Quzhou City’s policy on rehabilitation medicine

In order to implement the spirit of "Several Opinions of Zhejiang Provincial Health Commission and 12 Other Departments on Deeply Promoting the Development of Integrated Medical and Nursing Care" (Zhejiang Weifa [2021] No. 34), accelerate the implementation of the national plan to actively respond to the aging population strategy, further promote the integrated development of medical and health care, better meet the rapidly growing demand for health and elderly care services of the elderly, create the golden business card of "Zheli Health" and "Zheli Health Care", and launch the city brand of "World Longevity Capital", combining Based on the actual situation of our city, the following implementation opinions are put forward. 1. Work goals: By 2022, increase the proportion of rehabilitation and nursing beds in primary medical and health institutions, and the proportion of rehabilitation and nursing beds in primary medical and health institutions will reach 30%; more than 80% of general hospitals, rehabilitation hospitals, nursing homes and primary medical institutions will become Age-friendly medical facility. Each town (street) has built a model home-based elderly care service center with both day care and full-time care service functions; promote the three-year upgrade and renovation project of nursing homes in the city, and complete the aging-friendly renovation of the existing families of elderly people in need; social workers and communities The ratio of elderly people reaches 1:500, and the ratio of senior caregivers and technicians reaches 15. By 2025, cultivate a third-level or above hospital with outstanding geriatric medical disciplines, the city's second-level and above general hospitals and traditional Chinese medicine hospitals will have a geriatric medicine department ratio of more than 85%, and there will be 55 rehabilitation care beds in medical institutions for every 10,000 elderly people. . Establish a palliative care guidance center (training base) at the municipal level, build at least one palliative care ward in each county (city, district), and more than 20 township health centers (community health service centers) provide palliative care services . By 2025, the proportion of nursing beds in nursing homes will reach 60%, and there will be 20 cognitive impairment care beds for every 10,000 elderly people. The ratio of social workers to elderly people in the community reaches 1:450, and the ratio of senior caregivers to technicians reaches 18. 2. Main tasks (1) Strengthen the construction of institutions and facilities integrating medical and nursing care. 1. Strengthen the construction of integrated medical and nursing care institutions. Encourage large-scale elderly care institutions or those that mainly accept disabled elderly people to set up medical institutions to provide basic medical care, chronic disease management, rehabilitation care and other services for the elderly. Encourage elderly care institutions with many idle beds to cooperate with medical institutions to provide integrated medical and nursing care services. Support medical institutions to set up medical service stations in nursing homes in accordance with laws and regulations, and use relevant resources to carry out rehabilitation care, long-term care, hospice care and integrated medical and nursing care services. Comprehensively promote the construction of health care consortia, promote more medical rehabilitation resources to enter the field of elderly care services, and form a health care service network covering urban and rural areas. Encourage all types of entities to set up embedded medical and nursing care institutions in the community that integrate medical care, daily care and other services. By 2025, 50 health care complexes at different levels will be established at the city, county, and township levels, and recovery rooms will be generally established in nursing homes with more than 100 beds. Optimize the bed structure of nursing homes. By 2025, the proportion of nursing beds in nursing homes will reach 60%, and there will be 20 cognitive impairment care beds for every 10,000 elderly people. (The Civil Affairs Bureau and the Municipal Health Commission are responsible according to the division of responsibilities. The following tasks are the responsibility of the people's governments of each county (city, district) and will not be marked one by one.) 2. Coordinate and promote the construction of community home-based medical and nursing care facilities. Promote the overall planning and adjacent construction of community health service centers, township health centers and elderly care service institutions. Carry out actions to improve the ability to integrate community medical and nursing care, and support qualified community health service institutions, township health centers or home-based elderly care service centers, support service facilities for the poor (nursing homes), etc. to use existing resources to internally reconstruct and expand community (township) medical and nursing care Combined with service facilities, it focuses on providing health education, preventive health care, disease diagnosis and treatment, rehabilitation care, hospice care, and integrated medical and nursing care services for the disabled, chronically ill, elderly, disabled and other elderly people, taking into account daily life care. Newly built community health service institutions in urban areas can build community medical and nursing care service facilities internally, and new "future communities" must build medical and nursing care service facilities. Elderly care service areas in newly built, renovated and expanded community medical and nursing care service facilities should be set up in independent buildings or building partitions, and partition management should be strictly implemented. (The Municipal Health and Health Commission, the Municipal Development and Reform Commission, the Municipal Civil Affairs Bureau, the Municipal Finance Bureau, the Municipal Resources Planning Bureau, the Municipal Housing and Urban-Rural Development Bureau, and the Municipal Medical Insurance Bureau are responsible according to the division of responsibilities) 3. Improve the service supply capacity of social forces.

