China Launches 2018-2020 Action Plan to Improve Medical Services with Five Key Institutional Reforms

According to VCBeat, in order to promote the high-quality development of medical services and continuously enhance the public’s sense of gain and happiness, the National Health and Family Planning Commission recently released the Action Plan for Further Improving Medical Services (2018–2020).

The "Action Plan" requires that, starting from 2018, medical institutions establish systems for appointment-based diagnosis and treatment, telemedicine, clinical pathway management, mutual recognition of examination and test results, and the engagement of medical social workers and volunteers.

From 2018 to 2020, further consolidate and improve effective measures for enhancing medical services, institutionalize them as hospital work systems, and ensure their continuous implementation and deepening. Further apply new concepts and technologies to innovate medical service models, continuously meeting the public’s emerging demands for medical services.Over a three-year period, we will strive to make diagnosis and treatment safer, medical visits more convenient, communication more effective, and patient experience more comfortable. We aim to gradually establish a new-era healthcare service model characterized by regional coordination, information sharing, integrated services, and multidisciplinary collaboration. This initiative will promote high-quality development of medical services, significantly improve the quality of primary healthcare, continuously enhance social satisfaction, and further strengthen the public’s sense of gain in accessing medical care.

(I) Guiding Principles.Comprehensively implement the spirit of the 19th National Congress of the Communist Party of China and Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era. Earnestly carry out the decision-making arrangements of the CPC Central Committee and the State Council, as well as the spirit of the National Health and Wellness Conference. Adhere to a people-centered development philosophy, take the implementation of the Healthy China strategy as the main thread, and aim to improve modern hospital management systems and comprehensively establish a high-quality and efficient medical and health service system, thereby raising the level of livelihood protection and improvement. Highlight problem-oriented approaches and implement precise policies targeting issues of concern to the public. On one hand, focus on reform, leveraging the construction of medical consortia to enhance the quality of primary healthcare and strengthen the primary medical service system. On the other hand, focus on improvement by consolidating achievements, innovating services, providing technological support, and conducting publicity and guidance, striving to provide the public with higher-level and more satisfactory health and wellness services, thereby enhancing their sense of gain.

(II) Work Objectives.From 2018 to 2020, further consolidate and improve effective measures for enhancing medical services, institutionalize them as hospital work systems, and ensure their continuous implementation and deepening. Further apply new concepts and technologies, innovate medical service models, and continuously meet the public’s emerging demands for medical services. Over a three-year period, strive to make diagnosis and treatment safer, medical visits more convenient, communication more effective, and patient experience more comfortable. Gradually form a new-era pattern of medical services characterized by regional coordination, information sharing, integrated services, and multidisciplinary collaboration, thereby promoting high-quality development of medical services. Significantly improve the quality of primary healthcare services, continuously enhance social satisfaction, and further strengthen the public’s sense of gain in accessing medical care.

Based on a summary of the experience and effectiveness of the Action Plan for Improving Medical Services (2015–2017), medical institutions shall, starting from 2018, establish systems for appointment-based diagnosis and treatment, telemedicine, clinical pathway management, mutual recognition of examination and test results, and medical social workers and volunteers.

(I) Appointment-based Diagnosis and Treatment System.Tertiary hospitals shall further increase the proportion of appointment-based diagnosis and treatment services, vigorously promote time-slot appointments for clinical consultations and centralized appointments for examinations and tests, with appointment slots specified to within one hour. Tertiary hospitals shall prioritize reserving appointment slots for primary healthcare institutions within medical consortia. Patients with appointments and those referred through appointment-based channels shall receive priority in consultation, examination, and hospitalization, thereby encouraging initial consultations at primary care facilities and facilitating two-way referrals. Hospitals with adequate resources shall gradually improve appointment services for inpatient beds and day surgeries, and explore extended services such as reserved parking.

(II) Telemedicine System.Nationwide, all medical consortia have achieved full coverage of telemedicine services. The lead hospitals of these consortia have established telemedicine centers to provide services such as remote consultations, remote imaging, remote ultrasound, remote electrocardiography, remote pathology, remote ward rounds, remote monitoring, and remote training to healthcare institutions within the consortium. Primary healthcare institutions are gradually expanding the scope of their telemedicine services, enabling more eligible patients to access diagnostic and treatment services from higher-level hospitals close to home. Primary healthcare institutions may explore providing appropriate telemedicine, remote health monitoring, and remote health education services to enrolled patients.

