I. Work objectives
By 2022, the proportion of rehabilitation nursing beds in primary health care institutions will be increased, and the proportion of rehabilitation nursing beds in primary health care institutions will reach 30%; More than 80% of general hospitals, rehabilitation hospitals, nursing homes and primary medical institutions have become elderly-friendly medical institutions. Every township (street) has a demonstration home care service center, which has both day care and full-time care services; Promote the three-year upgrading and renovation project of nursing homes in the city, and complete the aging transformation of elderly families with difficulties in stock; The ratio of community social workers to the elderly reached 1∶500, and the ratio of senior nurses and technicians reached 15%.
By 2025, there will be/kloc-0 hospitals with outstanding geriatric characteristics, and the proportion of geriatrics departments in general hospitals and traditional Chinese medicine hospitals with secondary or above in the city will reach over 85%, and every 10,000 elderly people will have 55 beds for rehabilitation nursing in medical institutions. There are 1 hospice guidance centers (training bases) at the municipal level, and at least 1 hospice wards should be built in each county (city, district). More than 20% township hospitals (community health service centers) provide hospice care services. By 2025, the proportion of nursing beds in old-age care institutions will reach 60%, and the number of nursing beds for cognitive impairment per 10,000 elderly people will reach 20. The ratio of community social workers to the elderly reached 1∶450, and the ratio of senior nurses and technicians reached 18%.
Second, the main task
(1) Strengthen the construction of institutions and facilities that combine medical care with nursing care.
1. Strengthen the construction of medical and nursing institutions. Encourage large or disabled old-age care institutions to set up medical institutions to provide basic medical care, chronic disease management, rehabilitation care and other services for the elderly, and encourage old-age care institutions with more idle beds to cooperate with medical institutions to carry out medical and nursing services. Support medical institutions to set up medical service stations in pension institutions according to laws and regulations, and use relevant resources to carry out rehabilitation care, long-term care, hospice care and medical care. We will comprehensively promote the construction of rehabilitation complexes, promote more medical rehabilitation resources to enter the field of aged care services, and form a rehabilitation service network covering urban and rural areas. Encourage all kinds of subjects to set up embedded medical and life care service institutions in the community. In 2025, 50 rehabilitation complexes of different levels will be established at the city, county and township levels, and rehabilitation rooms will be generally established in old-age care institutions with more than 100 beds. Optimize the bed structure of old-age care institutions. By 2025, the proportion of nursing beds in old-age care institutions will reach 60%, and every 10,000 elderly people will have 20 nursing beds for cognitive impairment. (The Civil Affairs Bureau and the Municipal Health and Health Commission are responsible for the division of responsibilities. The following work by the county (city, district) people's government is responsible for, not one by one)
2. Promote the construction of community home medical care facilities as a whole. Promote the overall planning and adjacent construction of community health service centers, township hospitals and pension service institutions. We will carry out actions to improve the ability of combining medical care with nursing care in communities, support qualified community health service institutions, township hospitals or home care service centers, and support service facilities (nursing homes) for destitute people to make use of existing resources, and internally transform and expand community (township) service facilities that combine medical care with nursing care, focusing on providing health education, preventive care, disease diagnosis and treatment, rehabilitation care and hospice care for the disabled, chronic diseases, disabled and other elderly people, taking into account daily life care. Newly-built community health service institutions in cities can build community medical and nursing service facilities internally. If a new "future community" is built, it is necessary to build medical and nursing service facilities. The old-age service area in the newly-built and expanded community medical and nursing service facilities shall be set in an independent building or building partition, and the partition management shall be strictly implemented. (Municipal Health and Wellness Commission, Municipal Development and Reform Commission, Civil Affairs Bureau, Municipal Finance Bureau, Municipal Resources Planning Bureau, Municipal Housing and Construction Bureau and Municipal Medical Insurance Bureau are responsible for the division of responsibilities)
3. Improve the service supply capacity of social forces. The government does not make planning restrictions on the regional total number of social medical and nursing institutions. In accordance with the principle of "entry without prohibition", it is not allowed to set up and comprehensively clean up and cancel unreasonable pre-approval items without legal and regulatory basis. Without the basis of laws and regulations, the business nature of social organizations that combine medical care with nursing care shall not be restricted. Support social forces to set up medical institutions through market-oriented operation. On the basis of "ensuring the basics and grasping the bottom line", we will continue to promote the effective supply of inclusive old-age care services. Support qualified social medical institutions and medical institutions to undertake local public health, basic medical care, basic old-age care, needs assessment, talent training and other services. (The Municipal Development and Reform Commission, the Civil Affairs Bureau, the Municipal Finance Bureau, the Municipal Resources Planning Bureau, the Municipal Health and Wellness Commission, the Municipal Taxation Bureau and the Municipal Market Supervision Bureau are responsible for the division of responsibilities)
(2) improve the ability of medical treatment, health care and integrated services.