The government does not impose planning restrictions on the total number of areas for social-run integrated medical and nursing care institutions. In accordance with the principle of "nothing is forbidden, no entry is allowed", no pre-approval matters that have no legal and regulatory basis and are unreasonable shall be set up and comprehensively cleaned up and canceled, and the business nature of social-run integrated medical and nursing care institutions shall not be restricted without legal and regulatory basis. Support social forces to establish integrated medical and nursing care institutions through market-oriented operations. On the basis of ensuring the basics and ensuring the bottom line, we will continue to promote the effective supply of inclusive elderly care services. Support qualified social medical institutions and integrated medical and nursing institutions to undertake local public health, basic medical care, basic elderly care, needs assessment, talent training and other services. (The Municipal Development and Reform Commission, Municipal Civil Affairs Bureau, Municipal Finance Bureau, Municipal Resources Planning Bureau, Municipal Health Commission, Municipal Taxation Bureau, and Municipal Market Supervision Bureau are responsible according to the division of responsibilities.) (2) Improve the integrated service capabilities of medical and health care. 1. Accelerate the development of geriatric medicine. In accordance with the "Guidelines for the Construction and Management of Geriatric Medicine Departments (Trial)", the construction of geriatric medicine departments will be strengthened. In 2025, more than 85 of the city's second-level and above general hospitals and traditional Chinese medicine hospitals will set up geriatric medicine departments, and cultivate a third-level geriatric medicine department with outstanding characteristics. Level hospitals, promote the construction of municipal and county-level geriatric medical centers, and give full play to the center's guiding role in geriatric medical discipline construction, talent training, business guidance, quality management, etc. of regional medical institutions. In 2025, a municipal-level palliative care guidance center (training base) will be established, each county (city, district) will build at least one palliative care ward, and more than 20 township health centers (community health service centers) will carry out palliative care Serve. Guide primary and secondary hospitals and specialized hospitals to make rational use of idle medical resources during structural and functional adjustments, create conditions for providing elderly care, nursing, and rehabilitation services, and strengthen the construction of continuing medical institutions such as nursing homes and rehabilitation hospitals. Actively explore and carry out elderly care needs assessment and provide targeted integrated medical and nursing services for the elderly. Vigorously develop traditional Chinese medicine health and elderly care services, strengthen health management and comprehensive prevention and control of chronic diseases, and fully implement the free outpatient medication policy for patients with chronic diseases such as essential hypertension and type 2 diabetes over the age of 65. (The Municipal Health Commission, Municipal Finance Bureau, and Municipal Medical Insurance Bureau are responsible according to the division of responsibilities) 2. Support the development of home medical services for the elderly. Implement the spirit of the "Notice on Strengthening Home-based Medical Services for the Elderly" (National Health Bureau Medical Issues [2020] No. 24), and support qualified medical and health institutions and capable medical and nursing care institutions to provide services to elderly people with limited mobility who are at home. Establish home beds and carry out door-to-door services for the disabled elderly, as well as elderly patients with chronic diseases, in the recovery or terminal stages of disease, and who still need medical services after discharge. Establish the content, standards and specifications of door-to-door medical and health services, and reasonably formulate standards for consultation fees and home bed visits. Establish and improve the guarantee mechanism and appropriately improve the treatment level of door-to-door service personnel. Institutions