(3) Clinical Pathway Management System.Healthcare institutions should implement information-based clinical pathway management, gradually incorporating pharmaceutical care, diagnostic testing, and other services into clinical pathways. This aims to increase the proportion of inpatients managed under clinical pathways, achieve an integrated “physician–nurse–patient” model for clinical pathways, and enhance the standardization and transparency of clinical diagnosis and treatment practices. Within medical consortia that have the necessary conditions, integrated clinical pathways may be explored, with healthcare institutions at all levels collaborating through clear division of responsibilities to provide patients with seamless referral and continuous care services.

(IV) System for Mutual Recognition of Examination and Test Results.Comprehensive coverage of professional medical quality control has been achieved across all regions for disciplines including clinical laboratory medicine, medical imaging, and pathology. Medical institutions that have passed the relevant professional medical quality control assessments at the provincial or municipal level shall implement mutual recognition of examination and test results within their corresponding administrative jurisdictions. Within medical consortiums, data and information sharing for medical imaging, clinical laboratory tests, and pathological examinations has been realized, with mutual recognition of examination and test results implemented.

(V) Medical Social Worker and Volunteer System.Medical institutions shall establish medical social worker positions responsible for facilitating doctor-patient communication and providing patient support services, including assistance with diagnosis and treatment, daily living, legal affairs, and aid. Tertiary hospitals with the necessary conditions may establish dedicated medical social work departments, staffed with full-time medical social workers, and operate patient service call centers to coordinate and address patients’ needs. Medical institutions should vigorously promote volunteer services, encouraging medical personnel, medical students, and compassionate members of the public to provide volunteer services to patients after undergoing appropriate training.

All regions must conduct in-depth analyses of the changes in the principal contradiction facing Chinese society in the new era, fully leverage new concepts and technologies to promote high-quality development of medical services, and ensure medical safety. The Action Plan for Improving Medical Services (2018–2020) focuses on innovating medical services in the following 10 areas to further enhance the public’s sense of gain.

(1) Adopt a patient-centered approach and promote the multidisciplinary diagnosis and treatment model.For conditions such as tumors, refractory and complex diseases, and multi-system or multi-organ disorders, medical institutions may establish multidisciplinary treatment (MDT) outpatient clinics to provide patients with “one-stop” diagnostic and therapeutic services. For inpatients, efforts should be made to develop evidence-based MDT guidelines for specific single diseases, and to establish systems for MDT case discussions and joint ward rounds, thereby delivering multidisciplinary care to hospitalized patients. Medical institutions with the necessary capabilities are encouraged to incorporate professionals from anesthesiology, medical laboratory science, medical imaging, pathology, and pharmacy into MDT teams, so as to promote coordinated development across specialties, enhance comprehensive disease management, and improve patient experience. Traditional Chinese Medicine (TCM) institutions should continuously explore and establish models of integrated TCM therapy and multi-specialty collaborative care that align with the academic characteristics of TCM, leverage its unique advantages, improve clinical efficacy, and facilitate access to medical services for the public.

(II) Focusing on critical and severe cases, innovate emergency medical services.Within prefecture-level cities and counties, eligible medical institutions shall establish Chest Pain Centers, Stroke Centers, Trauma Centers, Centers for the Treatment of Critically Ill Pregnant and Postpartum Women, and Centers for the Treatment of Critically Ill Children and Neonates. These institutions shall achieve coordinated management across relevant specialties within their facilities to provide patients with green channels for medical treatment and integrated comprehensive care services, thereby improving the quality and efficiency of medical treatment for major acute conditions. Pre-hospital emergency medical services shall form a network with these centers to enable sharing of patient information between pre-hospital and in-hospital settings, constructing a rapid, efficient, and fully covered medical treatment system for critical and severe cases. Areas with appropriate conditions may explore the establishment of three-dimensional rescue models integrating land and air transport.

(3) Leverage medical consortia as the vehicle to deliver continuous healthcare services.Within the medical consortium, information sharing of electronic health records (EHRs) and electronic medical records (EMRs) is realized. Based on integrated clinical pathways for single diseases, medical institutions clarify their division of labor and collaborative tasks. Adopting a patient-centered approach, they provide continuous medical services—including health education, disease prevention, diagnosis, treatment, rehabilitation, and nursing care—and comprehensively document health information. Efforts are strengthened to build a medical quality control system, with a focus on enhancing quality control across all stages of continuous care within the consortium, thereby effectively improving primary care quality and ensuring medical safety. Leveraging informatization, the consortium establishes a tiered diagnosis and treatment framework characterized by orderly patient flow, on-demand allocation of medical resources, and integrated medical services.

