On August 9th, the Office of the Leading Group for Deepening the Reform of the Medical and Health System in Shanghai issued a notice entitled "Work Plan for Promoting the Experience of Fujian Sanming and Deepening the Reform of the Medical and Health System in Shanghai according to Local Conditions", which requires in-depth learning and full reference to the experience of Sanming's medical reform, deepening the reform of medical treatment, medical insurance, and pharmaceutical linkage, consolidating and improving the effectiveness of the comprehensive medical reform in this city, and accelerating the high-quality development of the health industry.

　　At the same time, the implementation of reform measures related to promoting the Sanming experience should be an important part of the assessment by the district government. Encourage and support non public medical institutions to complement and develop together with public medical institutions.

　　Attachment: Work Plan for Promoting the Experience of Fujian Sanming and Deepening the Reform of Shanghai's Medical and Health System Based on Local Conditions

1、 Establish a sound leadership system and work promotion mechanism for healthcare reform

　　1. Strengthen organizational leadership. Seriously study the reform spirit of Sanming, which adheres to the principle of putting the people first and daring to be the first, and truly focus on practical work and hard work. Further improve the efficient and effective leadership system for healthcare reform, with district chiefs serving as the leaders of healthcare reform leadership groups in each district, providing solid organizational support for deepening healthcare reform and promoting the experience of Sanming healthcare reform. The executive meeting of the district government, the standing committee of the district committee, and the meeting of the Shenzhen Reform Commission shall conduct at least one special study on medical reform work every year. Establish a database of medical reform research experts in this city to provide decision-making support for deepening medical reform work. (Leading department: Office of the Leading Group for Deepening Medical Reform in the City; cooperating department: People's governments of each district and member units of the Leading Group for Deepening Medical Reform in the City)

　　2. Implement government responsibilities. Strictly implement the government's leadership, guarantee, management, and supervision responsibilities for healthcare reform work. Implement government health investment policies in accordance with regulations, further improve the financial investment mechanism, focus on implementing the "20 Public Health Measures" and the construction of the public health system, promoting high-quality development of public hospitals, expanding and balancing high-quality medical resources, and digital transformation of "convenient medical services". Strengthen financial investment guarantees and improve the performance of fund utilization. Organize the annual assessment of medical reform work, and regard the implementation of reform measures related to the promotion of the Sanming experience as an important content of the district government's assessment. Encourage and support non public medical institutions to complement and develop together with public medical institutions. (Leading departments: Municipal Finance Bureau, Municipal Development and Reform Commission, Municipal Health Commission; cooperating departments: People's governments of each district, etc.)

2、 Continuously promoting the reform of bidding and procurement of pharmaceutical consumables

　　3. Deepen centralized and quantity based procurement of pharmaceutical consumables. Further fulfill the responsibilities of national drug procurement and promote the normalization and institutionalization of national drug procurement. Gradually expand the scope of procurement, striving to purchase more than 300 generic drugs by the end of 2022, and more than 500 drugs by the end of the 14th Five Year Plan period. Carry out the implementation of the results of the national centralized procurement of pharmaceutical consumables, implement the policy of retaining surplus medical insurance funds, and encourage medical institutions to use selected products reasonably and preferentially. Improve the mechanism for continuing procurement work after the expiration of the national drug procurement agreement. Research and carry out local volume based procurement for pharmaceutical consumables with large quantities and high procurement amounts that have not yet been included in national centralized procurement and local volume based procurement. Establish a sound pricing and procurement credit evaluation system for pharmaceuticals. Strengthen the quality supervision of the entire production, circulation, and use cycle of the winning varieties in centralized procurement, improve the procurement and inventory management of medical institutions, and adapt to the requirements of centralized quantity based procurement. (Leading department: Municipal Medical Insurance Bureau; cooperating departments: Municipal Health Commission, Municipal Drug Administration, Municipal Finance Bureau, etc.)

　　4. Explore normalized centralized negotiated procurement of drugs. Encourage and support public medical institutions to form medical consortia or voluntarily form procurement alliances, relying on the pharmaceutical procurement sunshine platform, to carry out centralized bargaining procurement for drugs that are not included in centralized volume procurement, and improve the scale effect of online bargaining. Strengthen supervision and guidance on centralized bargaining procurement to ensure standardized operations. Refine the incentive and constraint measures for centralized bargaining procurement of drugs, and implement the policy of retaining surplus medical insurance funds. (Leading departments: Municipal Medical Insurance Bureau, Municipal Health Commission; cooperating departments: People's governments of each district, Municipal Finance Bureau, Shenkang Hospital Development Center, etc.)