that provide door-to-door services must purchase medical liability insurance, personal accident insurance, etc. to prevent and deal with professional risks and personal safety risks. (The Municipal Health Commission, Municipal Finance Bureau, Municipal Civil Affairs Bureau, and Municipal Medical Insurance Bureau are responsible according to the division of responsibilities) 3. Promote the sharing of urban and rural medical resources. Deepen medical and nursing care services in remote mountainous areas, configure "roving medical vehicles", and rely on county medical teams to continue to carry out roving medical services such as medical and pharmaceutical delivery, health examinations, chronic disease follow-up, and family visits. The leading hospital of the county medical group promotes the construction of geriatric medical care and rehabilitation, nursing teams and special departments of member units through measures such as selecting key personnel and strengthening training, and improves the capabilities of family doctor contract services and integrated medical and nursing care services. We will provide solid basic public health services, implement elderly health and medical care service projects, and promote disease prevention and early intervention such as free screening for colorectal cancer and chronic obstructive pulmonary disease and free influenza vaccination. Township health centers (community health service centers) are actively opening beds for rehabilitation, nursing, long-term care, and palliative care. By 2022, the proportion of nursing beds in primary medical and health institutions will reach 30%. (The Municipal Health Commission, Municipal Finance Bureau, and Municipal Medical Insurance Bureau are responsible according to the division of responsibilities) 4. Improve information support capabilities. Accelerate the construction of network hospitals and telemedicine services, establish interoperability between urban hospitals, county medical system-led hospitals and primary medical and health institutions, and extend to villages (communities) and integrated medical and nursing institutions to provide services for the elderly and other actions Remote diagnosis and treatment services are provided for patients who are inconvenienced.

Promote the national second batch of pilot institutions for elderly health care combined with remote collaborative services, Longyou Longzhou Hospital and Jiangshan Zhuangyuanli Nursing Hospital to standardize telemedicine services. Relying on "Internet Medical Health" to create "DingTalk Family Medical Services", the DingTalk organizational structure organizes and matches communities, family doctors, and contracted residents, so that family doctors can provide residents with accurate and accessible health services. Develop "Internet nursing services" and promote the integration of online and offline services. Promote the development of the smart health and elderly care industry, promote the promotion and application of high-quality products and services, and provide remote real-time care, real-time positioning, health monitoring, emergency rescue calls and other services for the elderly. Explore the use of wearable devices and portable, self-service health testing and other equipment to carry out real-time monitoring of basic health conditions for key groups such as the elderly, those who live alone, and those who are disabled or partially disabled. (The Municipal Health Commission, the Municipal Economic and Information Bureau, the Municipal Civil Affairs Bureau, the Municipal Medical Insurance Bureau, and the Municipal Big Data Bureau are responsible according to the division of responsibilities) (3) Promote the standardized and orderly development of the integration of medical and health care. 1. Simplify the approval and registration of integrated medical and nursing care institutions. Implement the spirit of the National Health Commission and other ministries and commissions’ “Notice on Effectively Completing the Approval and Registration of Integrated Medical and Nursing Institutions” (National Health Office Lao Laing Fa [2019] No. 17), optimize the approval process for integrated medical and nursing institutions, and ensure that the same level of health, civil affairs or The market supervision and management department has established a joint handling working mechanism and operating