The "Opinions" require that the province's second-level medical institutions strictly control and gradually cancel outpatient infusions. Xinhua News Agency (data map) How much does it cost Guangdong people to visit and stay in a public hospital? According to statistics, the medical income of public hospitals in Guangdong increased by 9.3% in 2015 compared with 2014, and the average outpatient cost was 208.7 yuan. A year-on-year increase of 7.3%; the second-time average hospitalization cost reached 9761.7 yuan, an increase of 7.2% year-on-year. Although the growth rate of medical expenses in Guangdong Province is lower than the national average, it is still one of the important goals of Guangdong's medical reform to control the unreasonable growth of medical expenses. To this end, Guangdong Province issued the "Implementation Plan for Controlling the Unreasonable Increase of Medical Expenses in Public Hospitals" (hereinafter referred to as the "Plan"). The goal is that by the end of 2017, the per capita medical expenses of outpatients and medical expenses per inpatient of Guangdong public hospitals should not exceed the average level of similar hospitals at the same level in the country, and the growth rate of regional medical expenses should fall below 10%. Measures to implement pay-by-case and gradually reduce pay-by-project The provincial health and planning committee said that it will promote the reorganization of the hospital's business processes, increase the rate of first diagnosis, timely report of inspections, and three-day admission rate. By improving the level of medical technology, optimizing the diagnosis and treatment process, and carrying out day surgery, the average length of hospital stay was shortened. At the same time, implement clinical path management. Implement the diagnosis and treatment of primary lung cancer, breast cancer, liver cancer and other malignant tumors issued by the National Health and Family Planning Commission, further expand the clinical path management coverage, professional and disease types, and promote the standardized diagnosis and treatment of major diseases such as tumors. By the end of 2016, the number of clinical path management cases in the pilot areas of urban public hospital reform has reached more than 30% of the number of discharged cases, and no less than 100 cases have been paid per disease type. Strengthen the income and expenditure budget of the medical insurance fund, and under the control of the total amount, the system promotes compound payment methods such as disease-based payment, head-on payment, bed-based payment, and total prepayment, and gradually reduces payment by project.

Common clinical diseases and frequently-occurring diseases such as clear clinical diagnosis and treatment path, few complications and comorbidities, mature treatment technology and controllable quality, and cost level can be considered, as well as major diseases such as childhood leukemia and congenital heart disease, priority is to be paid by disease type. At the same time, give play to the role of various types of medical insurance in regulating, guiding and supervising medical service behaviors and expenses. On the basis of standardizing day surgery and non-pharmaceutical diagnosis and treatment technology of traditional Chinese medicine, gradually expand the scope of non-pharmaceutical diagnosis and treatment technology of traditional Chinese medicine, such as traditional Chinese medicine preparations, acupuncture, therapeutic massage and other treatments for day surgery and medical institutions included in medical insurance payments.

The gradual cancellation of outpatient infusions in second-level hospitals and above is to further standardize outpatient management. The "Proposal" proposes that in addition to children's hospitals, strict anti-infusion of antimicrobial drugs and intravenous infusions for outpatients should be gradually controlled in medical institutions in the province and above. It will also adopt a prescription negative list management, implement a prescription review system, control the unreasonable application of antibiotics, standardize the clinical application of hormone drugs, anti-tumor drugs, and auxiliary drugs, and strengthen clinical use interventions.