1. Accelerate the development of geriatrics. Strengthen the construction of geriatrics according to the Guide to the Construction and Management of Geriatrics (Trial). In 2025, more than 85% of the second-level and above general hospitals and traditional Chinese medicine hospitals in the city will offer geriatrics, cultivate 1 tertiary hospitals with outstanding geriatrics, promote the construction of geriatrics centers at city and county levels, and give full play to the center's contribution to the discipline construction, personnel training, business guidance and quality management of geriatrics in regional medical institutions. In 2025, municipal hospice guidance centers (training bases) will be established, and at least 1 hospice wards will be built in each county (city, district), and more than 20% of township hospitals (community health service centers) will provide hospice care services. Guide first-and second-class hospitals and specialized hospitals to make rational use of idle medical resources in structural and functional adjustment, create conditions to carry out pension, nursing and rehabilitation services, and strengthen the construction of continuous medical institutions such as nursing homes and rehabilitation hospitals. Actively explore the assessment of nursing needs of the elderly and provide targeted medical and nursing services for the elderly. Vigorously develop traditional Chinese medicine health care services for the elderly, strengthen health management and comprehensive prevention and control of chronic diseases, and fully implement the policy of free medication for outpatients with chronic diseases such as essential hypertension and type 2 diabetes over 65 years old. (The Municipal Health and Wellness Commission, the Municipal Finance Bureau and the Municipal Medical Insurance Bureau are responsible for the division of responsibilities)
2. Support the development of home medical services for the elderly. Implement the spirit of the Notice on Strengthening Home Medical Services for the Elderly (Guo Wei Ban [2020] No.24), support qualified medical and health institutions and institutions with the ability of combining medical care with nursing care, set up home beds for the elderly with mobility difficulties, as well as elderly patients with chronic diseases, convalescence or terminal diseases and elderly people who still need medical services after discharge, and provide on-site services. Establish the contents, standards and norms of on-site medical and health services, and reasonably formulate the fees for outpatient service and family sickbed inspection. Establish and improve the security mechanism and appropriately improve the treatment level of door-to-door service personnel. Institutions providing on-site services shall be insured with medical liability insurance, personal accident insurance, etc. , to prevent and deal with business risks and personal safety risks. (The Municipal Health and Wellness Commission, the Municipal Finance Bureau, the Civil Affairs Bureau and the Municipal Medical Insurance Bureau are responsible for the division of responsibilities)
3. Promote the sharing of medical resources between urban and rural areas. We will deepen the service of sending doctors to help raise children in remote mountainous areas, allocate "mobile medical vehicles", and rely on county-level medical institutions to continue to carry out mobile medical services such as sending medicines, physical examination, follow-up of chronic diseases, and family rounds. The county-level medical institutions lead hospitals to promote the construction of geriatric medical care and rehabilitation, nursing teams and special departments in member units through measures such as selecting backbone and strengthening training, so as to enhance the ability of family doctors to sign contracts and combine medical care with nursing. We will do a solid job in basic public health services, implement a service project that combines health care with medical care for the elderly, and promote disease prevention and early intervention such as free screening for colorectal cancer and chronic obstructive pulmonary disease and free influenza vaccination. Township hospitals (community health service centers) actively set up beds for rehabilitation, nursing, long-term care and hospice care. By 2022, the proportion of nursing beds in primary health care institutions will reach 30%. (The Municipal Health and Wellness Commission, the Municipal Finance Bureau and the Municipal Medical Insurance Bureau are responsible for the division of responsibilities)
4. Improve information security capabilities. Accelerate the construction of network hospitals and telemedicine services, establish communication between urban hospitals and county-level medical institutions and primary medical and health institutions, and extend the service network to villages (communities) and medical and nursing institutions to provide remote diagnosis and treatment services for elderly people and other patients with mobility difficulties. Promote the standardization of telemedicine services in the second batch of pilot institutions in China, such as Longyou Longzhou Hospital and Jiangshan Zhuangyuanli Nursing Hospital. Relying on "Internet+medical health" to create "nail family medical service", the community, family doctors and contracted residents are organized through nail organizational structure to match, so that family doctors can provide accurate and accessible health services for residents. Develop "internet plus nursing service" to promote the combination of online service and offline service. Promote the development of smart and healthy pension industry, promote the popularization and application of high-quality products and services, and provide services such as remote real-time care, real-time positioning, health monitoring and emergency rescue calls for the elderly. Explore the real-time monitoring of the basic health status of key groups such as the elderly, the elderly living alone, the disabled or some disabled people through wearable devices and portable and self-service health testing equipment. (The Municipal Health and Wellness Commission, the Municipal Economic and Information Bureau, the Civil Affairs Bureau, the Municipal Medical Insurance Bureau and the Municipal Big Data Bureau are responsible for the division of responsibilities)
(3) Promote the standardized and orderly development of the combination of medical care and nursing.
