85% of Prefecture-Level Cities to Pilot Tiered Diagnosis and Treatment System in 2017, Focusing on Medical Consortia and Ambulatory Surgery Centers

The 2017 National Healthcare Administration Work Conference was held in Beijing on January 16. Wang Hesheng, Deputy Director of the National Health and Family Planning Commission, member of its Party Leadership Group, and Director of the State Council’s Office for Healthcare Reform, attended the conference, delivered a speech, and outlined specific arrangements for healthcare administration work in 2017.

Speech by Wang Hesheng, Deputy Director of the National Health and Family Planning Commission, Member of the Party Leadership Group, and Director of the State Council’s Office for Healthcare Reform

Wang Hesheng outlined five key priorities for 2017 in his speech: First, advance the development of a tiered diagnosis and treatment system to establish an orderly medical care sequence. Second, continue implementing the Action Plan for Improving Medical Services and optimize the allocation of medical resources to enhance the public’s sense of gain in health. Third, deeply implement targeted health-based poverty alleviation initiatives to support the national campaign against poverty. Fourth, safeguard medical quality and patient safety by upholding fundamental service standards. Fifth, comprehensively strengthen Party building and professional ethics within the healthcare sector to foster a clean and upright industry culture.

Jiao Yahui, Deputy Director of the Bureau of Medical Administration and Hospital Management under the National Health and Family Planning Commission, clarified the development direction and objectives for tiered diagnosis and treatment in 2017 and provided an on-site update on the progress of its implementation in China.

Implementing a tiered diagnosis and treatment system is a key objective of China’s healthcare reform, serving as an effective solution to alleviate patient overcrowding in large hospitals and address the difficulty of accessing medical care. The so-called tiered diagnosis and treatment system classifies diseases based on their severity, urgency, and complexity of treatment, with medical institutions at different levels assuming responsibility for treating corresponding conditions. This model, progressing from general practice screening to specialized care, facilitates initial consultations at primary care facilities, two-way referrals, differentiated management of acute and chronic conditions, and coordinated collaboration between upper- and lower-level institutions. Ultimately, it aims to establish an ideal healthcare pattern where “minor ailments are treated in the community, serious diseases are managed in hospitals, and rehabilitation takes place back in the community.”

Establishing a tiered diagnosis and treatment system is a complex systemic project with broad scope and intricate circumstances, requiring a long-term process. We must adhere to the principles of “voluntary participation by residents, initial consultation at primary care institutions, policy guidance, and institutional innovation,” focusing on resolving four key issues: “willingness of the public to seek care at primary levels, capacity of primary care institutions to provide adequate services, willingness of large hospitals to refer patients appropriately, and supporting policy measures.” Jiao Yahui introduced that in 2017, pilot programs for tiered diagnosis and treatment would be comprehensively launched in 85% of prefecture-level cities across China. Typical best practices would be summarized and promoted, leveraging family doctor contract services and medical consortia as key instruments, and targeting chronic diseases such as hypertension and diabetes as entry points to implement “initial consultation at primary care institutions.”

The key to reforming public hospitals lies in separating government administration from institutional operations, and distinguishing regulatory functions from managerial responsibilities, thereby clarifying the relationship between the government and hospitals and ensuring hospitals’ autonomy in operational management. The government should focus on strengthening macro-level management, directing its primary efforts toward formulating policies, setting strategic directions, developing plans, and conducting evaluations, while intensifying oversight of irregular medical practices and unreasonable growth in healthcare costs. Large hospitals should primarily focus on diagnosing and treating complex, difficult cases as well as acute and critical conditions, whereas primary healthcare institutions should mainly handle the routine diagnosis and treatment of common and frequently occurring diseases.

In 2017, efforts should continue to advance the modern hospital management system and establish a compensation system for public hospitals that aligns with the characteristics of the healthcare industry. Medical and health institutions should be permitted to exceed the current wage control levels applicable to public institutions, and revenue from medical services, after deducting costs and allocating various funds as required, should be primarily used for personnel incentives. The principle of “more pay for more work and higher pay for better performance” should be encouraged, restrictions on talent mobility should be relaxed, and policies enabling physicians to practice at multiple locations should be fully implemented.

Promote the development of medical consortia by leveraging them as a platform to strengthen the construction of urban medical consortia, county-level medical communities, cross-regional specialty alliances, and telemedicine collaboration networks. Gradually establish a clear division of labor and collaborative mechanism with well-defined objectives and responsibilities among medical institutions at different levels and of different categories, fostering a community of shared interests, responsibilities, and services. This will facilitate the effective decentralization of high-quality medical resources and continuously enhance the service capacity of primary healthcare institutions.

Day surgery refers to a surgical model in which patients undergoing elective procedures are admitted in a planned manner, undergo surgery on the same day, and are discharged without an overnight stay. Due to its high cost-effectiveness and short hospital stays, the day surgery model has been widely adopted for elective surgeries in European and American countries. Promoting day surgery centers can facilitate a tiered diagnosis and treatment model characterized by “surgery in hospitals, recovery in communities,” thereby achieving “efficiency-driven benefits.”

Jiao Yahui stated that the National Health and Family Planning Commission, in conjunction with the Ministry of Human Resources and Social Security, has launched a pilot program for day surgery in tertiary hospitals, with the list of pilot hospitals to be finalized in the near future. All regions should take the promotion of day surgery centers as an entry point to enhance the efficiency of tertiary hospitals.