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Implementing Condition on Comprehensive Reform of Separation of Clinic from Pharmacy
From:Beijing Maternal and Child Health Care Hospital
Date:07/31/2017
Following the overall deployment by Beijing Municipal Committee and the Municipal Government, Beijing Municipal Commission of Health and Family Planning and the Municipal Administration of Hospitals, Beijing Maternal and Child Health Care Hospital officially launched medical reform work on April 8, 2017. Two-month efforts on medical reform in the hospital obtained initial effects that rooted sound foundation for implementation of various items of work.
I. Basic condition
Beijing Maternal and Child Health Care Hospital is the sole Class-Three Hospital at Grade One on obstetrics and gynecology in Beijing. The hospital undertakes the assignment of healthcare for women and children in the city while accomplishing diagnosis on common diseases, frequently-occurring diseases and critical diseases in gynecology and obstetrics. The Hospital has open 536 beds. In 2016, its outpatient emergency treatment received 1,407,257 patients with the number standing at 5,583 per day. Its number of childbirth per year stands at 14,778.
Prior to launching of the medical reform, the hospital set up leadership team with director and secretary as the chair. It formulated work plans, clarified time node, implemented division of responsibilities, conducted deployment following the principle of ‘full coverage both horizontally and vertically’, organized staffs at all levels to attend training, released ‘pocket book’ on training medical reform and conducted assessment on all staffs. It mainly conducted social mobilization and publicity on patients concerning medical reform policies and pro-people measures by website and panel. It accomplished information system reform, data docking and risk assessment. By consulting to table drilling, practical drilling, cut-power emergency, systematic failure and test drilling at all levels and in different environment, it ensured smooth switch of medical reform at 0:00 a.m. on April 8 as well as two-month successful implementation of medical reform after that.
II. Main methods
It sticks to synchronous implementation of medical reform and improvement of services, putting patients in the center and boosting sense of acquisition among the masses by working on diagnosis environment and optimizing service flow.
(1) Set up consultancy office for medical reform policies. It sets up consultancy office for medical reform policies in the outpatient lobby on the first floor to timely response to questions on drugs, price, medical assurance and so forth from patients. It sets up ‘love action’ team of volunteers to tackle with the phenomenon of soaring people for consultant. Each day, four volunteers and five full-time medicare guiding service staffs would answer questions to patients or guide routes.
(2) Adjust common registration number. As regards designing of registration number the hospital would take patients’ demands into full account. For example, outpatient for screening newly-born children and patients suffering PKU, TSH and other inborn genetic diseases would come over to the hospital for check each month, so neonatal screening department would assign common registration numbers on Thursdays and Fridays to fully decrease burdens of patients and facilitate check on patients.
(3) Work on diagnosis environment. We would position 8 second-generation self-aid machines for Beijing medical one-card to the side at the entrance to the outpatient lobby. With patient services and initiative guidance by volunteers, patients would use self-aid machines more, which helps reduce queueing in front of the registration window. We would unify identification guidance and set up target identification on the floor of the outpatient lobby so as to guide patients for clear doctor-seeing.
(4) Open refunding window. The hospital specially sorts out and simplifies refunding of registration number and flow for refunding money. It sets up specialists at the outpatient service center to conduct accurate settlement on refunding of fees and number before leading patients to special window for refunding to accomplish the refunding. It helps diversion of fees-submitting patients, guarantees order of submitting fees, facilitates servicing of patients and boosts work efficiency.
(5) Provide free replicating, fax and receiving services. As lying-in women would return to the hospital to fetch certificate of birth. To avoid the case that certificates of birth can’t be taken if they forget to bring duplicates of their ID cards, the outpatient service center provides free copying services for ID card, residence booklet and other ID certificates. Pertinent to the special case that non-local patients would forge to bring relevant materials and documents for check, the outpatient service center would provide services to receive fax.
(6) Set up service station for posts. EMS sets up post service station at the outpatient lobby to provide distribution of TCM and fried decoction of medicinal ingredients to home. It helps shorten time to waiting for drugs.