procedures, and has incorporated matters into the "undifferentiated acceptance" window of the administrative service center for acceptance, achieving "comprehensive acceptance at the front desk, classified approval at the backend, and issuance at the comprehensive window." The administrative examination and approval for clinics, health clinics (rooms), medical offices, and nursing stations in nursing homes will be cancelled, and record-keeping management will be implemented. If medical and health institutions use existing resources to provide elderly care services that involve construction, fire protection, food safety, health and epidemic prevention and other relevant conditions, they can directly register and file based on the above-mentioned corresponding qualifications that the medical and health institutions already have, and simplify the process without affecting safety. formalities. Qualified medical institutions in integrated medical and nursing care institutions will be included in the designated scope of basic medical insurance. Applications for designated sites can be made after 3 months of formal operation. The time limit for completing designated site assessments shall not exceed 20 working days. (The Municipal Health Commission, Civil Affairs Bureau, Municipal Housing and Urban-Rural Development Bureau, Municipal Emergency Management Bureau, Municipal Market Supervision Bureau, and Municipal Medical Insurance Bureau are responsible according to the division of responsibilities) 2. Deepen medical and nursing contract cooperation. In accordance with the requirements of the Provincial Health and Health Commission, the Provincial Civil Affairs Bureau, and the Provincial Administration of Traditional Chinese Medicine on Further Strengthening the Contracting and Cooperation Services between Medical and Health Institutions and Elderly Care Institutions (Zheweifa [2022] No. 11), encourage unestablished medical institutions Or elderly care institutions with weak medical and health service capabilities can carry out contract cooperation with surrounding medical and health institutions in various forms, and deepen the contract cooperation between home elderly care service centers, home elderly care centers and other institutions and medical and health institutions. Both parties should sign an agreement to clarify the content, methods, costs and responsibilities of both parties. Elderly care institutions can also provide medical and health services to the elderly residents through service outsourcing, entrusted operation, etc. Qualified medical institutions in nursing homes can establish a two-way referral mechanism with contracted medical and health institutions. By 2022, all elderly care institutions will be able to provide standardized medical and health services in different forms to the elderly residents. (The Municipal Health Commission, Municipal Civil Affairs Bureau, and Municipal Finance Bureau are responsible according to the division of responsibilities) 3. Strengthen the supervision of integrated medical and nursing care institutions. The health, civil affairs, medical insurance and other departments should strengthen coordination and cooperation, in accordance with their respective responsibilities, increase industry supervision of integrated medical and nursing care institutions, carry out actions to improve the service quality of integrated medical and nursing care institutions, improve the standardization and institutionalization level of integrated medical and nursing care, and ensure services Quality and safety. Integrated medical and nursing institutions must implement the main responsibilities, establish and improve various management systems and personnel job responsibilities, strictly implement policies, standards and norms related to medical and health and elderly care services, promote fire safety standardized management, and implement fire safety responsibilities and various safety systems; In accordance with the "Guidelines for Infection Prevention and Control in Integrated Medical and Nursing Institutions of Zhejiang Province", we must effectively prevent and control infectious diseases such as COVID-19, implement normalized prevention and control measures, strengthen emergency knowledge training for staff and publicity on protection knowledge for the elderly, and improve Emergency support capabilities.