1. Simplify the examination, approval and registration of institutions combining medical care with nursing care. Implement the spirit of the Notice of the National Health and Wellness Commission and other ministries on Doing a Good Job in the Examination and Registration of Institutions Combining Medical Care with Nursing Care (No.Lao Nianfa [2065 438+09] 17 of the State Council), optimize the examination and approval process of institutions combining medical care with nursing care, establish a joint handling mechanism and operation process with the health, civil affairs or market supervision and management departments at the same level, and incorporate matters into the "non-discriminatory acceptance" window of the administrative service center to achieve "front-loading" Medical and health institutions use existing resources to provide old-age services, involving construction, fire protection, food safety, health and epidemic prevention and other related conditions, according to the above-mentioned corresponding qualifications that medical and health institutions already have, without affecting safety, simplify procedures and directly register for the record. Will meet the conditions of the combination of medical care institutions into the scope of the basic medical insurance, the official operation of 3 months after the designated application can be made, the completion time of the designated review is not more than 20 working days. (Municipal Health and Wellness Commission, Civil Affairs Bureau, Municipal Housing and Construction Bureau, Municipal Emergency Management Bureau, Municipal Market Supervision Bureau and Municipal Medical Insurance Bureau are responsible for the division of responsibilities)
2. Deepen medical contract cooperation. According to the Notice of the Provincial Health and Health Commission, the Provincial Civil Affairs Department and the Provincial Administration of Traditional Chinese Medicine on Further Strengthening the Signing Cooperation between Medical and Health Institutions and Aged Care Institutions (Zhejiang Weifa [2022]1No.), the aged care institutions without medical institutions or with weak medical and health services are encouraged to sign contracts and cooperate with neighboring medical and health institutions in various forms, and the cooperation between institutions such as home-based aged care centers and home-based aged care centers and medical and health institutions is deepened. Both parties shall sign an agreement to clarify the contents, methods, expenses and responsibilities of cooperation. Old-age care institutions can also provide medical and health services for the elderly through service outsourcing and entrusted operation. Conditional medical institutions for the aged can establish a two-way referral mechanism with contracted medical and health institutions. By 2022, all pension institutions can provide standardized medical and health services for the elderly in different forms. (The Municipal Health and Wellness Commission, the Civil Affairs Bureau and the Municipal Finance Bureau are responsible for the division of responsibilities)
3 to strengthen the supervision of the combination of medical and nursing institutions. Health, civil affairs, medical insurance and other departments should strengthen coordination and cooperation, according to their respective responsibilities, increase the industry supervision of the combination of medical care and nursing institutions, carry out actions to improve the service quality of the combination of medical care and nursing institutions, improve the standardization and institutionalization of the combination of medical care and nursing, and ensure the quality and safety of services. The combination of medical and nursing institutions should implement the main responsibility, establish and improve various management systems and post responsibilities of personnel, strictly implement policies, standards and norms related to medical and health care and old-age services, promote standardized management of fire safety, and implement fire safety responsibilities and various safety systems; According to "Guidelines for Prevention and Control of Infection in Institutions Combining Medical Care with Nursing Care in Zhejiang Province", we should do a good job in the prevention and control of infectious diseases such as COVID-19, implement normalized prevention and control measures, strengthen staff's emergency knowledge training and publicity of elderly protection knowledge, and enhance emergency support capabilities. Clarify the payment boundary between medical and health services and old-age services. Medical institutions should strictly follow the norms of diagnosis and treatment. The basic medical insurance fund can only be used to pay for medical services such as diagnosis and treatment of diseases, medical care and medical rehabilitation that meet the scope of basic medical security, and shall not be used for life care and other old-age services. (The Municipal Health and Wellness Commission, the Civil Affairs Bureau, the Municipal Emergency Management Bureau, the Municipal Market Supervision Bureau, the Municipal Medical Insurance Bureau and the Municipal Fire Rescue Detachment are responsible for the division of responsibilities)
(4) promoting the construction of talent team.