(4) Using day services as an entry point to promote the implementation of separate management for acute and chronic conditions.Tertiary hospitals that meet the criteria shall steadily implement day surgery programs, improve operational protocols and workflows, gradually expand the range of conditions eligible for day surgery, and increase the proportion of day surgeries among elective procedures year by year. These measures aim to reduce patients’ waiting times for hospital admission and surgery, thereby enhancing the efficiency of medical services. Hospitals with adequate resources are encouraged to establish day wards and day treatment centers to provide day-care services such as daytime chemotherapy and neonatal phototherapy, thus improving bed utilization rates and benefiting more patients. Primary healthcare institutions within medical consortia shall provide follow-up and other post-discharge services for patients undergoing day surgery and day treatment.

(5) Leverage “Internet+” as a means to build smart hospitals.Healthcare institutions, centering on patients’ medical service needs, leverage internet information technologies to expand the scope and content of medical services, providing appropriate care consistent with their approved diagnostic and therapeutic specialties. By continuously optimizing service workflows through internet technologies, they offer convenient services such as appointment scheduling, mobile payments, bedside settlement, visit reminders, result inquiries, and information push notifications. Wearable devices are employed to provide remote monitoring and guidance for enrolled patients and those requiring key follow-up care, thereby achieving effective integration between online and offline medical services. Healthcare institutions strengthen the development of comprehensive information systems centered on outpatient and inpatient electronic medical records (EMRs), utilizing big data technologies to support medical quality control, standardization of clinical practices, evaluation of rational drug use, optimization of service processes, and allocation of medical resources. New tools such as intelligent patient triage, AI-based medical image recognition, and centralized monitoring of patient vital signs are applied to enhance diagnostic and treatment efficiency. Furthermore, new technologies including the internet and the Internet of Things (IoT) are utilized to achieve informatization and intelligent management in medication dispensing, internal logistics, and patient safety management.

(6) Aim for a “One-Card System” to achieve interconnectivity and interoperability of medical visit information.Based on regional public health information platforms, strengthen the application of resident health cards, medical insurance cards, and other tools to achieve a “universal card” system for medical visits within prefecture-level cities, enabling patients to seek care at any medical institution using a unified medical visit card. Encourage provincial administrative regions with the necessary conditions to implement a “universal card” system for patient visits. Encourage localities with the requisite capabilities to integrate functions such as consultation, settlement, payment, inquiry, and appointment registration into the medical visit card.

(VII) Guided by emerging societal needs, extend the provision of high-quality nursing services.Further expand the coverage of high-quality nursing services, gradually achieve full coverage of such services in secondary and tertiary hospitals, and progressively implement high-quality nursing services in primary healthcare institutions. Promote the decentralization of high-quality nursing services within medical consortia by extending geriatric nursing, rehabilitation nursing, and palliative care to primary healthcare institutions through training, guidance, mentorship, and telehealth. Where conditions permit, medical institutions may provide nursing service guidance to internal medical units established within partnered elderly care facilities, thereby enhancing the quality of integrated medical and elderly care services. Primary healthcare institutions with adequate resources may explore providing home-based nursing services and in-home nursing guidance for patients.

(8) Leverage contracted services to expand into new areas of pharmaceutical care.Pharmaceutical care coverage has been fully realized in hospitals at Level II and above. Clinical pharmacists leverage information technology to provide personalized guidance on rational drug use for both outpatient and inpatient patients. Coordination of medication management across medical institutions within medical consortia has been strengthened, with prescription reviews conducted for those extended to primary healthcare facilities, thereby decentralizing pharmaceutical care services. Through on-site or remote guidance, clinical pharmacists assist healthcare personnel in primary healthcare institutions in improving their standards of rational drug use, with a particular focus on providing medication guidance to patients with chronic diseases under contracted care services, thus addressing emerging patient needs. Traditional Chinese Medicine (TCM) hospitals are encouraged to offer personalized services such as individualized processing of TCM formulations for patients, and to fully utilize information technology to facilitate services like the delivery of TCM decoction pieces, thereby reducing waiting times for patients during medication collection and other processes.