3、 Building an integrated medical and health service system

　　5. Strengthen the deep integration and efficient collaboration of medical and preventive measures. Continuously improving the public health emergency management system that conforms to the characteristics of mega cities, promoting the establishment of public health departments in public hospitals, and enhancing early monitoring and early warning, rapid detection, emergency response, and comprehensive treatment capabilities. Promote the construction of emergency medical treatment system at different levels and regions, enhance the comprehensive diagnosis and treatment capabilities of infection departments in municipal comprehensive hospitals and regional medical centers, and enhance the treatment capabilities of complex and severe patients. Promote the construction of national TCM epidemic prevention and control bases and national TCM emergency medical rescue bases, and enhance the capacity of TCM treatment for infectious diseases. Implement the reform deployment of the national disease prevention and control system, build a digital and intelligent disease prevention and control system, and achieve hardware facility upgrading and level enhancement. Promote the three-year action plan for the fifth round of public health system construction, improve the comprehensive public health service mechanism with clear responsibilities, orderly connection, integration of medical and preventive measures, equal emphasis on traditional Chinese and Western medicine, and strong guarantee, and initiate the preparation and implementation of the sixth round of three-year action plan. (Leading department: Municipal Health Commission; cooperating department: member units of the municipal leading group for the prevention and control of COVID-19, municipal party committee, municipal finance bureau, district people's governments, etc.)

　　6. Accelerate the expansion and balanced layout of high-quality resources. Implement the 14th Five Year Plan for Health Development and the Plan for Setting up Medical Institutions (2021-2025), optimize the overall structure of the city's medical and health service system, and position the functions of various levels and types of institutions. Create a number of national medical centers and regional medical centers (including traditional Chinese medicine), and create high-level medical research peaks, achievement transformation highlands, talent training bases, and data collection platforms. Promote the expansion and sinking of high-quality medical resources at the municipal level to five new cities and suburban areas such as Jinshan and Chongming. Based on the serving population and radius, strengthen the construction of professional public health institutions in the new city, and improve the establishment of grassroots medical and health institutions. Persist in improving levels, enhancing functions, and addressing shortcomings, and continuously enhance the comprehensive service capabilities of regional medical centers. Deepen the integration reform of four new suburban hospitals and parent hospitals, and improve the multi hospital management of tertiary hospitals. (Leading department: Municipal Health Commission; cooperating departments: People's governments of various districts, Municipal Development and Reform Commission, Municipal Medical Insurance Bureau, Municipal Finance Bureau, Development Center of Shenkang Hospital, etc.)

　　7. Deepen the construction of a hierarchical diagnosis and treatment pattern. Promote the construction of medical consortia mainly in the form of regional medical consortia and specialized medical consortia, further improve the grid layout of medical consortia, achieve full coverage of regional, traditional Chinese and Western medicine, and specialized diseases, and encourage social medical institutions to join medical consortia. Deepen the construction of close medical consortia such as Xinhua Chongming, City One Jiading, and City Six Lingang, as well as the regional medical consortia in Jinshan District, strengthen the overall management and intensive use of personnel, finance, materials, and information among the member units of the medical consortia, and simultaneously improve service capabilities. Continuously promoting the "1+1+1" combination signing, expanding the channels for family doctor signing, and combining with the pilot work of "functional community" community health services, the signing services will cover more working and school groups, further promoting the sinking of medical treatment. Implement a new round of functional construction standards for community health service institutions, create community health management centers, rehabilitation centers, and nursing centers, and gradually improve the visit rate of grassroots medical and health institutions. (Leading department: Municipal Health Commission; cooperating department: People's governments of each district, Municipal Medical Insurance Bureau, Shenkang Hospital Development Center, etc.)

4、 Strengthen the reform and management of public hospitals

　　8. Promote the high-quality development of public hospitals. Implement the implementation plan for high-quality development of public hospitals in this city, strengthen innovation in the public hospital system, technology, model, and management, promote the development mode of public hospitals from scale expansion to quality and efficiency improvement, shift the operation mode from extensive to refined management, and shift the focus of resource allocation from material elements to more emphasis on talent and technology. Efforts will be made to strengthen support for high-level hospitals, represented by Zhongshan Hospital affiliated with Fudan University and Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine, as national pilot hospitals for high-quality development. Public medical institutions with strong reform awareness, strong innovation momentum, solid disciplinary foundation, and large room for improvement will be selected as pilot units. Efforts will be made to accelerate the exploration of scientific models and effective paths for high-quality development, fully play a leading and driving role, and create the "Shanghai Plan" for high-quality development of public hospitals. (Leading department: Municipal Health Commission; cooperating departments: People's governments of each district, Municipal Medical Insurance Bureau, Municipal Finance Bureau, Shenkang Hospital Development Center, etc.)