1. Strengthen the construction of medical and health personnel. Strengthen the combination of medical care and related professional training, support and guide Quzhou Vocational and Technical College, Quzhou Nursing School, Quzhou Technical Secondary School and other qualified schools to offer geriatric medicine, rehabilitation, nursing, hospice care, geriatric nursing and other majors, and cultivate geriatric medicine and geriatric nursing staff. By 2025, there will be no less than 5,000 nursing staff for the aged and no less than 20,000 nursing staff at home. Construction of geriatrics, hospice care, medical care and rehabilitation guidance centers, skills training bases, etc. And give appropriate financial subsidies at all levels. Vigorously carry out the vocational skills training of employees in the combination of medical care and nursing care, identify the vocational skills level of the old-age care institutions in the combination of medical care and nursing care, and encourage the old-age care institutions in the combination of medical care and nursing care to give priority to recruiting qualified skilled personnel such as nurses and nursing workers. Expand the ranks of social workers and volunteers who serve the elderly, and increase support for volunteer service projects and non-profit organizations. (The Municipal Education Bureau, the Civil Affairs Bureau, the Municipal Human Resources and Social Security Bureau and the Municipal Health and Wellness Commission are responsible for the division of responsibilities)
2. Support medical staff to engage in the combination of medical care and nursing services. The medical staff of the combination of medical and nursing institutions and the medical staff of medical and health institutions enjoy the same professional title evaluation and employment, continuing education for professional and technical personnel, etc. If the combination of medical and nursing institutions has no conditions to provide continuing education and training for medical personnel, the administrative department of health shall make overall arrangements for centralized training. Implement the filing system of doctors' multi-point practice institutions, and support medical personnel to practice in institutions that combine medical care with nursing. Encourage retired medical personnel to participate in the combination of medical care and nursing services, and bring eligible retired rehired personnel into the overall management of the industrial injury insurance system. (The Municipal Human Resources and Social Security Bureau, the Civil Affairs Bureau and the Municipal Health and Health Commission are responsible according to the division of responsibilities)
(5) Strengthen policy support and guarantee.
1. Improve the medical insurance support policy. Reasonably set up the standard and method of medical insurance expense settlement in line with the characteristics of the elderly, carry out the research on the group paying by bed for hospice patients, promote multiple medical insurance payment methods such as grouping by disease diagnosis (DRG) and paying by bed, and gradually raise the standard of paying by bed. Implement a long-term prescription system for chronic diseases in the elderly. Relevant diagnosis, treatment and rehabilitation projects that meet the basic needs of the elderly will be gradually included in the scope of basic medical insurance payment according to regulations, and a dynamic adjustment mechanism will be established. We will continue to promote accident insurance for the elderly and support commercial insurance institutions to vigorously develop insurance products suitable for the elderly. (The Municipal Medical Insurance Bureau and the Municipal Health and Health Commission are responsible for the division of responsibilities)
2. Improve the investment guarantee mechanism. Implement the financial investment policy of medical and health institutions and support the improvement of the service capacity of combining medical care with nursing care. Give full play to the synergy between public health and basic medical insurance, and eligible grassroots medical and health institutions will carry out basic public health services such as health management of the elderly and service management of combining medical care with nursing care, and the government will purchase services according to regulations; Eligible primary medical and health institutions carry out the combination of medical care and nursing services within the scope of basic medical insurance payment. In principle, medical service fees are compensated, and where conditions permit, insufficient cost compensation can be incorporated into standardization work to implement equivalent purchase services. Governments at all levels arrange special funds for the development of the combination of medical care and nursing care, support the standardization of geriatric medicine, and give certain subsidies to geriatric medical centers (training bases) and hospice care guidance centers (training bases). Give a one-time construction subsidy to the standardized geriatric medical institutions that were built and put into operation before 2025. For hospice wards (rooms) built and put into operation before 2025, a one-time construction subsidy will be given according to the number of beds. The lottery public welfare funds used by governments at all levels for social welfare undertakings shall increase their support for medical and health institutions and pension institutions to carry out the service of combining medical care with nursing care, and give special funds to support the combination of medical care and nursing care. If the medical institution set up by the old-age care institution has been officially operated for 2 years, its county (city, district) can give appropriate support through the welfare lottery public welfare fund. Medical and health institutions carry out pension services, and their pension services enjoy the same support policies as pension institutions. (The Municipal Finance Bureau, the Civil Affairs Bureau and the Municipal Health and Health Commission are responsible for the division of responsibilities)
