Beijing Releases Key Tasks for Tiered Diagnosis System: All 2,510 Reimbursable Medicines Extended to Community Healthcare Facilities

On August 15, Beijing Municipality announced the key tasks for its tiered diagnosis and treatment system for 2016–2017. Several aspects deserve particular attention: first, renewed emphasis on the family doctor contract service; second, an increase in the total amount of performance-based wages for primary healthcare institutions; third, an expansion of medical insurance reimbursement coverage and services, with all 2,510 drugs listed in the basic medical insurance catalog made fully available at the primary care level; and fourth, the launch of pilot programs for chronic disease management targeting four conditions: hypertension, diabetes, coronary heart disease, and cerebrovascular diseases.

The Beijing Municipal People's Government website has organized the content of the document release, covering seven innovations, six key priorities, and four areas of public concern. The full text is as follows:

First, the primary objective of healthcare reform is to address the prominent supply-demand mismatch characterized by major health threats—predominantly chronic diseases—and a severe shortage of medical service provision. Establishing family physician services as a breakthrough point to build a tiered diagnosis and treatment system is an effective approach to rationally allocate medical resources and enhance their utilization efficiency. However, in practice, several challenges hinder the implementation of the family physician system, including relatively insufficient capacity of primary care services, inadequate alignment of medication formularies between different levels of medical institutions, and loose coordination of medical insurance policies. In Beijing’s current effort to construct a tiered diagnosis and treatment system, the top priority is strengthening primary care. The family physician service model serves as a key indicator for enhancing community-based service capabilities, promoting voluntary contract signing between residents or families and family physician teams to establish stable service relationships. After signing up, patients can enjoy benefits such as priority appointments, referral services, green channels, and continuous access to medications from higher-level hospitals, thereby ensuring that patient needs are met, medical services are delivered, drug formularies are adjusted, and medical insurance payment policies are aligned.

Second, implement the requirement for initial diagnosis at the primary care level and reflect the principle of distribution according to work. Since 2016, the total amount of performance-based wages for primary healthcare institutions has been increased by 20%. However, this should not be interpreted as a 20% increase in average individual salaries. Instead, allocations are primarily based on the quantity and quality of work, assessed through a three-tier evaluation system involving municipal, district, and institutional authorities. Primary healthcare public institutions then independently distribute the funds based on the assessment results and requirements.

Third, fully leverage the technical expertise and advantages of specialist teams at tertiary hospitals and retired experts. Multiple measures will be adopted to support the decentralization of high-quality medical resources, with institutional frameworks ensuring that healthcare personnel from large hospitals provide support to primary care settings. Primary healthcare institutions may engage physicians from large hospitals or rehire retired doctors through service procurement, offering them equivalent compensation and benefits, supplemented by appropriate government subsidies. The daily subsidy shall be no less than 200 yuan per working day.

Fourth, address the prominent issues faced by patients seeking medical care at the primary level through a problem-oriented approach. Taking hypertension, diabetes, coronary heart disease, and cerebrovascular diseases as pilot conditions, community physicians may prescribe up to two months’ supply of medication for patients in the stable phase of these four diseases who meet six basic criteria, in accordance with relevant chronic disease management requirements.

Fifth, promote coordination between medical care and health insurance. Further expand the scope of drug reimbursement for community health institutions designated by medical insurance, ensuring seamless alignment of drug reimbursement across healthcare institutions at different levels within medical consortia. Under the global budget control of medical insurance funds, adhere to the principles of aggregate control and structural adjustment, increase resource allocation toward community-level facilities, with growth rates significantly higher than those of large hospitals, thereby advancing the development of a tiered diagnosis and treatment system within medical consortia.

Sixth, explore classified management, implement the adjustment and improvement of medical service prices, and actively and steadily advance the price standardization work for medical service items that reflect the technical and labor value of medical personnel, such as pre-hospital emergency care, nursing, traditional Chinese medicine, and rehabilitation, following a step-by-step approach with key breakthroughs.

Seventh, promote interoperability of standards and accelerate the informatization construction of tiered diagnosis and treatment in Beijing. Priority should be given to strengthening the construction of healthcare information management systems and hospital information integration platforms. In light of practical conditions, implement standards for the integration of medical cards to lay the foundation for real-name registration and two-way referrals, thereby improving diagnostic and treatment efficiency. Leverage information technology to enhance teleconsultation capabilities, expand the scope of disease treatment, and establish a tiered diagnosis and treatment consultation platform in Beijing. This includes setting up multi-platform municipal clinical consultation centers and multi-platform municipal medical technology consultation centers, covering imaging, blood testing, pathological diagnosis, and electrocardiogram (ECG) interpretation. Provide corresponding examination and medical services to primary healthcare institutions to minimize disordered patient flow within the shortest possible time.

