equipment. For weak areas such as new urban areas, suburbs and satellite urban areas, the government should build public medical and health institutions in a planned and step-by-step manner to meet the basic medical and health needs of the people. Focus on strengthening the construction of service capacity in weak areas such as traditional Chinese medicine, pediatrics, obstetrics and gynecology, maternal and child health care, family planning, mental health, infectious diseases, elderly care, oral cavity and rehabilitation. Give priority to supporting the development of concentrated contiguous destitute areas, populous counties and areas lacking medical resources, and guide the flow of urban high-quality medical and health resources to grassroots and rural areas. Priority should be given to strengthening the service capacity of county-run hospitals and improving the medical capacity and level in the county. By 2020, 90% of county-run hospitals and county-run Chinese medicine hospitals will meet the basic standards for comprehensive capacity building of county hospitals and county Chinese medicine hospitals respectively, and the rate of medical treatment in the county will increase to 90%. Support the standardization of village clinics, township hospitals and community health service institutions, and build a "15-minute health service circle in dam area" and a "30-minute health service circle in mountain area". We will increase support for the development of medical and health service system and the targeted training of talents in ethnic minority areas, border areas and concentrated contiguous destitute areas. Newly built residential areas and communities shall ensure basic medical and health facilities in accordance with relevant regulations. In areas with surplus resources of public hospitals, it is necessary to optimize the structure and layout and proceed from reality.According to the needs, some public hospitals will be actively and steadily transformed into rehabilitation, elderly care and other continuing medical institutions or community health service institutions. For public hospitals that exceed the scale standard, comprehensive measures should be taken to gradually compress beds.
Section IV Strengthening the Training and Use of Talents
Carry out the basic talent training plan, strengthen the coordinated development of medical education, establish a supply-demand balance mechanism between medical talent training and talent demand in health and family planning industry, accelerate the construction of a clinical medical talent training system with "5+3" as the main body and "3+2" as the supplement, continue to carry out the free training of rural order-oriented medical students, and explore the "5+3+X" specialist training model. We will fully implement standardized training for residents and assistant general practitioners, and carry out pilot projects for standardized training system for specialists. Further promote continuing medical education. By 2020, a standardized and standardized clinical medical personnel training system with Yunnan characteristics will be basically established, which is organically connected with college education, post-graduation education and continuing education.
Carry out the training plan for 10,000 doctors and speed up the construction of practicing (assistant) doctors. Strengthen the construction of grassroots medical and health teams focusing on general practitioners, improve the on-the-job training system, and encourage rural doctors to participate in academic education. Strengthen the training of nursing, pediatrics, psychiatry and other urgently needed professionals. Taking the training project of "Yunling famous doctor", high-level talents and "provincial famous Chinese medicine practitioners" as the starting point, the selection and training of "Yunling famous doctor" and high-level talents will be carried out in a planned way in the whole province every year, and the introduction plan of high-level talents will be carried out to promote and lead the development of high-level talents in various fields of health and family planning, such as public health, medical care and health management, and to expand the ranks of high-level talents and improve their level. Improve the policy environment for the development of medical and health talents, and improve the systems and mechanisms for the evaluation, selection, mobility, incentive and guarantee of medical and health talents. Strengthen the government’s policy guidance on the flow of medical and health talents, formulate and implement the policy of "keeping people at the grassroots level", promote the flow of medical and health talents to the grassroots level, study and implement the special post plan for general practitioners and county-run hospitals in grassroots medical and health institutions, create good career development conditions, and encourage and attract medical personnel to work at the grassroots level. Improve the employment mechanism of public institutions with the employment system and post management system as the main content, improve the post setting management, ensure that the professional and technical posts are not less than 80% in principle, and implement open recruitment and competitive recruitment for posts. Improve the scientific and socialized evaluation mechanism based on job responsibilities, oriented by morality, ability and performance, and in line with the characteristics of health talents.Improve the evaluation system of professional and technical titles of health and family planning personnel, and promote the growth and development of talents and rational flow. We will deepen the reform of the income distribution system, establish an assessment and incentive mechanism centered on service quality, service quantity and satisfaction of clients, based on job responsibilities and performance, adhere to the principle of getting more for more work and excellent performance, and give priority to key positions, business backbones and medical and health personnel with outstanding achievements. Establish an investment mechanism for the construction of health talent team with government investment as the main input, supplemented by employers and social assistance, give priority to ensuring investment in talent development, and provide necessary financial guarantee for the development of medical and health talents. Innovating the organization of public hospitalsSystem management, reasonably check the total establishment of public hospitals, and make dynamic adjustments, gradually implement the establishment and filing system, and explore various forms of employment mechanisms and government procurement services.
Section 5 Strengthening Supervision and Evaluation
First, standardize the planning process
States and cities in the preparation of medical and health resources allocation standards and regional health planning, according to the health needs of the masses, to set a reasonable allocation of various medical and health resources. Do a good job in connecting with this plan, local economic and social development planning, urban and rural planning, overall land use planning, etc., reasonably control the standard of total resources and the single scale of public hospitals, and make appropriate adjustments to the proportion of beds in different levels and types of institutions according to actual needs on the basis of strengthening the grassroots. The drafting of regional health planning in each state and city shall be approved by the provincial health and family planning administrative department and then submitted to the people’s government of Honshu for approval to ensure the suitability, feasibility and authority of the planning. The cycle of regional health planning is generally 5 years.
Second, strict planning and implementation
Timely release information such as institutional setup and planning layout adjustment, and encourage qualified areas to determine the host or operation subject by means of bidding. Incorporating planning as a prerequisite for the establishment of construction projects. All new medical and health resources, especially the establishment, reconstruction and expansion of public hospitals, the expansion of hospital beds and the purchase of large-scale medical equipment, must be strictly managed in accordance with the requirements and procedures of regional health planning, regardless of the funding channels. Establish a grading filing and publicity system for the size of beds in public hospitals. In public hospitals with more than 1,500 beds, the increase in beds must be reported to the National Health and Family Planning Commission for the record (Chinese medicine hospitals should also be reported to state administration of traditional chinese medicine for the record); In public hospitals with more than 1,000 beds, the increase of beds shall be reported to the Provincial Health and Family Planning Commission for the record. For public hospitals that seriously exceed the prescribed number of beds, carry out project construction without approval, expand the construction scale and improve the construction standards without authorization, informed criticism should be carried out, and the allocation of large medical equipment, grade evaluation and financial arrangements should be suspended.
Third, establish a supervision and evaluation mechanism for the implementation of the plan
The people’s governments of prefectures and cities should strengthen the supervision and evaluation of planning implementation, establish a supervision and evaluation mechanism of regional health planning and resource allocation, set up a special evaluation working group, organize the evaluation of the implementation progress and effect of regional health planning, find out the problems existing in the implementation in time, and study and solve countermeasures. In the process of evaluation, public appraisal and fair competition should be carried out, and legal, economic and administrative means should be used to standardize, manage and ensure the effective implementation of regional health planning.
Attachment: Division of Key Tasks of Provincial Departments