　　9. Strengthen reasonable cost control in public hospitals. Establish and improve a reasonable control mechanism for medical expenses in public hospitals that is coordinated with economic and social development, and adapted to the affordability of all parties. Taking into account factors such as historical changes in medical expenses, medical service needs, functional positioning and diagnosis and treatment characteristics of public hospitals at all levels and types, medical technology development, price changes, and socio-economic development level, set reasonable cost control goals. Deepen the mutual recognition of inspection results among medical institutions. Strengthen the monitoring of the increase in medical services, drugs, inspection and testing costs, and include the control of medical expenses in the assessment indicators of public hospital deans. Improve the supervision and evaluation mechanism of public hospitals based on big data, establish a multi-dimensional disease combination evaluation index system, focus on relevant indicators such as medical expenses, strengthen dynamic monitoring and evaluation, and explore the application of evaluation results to the allocation of central transfer payment subsidies, the comprehensive reform of public hospitals, and local recommendations with significant practical results. (Leading department: Municipal Health Commission; cooperating departments: People's governments of each district, Municipal Medical Insurance Bureau, Municipal Finance Bureau, Shenkang Hospital Development Center, etc.)

　　10. Improve the quality of medical services. Strengthen clinical pathway management in public hospitals, increase the proportion of disease types and patients under pathway management, and achieve reasonable treatment. Strengthen hospital infection management. Promote the application of information-based prescription review and evaluation systems, and standardize clinical medication. Explore the establishment of an intelligent disease quality control management platform, which can monitor the quality data of individual diseases in real-time, intervene and evaluate in a timely manner, promote cost control, optimize disease structure, and continuously improve medical quality. Innovate medical service models, promote multidisciplinary diagnosis and treatment (MDT), painless diagnosis and treatment, holistic nursing, daytime management, and accelerated rehabilitation surgery. Consolidate and improve the effectiveness of the digital transformation of "convenient medical services" in version 1.0, accelerate the construction of application scenarios in version 2.0, and further enhance the patient's medical experience. According to national requirements, build and apply a nationwide unified medical insurance information platform. (Leading departments: Municipal Health Commission and Municipal Medical Insurance Bureau; cooperating departments: People's Government of each district, Municipal Economic and Information Commission, Shenkang Hospital Development Center, Municipal Big Data Center, etc.)

　　11. Deepen the reform of personnel and salary system. Reasonably establish staffing standards for public hospitals and establish a dynamic increase mechanism. Explore the establishment of a management system for controlling the number of personnel in public hospital staffing, strengthen the overall planning of healthcare sector staffing resources, and ensure the strength of basic medical and public health work. Focusing on the orderly expansion and balanced layout of high-quality medical resources, supporting the construction of high-level hospitals with multiple districts and medical consortia, and ensuring the staffing of new hospitals in five new cities and other regions. Combining with the acceleration of Shanghai's construction of a high-level talent highland, exploring innovative guarantee channels, and supporting the development and talent introduction of some hospitals under the National Health Commission in Shanghai. Improve the standardized training system for resident physicians and specialist physicians, expand the training scale of the "5+3+X" project, and strengthen the cultivation of composite talents in public health and clinical medicine, as well as various scarce medical talents. Implement the autonomy of personnel selection in public hospitals, and independently determine the total number of positions and job standards in accordance with regulations. Implement the spirit of the relevant documents on the reform of the national health professional and technical personnel title system, further optimize the evaluation system for senior health titles in this city, and strengthen clinical practice evaluation. Introduce evaluation methods for professional and technical titles of healthcare professionals. Promote the implementation of the plan to deepen the reform of the salary system in public hospitals in this city, and implement the requirements of "two allowances". (Leading departments: Municipal Party Committee Compilation Office, Municipal Human Resources and Social Security Bureau; Cooperating departments: People's governments of various districts, Municipal Health Commission, Municipal Finance Bureau, Shenkang Hospital Development Center, etc.)

5、 Deepen the reform of medical service prices

　　12. Improve the mechanism for adjusting medical service prices. Promote the implementation of relevant documents on the dynamic adjustment mechanism of medical service prices in this city, and improve the mechanism for price formation and dynamic adjustment. According to the principle of "total quantity control, structural adjustment, some increases and some decreases, and gradual implementation", price adjustments will be implemented steadily and orderly, and the price structure of medical services will be continuously optimized, the price comparison relationship will be clarified, and efforts will be made to reflect the technical and labor value of medical personnel. Explore the establishment of a multi-level health management service fee mechanism. Improve the management system for special medical services, explore relaxing restrictions on special medical services for public hospitals participating in pilot projects according to regulations, and implement market adjusted prices. Research and establish a comprehensive evaluation index system for medical service price adjustment, and timely carry out price adjustment evaluation work. Comprehensively promote the compilation of pharmaceutical price indices. (Leading department: Municipal Medical Insurance Bureau; cooperating departments: Municipal Health Commission, Municipal Development and Reform Commission, Municipal Finance Bureau, Shenkang Hospital Development Center, etc.)