First, the reimbursement rate at community health centers should be higher. The reimbursement rate for outpatient medical expenses incurred by urban employee basic medical insurance enrollees at community clinics is 90%, which is 20 percentage points higher than that at other facilities.

Second, expand the range of reimbursable medications in community health centers. Through policy adjustments, any medication eligible for reimbursement at large hospitals will also be reimbursable at community health centers. Currently, the municipal basic medical insurance drug list includes 2,510 medications, while the community formulary covers 1,435. Moving forward, to support the development of medical consortia, all 2,510 medications will be made available at the community level within these consortia, enabling patients to obtain at community health centers the same medications prescribed at large hospitals.

Third, long-term prescriptions for chronic diseases are covered by medical insurance. In our city, the basis for prescription quantities under medical insurance is primarily derived from the Ministry of Health’s “Measures for Prescription Management.” This time, the prescription duration has been extended for four types of chronic diseases, subject to certain prerequisites. For chronic disease conditions eligible for extended treatment durations, the social security department has simultaneously authorized an increase in prescription quantities. The prescription supply at community health centers has been increased from one month to two months, and all such prescriptions are reimbursable using the medical insurance card. Naturally, the specific medications prescribed must comply with medical insurance regulations, falling within the scope of the current National Reimbursement Drug List and adhering to reimbursement policy requirements.

Fourth, within the scope of medical insurance fund management, adhering to the principles of aggregate control and structural adjustment, and following the orientation of favoring tertiary hospitals for inpatient care and secondary or lower-level institutions for outpatient services, we will continue to increase support for community-based primary healthcare institutions.

Fifth, promote the reform of separating medical services from pharmaceutical sales. Implement differentiated reimbursement policies for medical service fees at primary healthcare institutions and large hospitals, raise the level of medical service fees at primary healthcare institutions, and guide patients to seek medical care at the grassroots level.

6. Community Referrals. In accordance with the referral procedures established by health authorities, patients can be referred from community healthcare facilities to tertiary hospitals, and vice versa. Medical expenses incurred through these referrals are eligible for reimbursement under medical insurance schemes.

1. Does the 20% increase in the total performance-based salary pool for primary healthcare institutions since 2016 constitute a pay raise for grassroots medical personnel?

It is not a flat 20% salary increase for everyone; rather, performance appraisals are conducted through a three-tier system involving municipal-level, district-level, and competent business departments. If the assessment meets the corresponding standards and requirements, the overall salary adjustment should be around 20%. On an individual basis, some employees may receive more than 20%, while others may receive less. This approach represents a new step in incentive mechanisms.

2. What is the current family doctor contract signing rate in Beijing?

Currently, over 3 million households in Beijing have signed up for family doctor services, covering nearly 8 million people. However, the enrollment rate remains relatively low given the target population, as Beijing’s permanent resident population stands at 25.75 million, meaning only about one-third of residents are currently served. Enrolling with family doctors enables precise monitoring of patients’ health conditions and facilitates effective health management. Beijing currently has more than 5,000 family doctors. According to the requirements set by the National Health and Family Planning Commission, there should be 2–3 family doctors per 10,000 residents. Beijing’s current ratio is 2.7 per 10,000, still falling short of the target of 3. Nevertheless, family doctor enrollment is a two-way process involving both public outreach and the voluntary participation of residents within the service area. Once enrolled, patients benefit significantly from chronic disease management and overall health management. We believe that promoting family doctor contracts will further advance the tiered diagnosis and treatment system.

3. What is the approximate annual service fee for Beijing residents to sign up with a family doctor?

Currently, grassroots-level contract signing is free of charge. Following the issuance of documents on tiered diagnosis and treatment, we will vigorously promote family doctor contracting services. According to State Council guidelines, further exploration and research are needed to determine how contracting fees will be collected, what specific contents and items are included in the contracts, which costs will be covered by medical insurance, and which costs will be borne by individuals. The current documents do not yet address fee-related issues. Any current charges for family doctor contracting services should be reported, as these services are currently provided free of charge.

4. When will the tiered diagnosis and treatment system, based on medical consortiums, achieve citywide coverage?

Since the establishment of medical consortia in Beijing in 2013, 48 such consortia have been formed, covering 80% of primary healthcare institutions in the city. By the end of 2016, we aim to establish more than 50 medical consortia across all 16 districts, thereby achieving full coverage.