(7) Add momentum to consultancy services on drugs in outpatient. The drug consultancy center would provide guidance on reasonable drug use, publicity and interpretation on policy of drug use and participation of clinical physicians in clinical drug treatment. It would provide beside guidance for special patients who are to check out and bedside drug-use education on pregnant and lying-in women, and carry out precise medical drug use such as monitoring and use of folic acid and test on infertility.
III. Work achievements
For the two-month medical reform, data monitoring reveals that the anticipation effects are sound, which are mainly demonstrated in the following aspects:
First, registration fees and diagnosis fees are abolished and medical service fees are set up. Profits in the hospital slightly rise. Outpatient medical incomes: it rose from 54.1365 million in May 2016 to 59.3791 million Yuan in May 2017 with a growth range at 9.68%. In terms of hospitalization incomes: it rose from 24.2396 million in May 2016 to 26.5976 million Yuan in May 2017 with growth range at 9.73%.
Second, fees per time for outpatient are slow in growth and drug fees per time drop. After the medical reform cancelled the drug price addition, the drug ratio dropped obviously. For example, the income from outpatient drugs dropped from RMB17.2661 million in March to RMB11.821 million in May, 2017; the ratio of outpatient drugs dropped from 27.87% in March to 20.25% in May, 2017. The cancellation of drug price addition effectively promoted the rational drug use and alleviated patients’ medical burden.
Third, the fees of medical assurance per time is steady in general, patients’ actual burden is not increased obviously. After drug price addition is canceled in the medical reform, structure of outpatient patients witnesses changes and ratio of patients enjoying medical assurance rises. Patients do not see their burdens significantly rising. For example, in May 2016, patients enjoying medical assurance would burden a cost of 201.11 but this number was 217.14 Yuan in May 2017.
Fourth, outpatient number drops and patients are guided for tiered diagnosis. As is reflected from composition of patients and changes on registration number, the number of outpatient services was 105,298 for May 2017 (excluding those calling for special needs), among which those calling for famous experts and botanic physicians totaled 32,299. Number of outpatient services was 113,902 in May 2016 and those calling for botanic physicians totaled 38,173. It dropped by around 15.3% when compared with that in the same period last year. It fully verifies changing tendency of tiered diagnosis among patients after the medical reform and reflects guiding direction of reform in public hospitals.
Fifth, internal performance appraisal is completed and performance assessment distribution mechanism corresponding to medial reform is established. It sticks to the orientation of public welfare, boosts medical quality and reflects roles and values of medical staffs. On June 1, it held workers’ congress and passed performance distribution plan for 2017 by voting. Main assessment indexes system covers work quality, work efficiency, cost control and annual special item. Set-up of its index system is stably connected to performance assessment index in administration of hospitals.
Sixth, internal hospital management is enhanced and sense of acquisition for medication among people is boosted. From the perspective of hospital management, medical staffs have their sense of occupational honor and sense of mission enhanced and the hospital has its scientific and refined management level constantly improved by regulating medical behaviors, working on medical services and referring to multi-channel cost control. From the perspective of patients, communication between patients and doctors would be more unhindered, hospital layout would be more reasonable, self-aid registration would be more convenient, diet quality would be more satisfying and patients’ burden of drugs would be validly mitigated. It can be said that patients’ overall satisfaction of hospitals is being improved.
Medical reform is correlated with people’s livelihood. Beijing Maternal and Child Health Care Hospital will unswervingly implement policy spirits on medical reform of the country and the superior body, highlight the nature of public welfare in public hospitals, follow the principle of ‘clearing space, adjusting structure and guaranteeing structure’, putting into force the objective on medical reform characterizing ‘wooing popularity among people for the Party and the government, getting bliss for the masses and acquiring encouragement for medical staffs’. ‘Sense of acquisition’ and ‘sense of felicity’ among the masses would be enhanced by improving effects of medical reform.