(9) Use humanistic services as a medium to build harmonious doctor-patient relationships.Promote the noble professional spirit of health and family planning; medical institutions shall establish standards for service language and conduct for medical staff and front-desk personnel. Strengthen patient privacy protection by improving privacy-protecting facilities in key areas and departments. Medical institutions with appropriate conditions may explore collaboration between clinical departments specializing in chronic diseases—such as cardiovascular diseases, tumors, and diabetes—and psychiatric and psychological departments, to provide patients with both diagnostic/treatment services and psychological guidance.

(10) Leverage logistics services as a breakthrough to comprehensively enhance patient satisfaction.Medical institutions continuously improve their facility environments, ensuring clear signage and rational layout. They strengthen logistics service management, with a focus on enhancing dietary quality and restroom cleanliness. Where conditions permit, medical institutions may provide services in public areas to help alleviate the anxiety of waiting patients, such as internet access, reading materials, and catering options, while offering health guidance and therapeutic diets to hospitalized patients in need.

(1) Strengthen organizational leadership to ensure tangible results.Local health and family planning administrative departments at all levels (including traditional Chinese medicine management departments, hereinafter referred to as the same) shall continue to strengthen organizational leadership over efforts to improve medical services, consolidate and deepen the experience and achievements gained from the first Three-Year Action Plan, and develop detailed implementation plans for the second Three-Year Action Plan based on the actual conditions of medical services within their respective jurisdictions. They shall guide medical institutions in continuously innovating concepts and measures for improving medical services, so as to steadily intensify efforts, deepen content, enhance quality, achieve more remarkable results, benefit a greater number of patients, and gradually narrow the supply-demand gap in the field of medical services.

(2) Mobilize the enthusiasm of medical personnel and enhance patient satisfaction.Health and family planning administrative departments at all levels and medical institutions must care for and support medical personnel, fully leveraging their role as the main force in building a Healthy China. Leaders at all levels should proactively engage with frontline healthcare workers, build genuine relationships with them, and provide encouragement in spirit, assistance in work, support in career development, and guarantees in daily life, thereby enabling them to serve patients with dedication, comfort, and peace of mind. Efforts must be made to improve working conditions and logistical support for medical staff, promote and enhance their physical and mental well-being, and ensure they share in the benefits of reforms and development in the healthcare sector. Provincial-level health and family planning administrative departments should actively utilize internet and big data technologies to establish satisfaction management systems that dynamically assess patient healthcare experiences and medical practitioners’ professional sentiments. Through satisfaction evaluations, prominent issues affecting the satisfaction of both patients and medical staff should be identified, and the implementation plans for improving medical services should be continuously adjusted and refined. Satisfaction evaluations should be incorporated into the comprehensive performance assessments of healthcare institutions and serve as key indicators for evaluating the effectiveness of initiatives to improve medical services, ensuring continuous improvement in healthcare delivery and steady enhancement of the sense of gain among both patients and providers. The National Health and Family Planning Commission will regularly provide feedback to provinces on national satisfaction evaluation results.

(3) Continuously deepen healthcare reform and ensure policy support.Local health and family planning administrative departments at all levels shall coordinate the improvement of medical services with the deepening of healthcare reform, ensuring simultaneous deployment and advancement, and adhering to a dual focus on both reform and service enhancement. Vigorous efforts shall be made to promote the establishment of a tiered diagnosis and treatment system, thereby creating favorable conditions for healthcare institutions to improve their medical services. Experience from the action plan that is replicable and scalable shall be institutionalized as a key component of the modern hospital management system to ensure sustainable outcomes. The reform of medical service pricing and the compensation system shall be accelerated to motivate healthcare professionals, encouraging them to engage in the improvement of medical services with enthusiasm and a proactive attitude.

(4) Intensify publicity efforts and leverage exemplary models for guidance.Local health and family planning administrative departments at all levels shall advance public awareness campaigns in tandem with efforts to improve medical services, ensuring that publicity plans are developed concurrently with action plans for implementation. Communication and collaboration with publicity departments and various media outlets shall be strengthened to integrate concentrated publicity efforts with routine outreach, and to combine traditional media with emerging media platforms, thereby sustaining the promotion of exemplary practices and achievements in improving medical services. Continuous efforts shall be made to identify and highlight role models in enhancing medical services, promoting a cohort of demonstration hospitals, model positions, and exemplary individuals, so as to foster a working environment driven by role models and guided by best practices.