It will also strengthen the supervision of the rational application of traditional Chinese medicine decoctions, establish a special review system for prescriptions of traditional Chinese medicine decoctions, and promote the rational use of medicines. For the follow-up monitoring system for auxiliary medicines, super-used medicines and high-value medical consumables in hospitals, the number of medicines that need to be monitored should be clarified, and a comprehensive evaluation system for clinical medicines focusing on essential medicines should be established. It is strictly forbidden to set requirements for the medical staff to generate income. The "Plan" requires that in order to control the increase in medical expenses, the personal salary of medical staff should not be linked to the income of the hospital's medicines, consumables, and large medical equipment inspection and treatment. Standardize inspection management, and issue inspection and inspection items according to the actual needs of patients. Those who can be clearly diagnosed through lower-cost inspections and inspections should not induce patients to undergo other similar inspections; non-disease diagnosis and treatment must not be repeated. Severely rectify the "large inspections and chaotic inspections" to improve the positive rate of large-scale imaging equipment inspections. The overall positive rate of large-scale X-ray machine examinations in tertiary hospitals is not less than 70%, and the positive rate of CT and MRI examinations is not less than 70%. The "Proposal" proposes to reduce the price of large-scale medical equipment inspection and treatment and inspection items, and rationally adjust and increase the prices of medical services that reflect the value of medical personnel's technical services, especially the prices of services such as diagnosis and treatment, surgery, nursing, beds, and traditional Chinese medicine. By reducing the cost of pharmaceutical consumables and strengthening cost control, space is reserved for adjusting the prices of medical services, especially the prices of services such as diagnosis and treatment, surgery, nursing, beds and traditional Chinese medicine. Under the premise of ensuring quality and safety, the cheap technology is preferred. The "Opinions" require the formulation of a list of clinical diagnosis and treatment technology projects in public hospitals in the province, and clarify the diagnosis and treatment technology service projects that public hospitals at all levels should provide. On the premise of ensuring the quality and safety of medical treatment, the preferred technology is safe, effective, convenient and cheap. And strengthen the management of clinical applications of high-risk and high-cost medical technology. Strictly control the diagnosis and treatment technology that does not meet the hospital's functional positioning, and strictly control the introduction and application of medical technology with insignificant clinical effects and high costs. The proportion of special medical services provided by public hospitals shall not exceed 10% of all medical services. Encourage all regions to establish regional centers for medical inspection, pathological diagnosis, medical imaging, and disinfection supply, and promote mutual recognition of inspection results. In addition, Guangdong will implement classified procurement of pharmaceuticals and medical consumables. It will use the advantages of the provincial third-party electronic trading platform for essential pharmaceuticals and generic medicines with large clinical consumption, high purchase amount, and many enterprises to conduct open bidding transactions. Establish a key monitoring catalog for high-priced medicines and high-value medical consumables to dynamically monitor the quantity and amount of high-priced medicines and consumables purchased in public hospitals. The implementation of patient self-paying medicines must be publicly controlled on the Internet and included in the requirements of the hospital president ’s annual assessment "Opinions". The health and family planning departments at all levels in Guangdong and the traditional Chinese medicine management departments are ordered by region and by medical institution according to the monitoring of cost indicators. Publicize and sort the results according to regulations, and strengthen information disclosure and social supervision. Public hospitals at all levels are required to establish a ranking system for medical staff's medication usage, total amount of medicines, antibiotic use, and patient self-paying medication usage, establish a ranking result analysis and evaluation system, and publish the ranking results online (or on the wall) every quarter. The Provincial Health and Family Planning Commission will regularly announce the ranking of the main monitoring indicators listed at various levels and copy the ranking to the governments at all levels. Provincial and municipal public hospitals are included in local medical expense control monitoring and disclosure in accordance with the principle of localization. Priority is given to the hospitals with the highest charge control goals in public hospital infrastructure investment, equipment purchase investment, key academic (special) department construction investment, and financial allocation budget arrangements.For hospitals that do not meet the charge control goals, according to the situation Reduce or cancel financial assistance. "Opinions" also proposed that a fee assessment and evaluation mechanism will be established. Take medical cost control as an important basis for public hospital grade review admission, new bed approval and large-scale medical equipment configuration, etc. For public hospitals that do not meet the cost control target requirements, the above qualifications are suspended, and restarted after rectification meets the requirements. . The medical expense control work is included in the target management of the affiliated public hospitals, the dean ’s annual performance evaluation and the dean ’s term evaluation, and the evaluation weight of the cost control index is increased. Establish and improve the scientific evaluation system and mechanism, highlight the performance indicators of job responsibilities, workload, service quality, service efficiency, code of conduct, technical capabilities, cost control, medical ethics and patient satisfaction, and strictly implement performance evaluation for all employees. The assessment results are linked to the employment of medical personnel, promotion of professional titles, and personal remuneration, and are included in the unified supervision of the medical service information supervision system.