3. Improve income distribution and price policies. In principle, the charging standard for public medical institutions to carry out pension services is based on the actual service cost, and is approved according to factors such as market supply and demand and people's affordability. The income of public medical institutions and old-age care institutions from contract services, the establishment of family beds for the elderly at home and on-site services, after deducting costs and withdrawing various funds according to regulations, is mainly used for personnel rewards and is not included in the total performance salary. In the internal deployment of the unit, it is necessary to tilt to the medical staff engaged in front-line work. (The Municipal Health and Wellness Commission, the Municipal Finance Bureau, the Municipal Human Resources and Social Security Bureau and the Municipal Medical Insurance Bureau are responsible for the division of responsibilities)
4. Fully implement various support policies. Conscientiously implement the various support policies of the state and our province to promote the development of the combination of medical care and nursing care, and effectively give support to relevant institutions and investors in terms of tax incentives, land security, investment and financing, and policy dividends. All localities should, according to the future growth of the elderly population and the new demand of the elderly for healthy old-age care, co-ordinate medical care, old-age care and other facilities, and reserve the necessary development space. Support party and government organs and state-owned enterprises and institutions to transform training and recuperation institutions into old-age service facilities, simplify administrative examination and approval, provide financial subsidies and other policy support, and enhance the service capacity of the transformed old-age service institutions. (Municipal Development and Reform Commission, Civil Affairs Bureau, Municipal Finance Bureau, Municipal Human Resources and Social Security Bureau, Municipal Resources Planning Bureau, Municipal Housing and Construction Bureau, Municipal Agriculture and Rural Bureau, Municipal Health and Wellness Commission, Municipal State-owned Assets Supervision and Administration Commission, Municipal Taxation Bureau, and Municipal Affairs Center are responsible for the division of responsibilities)
Third, the job requirements
(1) Strengthen organizational leadership. All localities and relevant units should attach great importance to the combination of medical care and nursing care, take it as an important starting point for actively implementing the national strategy to deal with the aging population, enhance their sense of responsibility, adhere to the problem orientation, refine the decomposition tasks, and strengthen coordination and cooperation. Based on the reality of Quzhou, we explore and practice in many fields, and use digital and intelligent means to solve the bottleneck problem that restricts the development of the combination of medical care and nursing, and create a development model of "combination of medical care and nursing" with Quzhou characteristics.
(2) Strengthen departmental coordination. The health department and the civil affairs department should establish a communication and coordination mechanism for the combination of medical care and nursing, and take the lead in promoting the combination of medical care and nursing and rehabilitation respectively. The financial department should implement the special fund guarantee. On the premise of ensuring the safety of the medical insurance fund, the medical insurance department should support the combination of medical care and nursing. The departments of education, human resources and social security shall provide education and skills training for medical and health service personnel in a planned way. Resource planning, development and reform, housing and construction departments should do a good job in overall planning, land demand and construction guidance of institutions and facilities. Market supervision departments should do a good job in business license registration and unlicensed operation supervision of relevant operating institutions.
(3) Strengthen the examination and supervision. The health department should strengthen supervision, inspection and evaluation in conjunction with the civil affairs department. It is necessary to strengthen the integrity construction of combining medical care with nursing care, identify the joint disciplinary object of dishonesty in this industry with reference to the identification system of joint disciplinary object of dishonesty in relevant national industries, and improve the credit evaluation of combining medical care with nursing care and the cross-departmental and cross-regional joint disciplinary mechanism. For regions and institutions that have actively implemented policies and made outstanding achievements, they will give inclined support in arranging financial subsidies, give play to their demonstration and leading role, and promote the sustainable and healthy development of the combination of medical care and nursing in the city.
This opinion shall come into force on October 30th, 2022/kloc-0. 165438.