Guangdong Healthcare Reform: Major Shift as Large Hospitals Phase Out General Outpatient Services
Patient Triage and Comprehensive Implementation of Family Doctor Contract Services
The plan proposes that tertiary hospitals gradually reduce general outpatient services for common and frequently occurring diseases, as well as for chronic diseases with clear diagnoses and stable conditions, so as to divert chronic disease patients; it also encourages some secondary hospitals in areas with abundant medical resources to transform into institutions specializing in chronic disease management.
According to the plan, Guangdong will encourage experts and renowned physicians to provide diagnosis and treatment services at primary healthcare institutions or establish physician studios at the grassroots level, gradually reduce the proportion of outpatient visits at large hospitals, and encourage these hospitals to phase out outpatient services. Furthermore, the plan supports the development of physician groups and specialized clinics led by renowned physicians in regions with appropriate conditions. Resources from existing medical laboratories, medical imaging centers, pathology diagnostic centers, blood purification facilities, and sterile supply centers in secondary and tertiary hospitals will be integrated and made accessible to primary healthcare institutions and chronic disease management facilities.
The tiered diagnosis and treatment system requires the support of a health information technology infrastructure. The plan proposes that by 2017, national health informatization projects will basically cover all secondary and tertiary hospitals, as well as more than 80% of community health service centers and township health centers. By 2018, a telemedicine platform enabling effective connectivity between Grade A tertiary hospitals and county-level hospitals will be established, with gradual extension to primary healthcare institutions. By 2020, the goal is to establish 10 internet hospitals and 10 smart nursing hospitals.
The plan proposes that Guangdong should comprehensively implement family doctor contract services, with the service fees primarily shared by medical insurance funds, basic public health service funding, and contracted residents themselves; local governments with sufficient fiscal capacity may provide appropriate support. By 2016, the coverage rate of family doctor contract services was to reach over 15%, with the coverage rate for key populations exceeding 30%; by 2017, the overall coverage rate was to reach approximately 30%, and the coverage rate for key populations was to reach around 60%.
Furthermore, the system of triage and differentiated treatment for acute and chronic conditions must be implemented. Patients with acute and critical illnesses may seek care directly at hospitals of Level II or higher, while the diagnosis, treatment, rehabilitation, and management needs of patients with chronic diseases, including tuberculosis, shall be addressed through division of labor and collaboration between primary healthcare institutions and general hospitals.
The plan proposes the implementation of a special post program for specialized disciplines in county-level public hospitals. Special posts will be established in critical care medicine, emergency medicine, obstetrics and gynecology, pediatrics, surgery, medical imaging, and pathological diagnosis, among others. The initiative aims to recruit outstanding professionals who hold senior professional technical titles, possess extensive frontline clinical experience, demonstrate proficiency in diagnosing and treating diseases within their respective specialties, and can drive the development of these disciplines, to work in county-level public hospitals.
Notably, the plan proposes to streamline the approval process for individual medical practice and encourage qualified physicians and nurses to establish private clinics and nursing stations at the grassroots level.
To cultivate general practitioners through multiple channels, the plan proposes implementing programs such as job-transfer training, standardized residency training, targeted directed training for rural health personnel, and on-the-job training for practicing physicians. By 2020, the goal is to achieve a ratio of more than three general practitioners per 10,000 permanent residents.
The plan also proposes that, provided capabilities are in place and safety is ensured, restrictions on the clinical application of medical technologies in county-level public hospitals should be appropriately relaxed. By 2016, at least one hospital in each county (or county-level city) should meet the standards for a Grade II Class A hospital. By 2017, the proportion of patients treated within their home counties should rise to approximately 90%, with primary healthcare institutions accounting for more than 65% of total patient visits, thereby basically achieving the goal that patients with serious illnesses can receive treatment without leaving their counties.
Guangdong will also implement the final phase of standardized construction for township health centers and a project to enhance community health services. By the end of 2017, all township health centers in the eastern, western, and northern regions of Guangdong will meet the upper limits of national construction standards. By the end of 2018, full compliance with standards will be achieved across all township health centers and community health service institutions in these regions.
Medical Insurance Regulation: Deductibles for Referred Hospitalizations Can Be Calculated Continuously
To ensure the smooth implementation of tiered diagnosis and treatment, the plan proposes advancing reforms in medical insurance payment methods, strengthening budgetary management of medical insurance fund revenues and expenditures, and comprehensively implementing global budgeting for basic medical insurance payments. A composite payment system shall be adopted, including capitation for outpatient pooling, diagnosis-related group (DRG) or disease-specific payment for inpatient care and designated outpatient conditions, and payment by service unit.
Furthermore, appropriately increase the medical insurance reimbursement rates for primary healthcare institutions, and allow the cumulative deductible to be calculated continuously for referred inpatients who meet regulatory requirements. Include eligible primary healthcare institutions and chronic disease management facilities within the designated network of basic medical insurance in accordance with relevant regulations.
The plan also proposes the rational formulation and adjustment of medical service prices, reducing the costs of drugs and medical consumables as well as the prices for examinations and treatments using large-scale medical equipment. It further calls for a reasonable increase in the prices of services that reflect the labor value of healthcare professionals, including diagnosis and treatment, surgery, traditional Chinese medicine (TCM), rehabilitation, and nursing care. Additionally, it aims to promote the implementation of diversified payment models in public hospitals, such as diagnosis-related group (DRG) payments and per-service-unit charging.
Appendix: 2017 Guangdong Province Assessment and Evaluation Criteria for Tiered Diagnosis and Treatment
2017 Assessment and Evaluation Criteria for Tiered Diagnosis and Treatment in Guangdong Province
1. The compliance rate for the development of primary healthcare institutions shall be ≥95%, and the proportion of visits to primary healthcare institutions out of total medical visits shall be ≥65%.
2. Each county (city) with a population of 300,000 shall have at least one Grade II Class A general hospital, one Grade II Class A traditional Chinese medicine hospital, and one maternal and child health service institution. The inpatient treatment rate within the county should reach approximately 90%, basically achieving the goal that patients with serious illnesses do not need to seek treatment outside the county. County-level hospitals with surplus medical resources are encouraged to transform into institutions focused on rehabilitation and nursing care.
3. There shall be at least two general practitioners per 10,000 urban residents, and each township health center shall have at least one general practitioner. The coverage rate of family doctor contract services shall exceed 30%, and the coverage rate for key populations shall exceed 60%.
4. The proportion of residents who choose primary healthcare institutions as their first choice for illness within a two-week period shall be ≥70%.
5. Complete the software development, hardware procurement, and system deployment for the telemedicine platform, covering more than 50% of counties (cities, districts).
6. In conjunction with the national health informatization construction project, establish a hierarchical diagnosis and treatment management information system that basically covers all secondary and tertiary hospitals and more than 80% of township health centers and community health service centers.
7. The annual growth rate of patient referrals from tertiary and secondary hospitals to chronic disease care institutions (such as rehabilitation and nursing facilities) and primary healthcare institutions shall exceed 10%.
8. All county-level hospitals and tertiary hospitals, as well as all community health service centers, township health centers, and secondary and tertiary hospitals, shall establish stable technical assistance and division-of-labor collaboration relationships.
9. The rate of standardized diagnosis, treatment, and management for urban patients with hypertension and diabetes shall reach over 40%.
10. The proportion of township health centers, community health service centers, village clinics, and other similar institutions providing traditional Chinese medicine (TCM) services reached 98%, 95%, 91%, and 85%, respectively. TCM consultations accounted for ≥30% of the total number of consultations at primary healthcare institutions.