Clarify the payment boundaries between medical and health services and elderly care services. Medical institutions strictly follow diagnosis and treatment standards. Basic medical insurance funds can only be used to pay for medical services such as disease diagnosis and treatment, medical care, and medical rehabilitation that are within the scope of basic medical insurance. They must not be used for Pay for elderly care services such as living care. (The Municipal Health Commission, Civil Affairs Bureau, Municipal Emergency Management Bureau, Municipal Market Supervision Bureau, Municipal Medical Insurance Bureau, and Municipal Fire Rescue Detachment are responsible according to the division of responsibilities) (4) Promote the construction of a talent team. 1. Strengthen the construction of medical and health care talent teams. Strengthen the training of professionals related to the integration of medical and nursing care, support and guide qualified schools such as Quzhou Vocational and Technical College, Quzhou Nursing School, Quzhou Technical Secondary School to open geriatric medicine, rehabilitation, nursing, hospice care, elderly care and other majors, and cultivate geriatric medicine, elderly care and other majors. Nursing team. By 2025, no less than 5,000 elderly care workers and no less than 20,000 home care workers will be trained. Build geriatric medicine, hospice care, medical and health care guidance centers, skills training bases, etc., with appropriate financial subsidies at all levels. Vigorously carry out vocational skills training for practitioners in integrated medical and nursing care services, carry out professional skill level certification for integrated medical and nursing care services such as elderly care caregivers, and encourage integrated medical and nursing care institutions to give priority to recruiting and training qualified medical caregivers, elderly care caregivers and other skilled talents. Expand the team of social workers and volunteers serving the elderly, and increase support for voluntary service projects and public welfare organizations that assist the elderly. (The Municipal Education Bureau, Civil Affairs Bureau, Municipal Human Resources and Social Security Bureau, and Municipal Health Commission are responsible according to the division of responsibilities) 2. Support medical personnel to engage in integrated medical and health care services. Medical staff in integrated medical and nursing care institutions enjoy the same treatment as medical staff in medical and health institutions, such as professional title evaluation and continuing education for professional and technical personnel. If the integrated medical and nursing care institution does not have the conditions to provide continuing education and training for medical staff, the health administrative department shall make overall arrangements. Arrange centralized training. Implement the registration system for multiple medical practice institutions and support medical personnel to practice in integrated medical and nursing care institutions. Encourage retired medical personnel to participate in integrated medical and nursing care services, and include qualified retired and re-employed personnel into the overall management of the work-related injury insurance system. (The Municipal Human Resources and Social Security Bureau, the Municipal Civil Affairs Bureau, and the Municipal Health Commission are responsible according to the division of responsibilities) (5) Increase policy support and guarantees. 1. Improve medical insurance support policies. Reasonably set up medical insurance fee settlement standards and methods that are consistent with the characteristics of the elderly, conduct enrollment research on bed-day payment in the hospice care group, and promote multiple and composite medical insurance payment methods such as diagnosis-related grouping (DRG) and bed-day payment. Gradually increase the bed-day payment standard. Implement a long-term prescription system for chronic disease medication for the elderly. Relevant diagnosis, treatment and rehabilitation projects that meet the basic needs of the elderly will be gradually included in the payment scope of basic medical insurance according to regulations, and a dynamic adjustment mechanism will be established. Continue to promote accident insurance for the elderly and support commercial insurance institutions in vigorously developing insurance products suitable for the elderly. (The Municipal Medical Insurance Bureau and the Municipal Health Commission are responsible according to the division of responsibilities) 2. Improve the investment guarantee mechanism. Implement financial investment policies for medical and health institutions to support the improvement of integrated medical and nursing care service capabilities. Give full play to the synergy between public health and basic medical insurance. If qualified grassroots medical and health institutions carry out basic public health service projects such as health management for the elderly and integrated service management of health and medical care for the elderly, the government shall implement it in accordance with regulations. Purchasing services; if qualified grassroots medical and health institutions carry out medical and nursing care service projects that fall within the payment scope of basic medical insurance, in principle, they will be compensated through medical service charges. Where conditions permit, the insufficient part of the fee compensation can be included in the standardized work equivalent. Purchase services. All levels of finance will arrange special funds for the integrated development of medical and health care to support the standardized construction of geriatric medicine departments and provide certain subsidies to geriatric medical centers (training bases) and hospice care guidance centers (training bases). A one-time construction subsidy will be provided to medical institutions with standardized geriatric medicine departments that are completed and put into operation before 2025. A one-time construction subsidy will be given to hospice wards (rooms) built and put into operation before 2025 based on the number of beds. The lottery public welfare funds used by governments at all levels for social welfare projects should increase their support for medical and health institutions and elderly care institutions to provide integrated medical and nursing care services, and provide special financial support for the combination of medical and nursing care. If the medical institution within the nursing home has been officially in operation for two years, the county (city, district) where it is located can provide appropriate support through the Welfare Lottery Public Welfare Fund.