　　13. Optimize the management of medical service pricing projects. Improve the management mechanism for the trial period of new projects, strengthen cost and price monitoring of medical service projects, and regularly evaluate the effectiveness of new project implementation. Adjust and optimize the application and review process for new projects, accelerate the progress of acceptance and review, and promote the innovative development and clinical application of medical technology. We will study and formulate charging policies for medical services such as Internet services. According to the bearing capacity of the medical insurance fund and following procedures such as expert evaluation, timely inclusion of medical service price items that meet regulations into the scope of medical insurance payment. (Leading department: Municipal Medical Insurance Bureau; cooperating departments: Municipal Health Commission, Shenkang Hospital Development Center, etc.)

6、 Strengthen refined management of medical insurance

　　14. Improve the multi-level medical security system. We will steadily promote the reform of individual accounts for basic medical insurance for employees, and improve the outpatient mutual assistance guarantee mechanism. Strengthen policy guidance for the "co insurance system" and ensure the participation and claims of the new version of "Shanghai Huibao". Improve the mechanism for ensuring medical treatment costs for major epidemics. Ensure an orderly connection between basic medical insurance, major illness insurance, and medical assistance policies for the beneficiaries. Promote the integrated development of medical insurance in the Yangtze River Delta, promote the convenient practices of public services for medical insurance in demonstration areas, and promote the unification of drug catalogs, diagnosis and treatment projects, and medical service facility catalogs in the Yangtze River Delta. (Leading department: Municipal Medical Insurance Bureau; cooperating departments: Municipal Health Commission, Municipal Civil Affairs Bureau, Municipal Development and Reform Commission, Shanghai Banking and Insurance Regulatory Bureau, etc.)

　　15. Deepen the reform of medical insurance payment methods. Promote a diversified and composite medical insurance payment method under the framework of total budget management, gradually reduce the proportion of medical insurance fund payment by project, and increase the proportion of payment methods such as DRG, DIP, bed day payment, and head payment. By 2025, the proportion of DRG/DIP medical insurance fund expenditures to all eligible inpatient medical insurance fund expenditures will reach 70%. Continuously deepen the national pilot program for DRG/DIP, improve policy frameworks, work mechanisms, and settlement methods, establish reasonable and moderate incentive and constraint mechanisms, and enhance the efficiency of using medical insurance funds. Deepen the pilot program of pay per head, optimize the performance evaluation index system, and actively and steadily expand the pilot scope in conjunction with the construction of a close medical consortium. Continuously carry out performance-based payment methods that link medical insurance payments to medical quality and other performance indicators for diagnosis and treatment projects. Improve the budget management mechanism for the total amount of medical insurance in the tight medical consortium, and ensure the retention of surplus and reasonable sharing of overspending. Solidly promote the pilot program of paying by disease for advantageous diseases in traditional Chinese medicine, and improve the mechanism of paying by bed for medical rehabilitation services. (Leading department: Municipal Medical Insurance Bureau; cooperating departments: People's governments of each district, Municipal Health Commission, Shenkang Hospital Development Center, etc.)

7、 Ensure effective organization and implementation

　　16. Strengthen monitoring and supervision. According to the requirements of documents such as the Notice on Deepening the Implementation Opinions of Deepening the Experience of Sanming City in Fujian Province and Deepening the Reform of the Medical and Health System (State Medical Reform Secretary Letter [2021] No. 67) issued by the Secretariat of the State Council Leading Group for Medical Reform, as well as the monitoring and evaluation index system for promoting the experience of Sanming medical reform, combined with the actual situation of this city, monitoring and evaluation of relevant work of various departments and districts will be carried out. All relevant departments should provide guidance to each district, provide necessary support for deepening reform and exploration, help solve existing problems, and promptly report and supervise the rectification of areas with lagging work. (Leading department: Office of the Leading Group for Deepening Medical Reform in the City; Supporting department: All member units of the Leading Group for Deepening Medical Reform in the City, and the people's governments of each district, etc.)

　　17. Strengthen publicity and promotion. Efforts should be made to deepen medical reform, and pilot units for high-quality development in public hospitals should compare with the requirements of this implementation plan, combine practical experience, and boldly break through and innovate. Intensify the promotion of typical experiences in deepening medical reform among relevant departments and districts, timely summarize, exchange, and promote good experiences and practices, and create a good social atmosphere for the implementation of medical reform measures. (Leading department: Office of the Leading Group for Deepening Medical Reform in the City; Supporting department: All member units of the Leading Group for Deepening Medical Reform in the City, and the people's governments of each district, etc.)