context: Seven years since healthcare reforms were first piloted in Sanming, Fujian, many measures are going national, implementing the tasks announced for 2019, but this time clear timelines are set out.
State Council Leading Group on Deepening Healthcare Reform issued ‘Announcement on further promoting the Fujian Model and Sanming Model of healthcare reform’. Main experience to draw on includes
- strong leadership and clear division of departmental responsibilities
- synergised reform in the pharmaceutical industry, care delivery institutions and health insurance
- performance-based incentive scheme
- strong supervision
- reforming payment methods
- enhancing grassroots institutions
Key tasks and timeline are specified
- strengthening leadership
- naming a leader for healthcare reform
- local authorities should draw up implementation plans before end 2019
- allocating funding
- reforming procurement schemes
- implementing centralised drug procurement before end 2019 and expanding scope of procurement in 2020
- implementing provincial drug procurement for drugs not included in centralised procurement
- implementing centralised procurement of high value medical devices
- stricter hospital performance evaluation and supervision on use of consumables
- tertiary public hospitals should be evaluated by Nov 2019, evaluations of secondary hospitals and below should start in 2020
- rolling out regulations on medical consumables in 2020
- drawing up provincial lists of drugs under strict monitoring and setting up monitoring mechanisms by end 2020
- enhancing management of drug lists to prevent over-prescription
- increasing public hospital income from medical services
- improving medical service pricing mechanism
- reforming public hospital operation and wage systems
- establishing tracking system on medical service prices in 2020
- annual evaluations on possibilities of increasing medical service prices from 2020 to 2022
- innovating practitioner wage scales
- detaching employee income from pharmaceuticals, medical devices and examination programs by Feb 2020
- allowing public hospital employees higher wages than employees in service agencies
- allowing income from medical services to be rewarded to hospital employees
- monitoring proportion of wages in total costs
- promoting targeted management of insurance funds
- promoting DRG-based payment reform
- adjusting payment standards of global budget and DRG-based payment
- exploring province-level coordination of medical insurance to improve efficiency
- establishing a stratified and integrated healthcare service system
- piloting close-form medical alliances and county-level medical alliances
- encouraging global budget payment in close-form medical alliances
- promoting ICT and family doctors
- enhancing implementation of rural doctor subsidies in 2020
- strengthening and innovating traditional Chinese medicine (TCM), achieving full coverage of TCM clinics at county level by 2022