If medical and health institutions provide elderly care services, their elderly care services will enjoy the same support policies as those provided by elderly care institutions. (The Municipal Finance Bureau, Civil Affairs Bureau, and Municipal Health Commission are responsible according to the division of responsibilities) 3. Improve income distribution and price policies. In principle, the charging standards for elderly care services provided by public medical institutions are based on actual service costs and are determined based on factors such as market supply and demand conditions and the affordability of the public. Income from contracted services between public medical institutions and elderly care institutions, establishment of home beds and door-to-door services for the elderly at home, after deducting costs and withdrawing various funds in accordance with regulations, is mainly used for personnel rewards and is not included in the total performance salary. When allocated within the unit , should be tilted towards medical staff engaged in front-line work. (The Municipal Health Commission, Municipal Finance Bureau, Municipal Human Resources and Social Security Bureau, and Municipal Medical Insurance Bureau are responsible according to the division of responsibilities) 4. Comprehensively implement various support policies. We will conscientiously implement various support policies from the state and our province to promote the development of integrated medical and nursing care, and effectively provide support to relevant institutions and investment entities in terms of tax concessions, land use guarantees, investment and financing, and realize policy dividends. According to the future growth of the elderly population and the new needs of the elderly for healthy and elderly care, all localities must coordinate the planning and layout of medical, elderly care and other facilities and reserve necessary development space. Support party and government agencies and state-owned enterprises and institutions in training nursing institutions to transform into elderly care service facilities, simplify administrative approvals, provide financial subsidies and other policy support, and enhance the combined medical and nursing service capabilities of transformed elderly care service institutions. (Municipal Development and Reform Commission, Municipal Civil Affairs Bureau, Municipal Finance Bureau, Municipal Human Resources and Social Security Bureau, Municipal Resources Planning Bureau, Municipal Housing and Urban-Rural Development Bureau, Municipal Agriculture and Rural Affairs Bureau, Municipal Health Commission, Municipal State-owned Assets Supervision and Administration Commission, Municipal Taxation Bureau, Municipal Government Affairs Center press Division of responsibilities and responsibilities) 3. Work requirements (1) Strengthen organizational leadership. Relevant units in all localities must attach great importance to the integration of medical and health care as an important starting point for actively implementing the national strategy to deal with population aging, strengthen responsibility, adhere to a problem-oriented approach, refine and decompose tasks, and strengthen coordination and cooperation. It is necessary to base on the actual situation of Quzhou, explore and practice in various fields, use digitalization, intelligence and other means to strive to solve the bottleneck problems that restrict the development of integrated medical and health care, and create a development model of "integrated medical and health care" with Quzhou characteristics. (2) Strengthen departmental coordination. The health department and the civil affairs department should establish a communication and coordination mechanism for the integration of medical and nursing care, and take the lead in promoting medical and health care work respectively. The financial department must implement special funding guarantees. On the premise of ensuring the safety of medical insurance funds, the medical insurance department must support the integration of medical and health care. Education, human resources and social security departments should carry out education and skills training for medical and health care service personnel in a planned manner. The resource planning, development and reform, and housing construction departments must do a good job in overall planning, land use requirements, and construction guidance for institutional facilities. Market supervision departments must do a good job in registering business licenses of relevant operating institutions and supervising unlicensed operations. (3) Strengthen assessment and supervision. The health department should work with the civil affairs and other departments to strengthen supervision, inspection and assessment. It is necessary to strengthen the integrity construction of integrated medical and nursing care institutions, identify the targets of joint punishment for dishonesty in local industries in accordance with the national system for identifying joint punishment for dishonesty in relevant industries, and improve the credit evaluation of integrated medical and nursing care services and the cross-department and cross-regional joint punishment mechanism. Regions and institutions that are proactive in implementing policies and have outstanding achievements will be given preferential support in arranging financial subsidies, giving full play to their exemplary and leading role, and promoting the sustainable and healthy development of the city's integrated medical and health care work. This opinion will be effective from November 30, 2022.