本报玉树讯 （记者 程宦宁） "家门口就有好医生，不用再去西宁和外地看病了。"1月12日，玉树藏族 自治州玉树市居民才藏感慨。"十四五"以来，玉树州聚焦破解卫生健康领域突出问题，在完善兜底保 障、提升服务能力等方面持续发力，全州卫生健康体系建设实现历史性跨越，医疗服务能力、保障水 平、可及性大幅提升。 坚持以基层地区为重点、公共卫生为底线、特殊群体为核心，构建全方位、全周期的健康兜底服务网 络，让群众感受到实实在在的健康温度。全州城乡居民基本公共卫生服务补助标准提高至人均99元，服 务项目拓展至29类，老年人、慢性病管理和"家庭医生"签约履约服务成效显著。健全公共卫生应急响应 机制，建成州级区域传染病防治中心，包虫病总患病率从2020年底的0.69%下降至0.42%。 玉树州全面推进紧密型县域医共体建设，组建一个区域紧密型医联体、7个县域紧密型医共体，所有乡 镇卫生院、社区卫生服务中心服务能力达到合格标准，远程会诊、双向转诊、检查检验结果互认等功能 实现全覆盖。因地制宜推动藏医药事业发展，建成全国基层名老中医药专家传承工作室8个、全国名老 中医药专家传承工作室3个、省级藏医流派工作室3个，21种藏医药适宜技术 ...

山海争辉，城乡 焕新：阳西亮 出"百千万工 程"三年答卷_南 方+_南方plus 山海阳西，热潮 涌动。蚝乡美食 与美景引得游人 纷至，智能牧海 重器传来丰收喜 悦，海上巨型风 机源源不断供给 绿色能源，高端 产业园区 领"鲜"阳西味 道，"教共 体""医共体"等 实践托起民生幸 福…… 站在"百县千镇 万村高质量发展 工程"实现"三年 初见成效"的关 键节点，回望三 年奋进征程，阳 西县全面推进强 县促镇带村，交 出了一份城乡协 调发展的精彩答 卷：获评全国乡 村振兴百强县、 国家农业现代化 示范区、国家级 县域商业建设行 动示范县，入选 省首批"百千万 工程"典型县、 省首批以县城为 重要载体的新型 城镇化试点；近 三年阳西规上工 业增加值年均增 长9.8%，海上风 电并网装机容量 跃居全国县级首 位；渔业产量稳 居全省县级第 一。 阳西沙扒月亮湾（受访者供图） 产业筑基 海陆联动激活县 域经济 是阳西县向海图 强的资本，海上 风电基地、海洋 牧场和健康食品 产业链不断做大 锻强，是阳西县 域经济破浪争先 的底气。三年 来，阳西以"全 产业链"思维推 进县域经济发 展，成功构 建"1+3+X"特色 产业集 ...

作者 | 第一财经 吴斯旻 超20%的人口为60岁以上老年人；"两慢病"住院费用年增长率一度达到22%，但参保人门诊报销年度 封顶线仅1500元；辖区内行政村达数百个，但政府办村卫生室占比少……这是浙江温州一个常住人 口约百万级的县城——平阳县，曾长期面临的县域医疗发展困境。 近期，第一财经记者对平阳县医改工作进行实地调研。通过三年多的紧密型医共体建设和"两慢 病"（高血压、糖尿病）改革，该县医保资金从2022年的超支2000余万元，到2024年实现3000万元结 余；与此同时，"两慢病"住院总费用增长率从22%降至12%，重点慢病及并发症控制的健康效益逐渐 显现。 平阳县的变化正是中国县域地区通过紧密型医共体改革，解决"患者不来、医护不去"问题的一个缩 影。 国家卫健委在《关于全面推进紧密型县域医疗卫生共同体建设的指导意见》中提出：到2025年底， 紧密型县域医共体建设取得明显进展，支持县域医共体建设的组织管理、投入保障、人事编制、薪酬 待遇、医保支付等政策进一步完善。 2025.12. 22 本文字数：4432，阅读时长大约7分钟 根据该委11月底发布的最新数据：全国目前共建设运行了3099个紧密型县域医 ...

根据该委11月底发布的最新数据：全国目前共建设运行了3099个紧密型县域医共体，基本覆盖了全部的 县和县级市以及1/3的城市区，惠及全国超六成人口（9.24亿），并有超过一半的县（市、区）正在积 极探索和落实对县域医共体实施总额付费、结余留用的政策。 但医共体人财物一体化建设的挑战依然存在。记者了解到，在平阳县，尽管医保控费、医疗强基和慢病 管理的多重目标均取得进展，但面对有限的医保和财政资金，当地县医院维持自身公益性运行机制以及 落实分级诊疗体系中的功能定位仍存在补偿缺口。 更为关键的是，城市医院的虹吸效应仍然突出，"10%左右的异地住院患者花费了超四成的县域医保基 金"，继而导致当地紧密型医共体单位面临医疗行为渐趋饱和但可支配收入增速放缓的压力。 城市医院的虹吸效应仍然突出，"10%左右的异地住院患者花费了超四成的县域医保基金"。 超20%的人口为60岁以上老年人；"两慢病"住院费用年增长率一度达到22%，但参保人门诊报销年度封 顶线仅1500元；辖区内行政村达数百个，但政府办村卫生室占比少……这是浙江温州一个常住人口约百 万级的县城——平阳县，曾长期面临的县域医疗发展困境。 近期，第一财经记者对平阳县医 ...

"廖爷爷，来测氧饱和度咯。""大医生今天来得早呢！等会吃了饭再走？"近日，米易县白坡彝族乡滩脚村 的"00后"村医罗建涛，像往常一样来到76岁的村民廖德兴家中，为常年受慢阻肺疾病困扰的他做检查。 盐边县红格镇联合村。受访者供图 贺国欣走在出诊的路上。受访者供图 罗建涛帮村民做健康检查。受访者供图 别看廖德兴现在热情，罗建涛第一次上门随访时，廖德兴却满是怀疑："这小年轻，能不能看好病？" 从小年轻到"大医生"，变化背后，是攀枝花加快紧密型县域医共体建设、以数字技术和专家团队赋能基层医 疗事业发展的缩影。作为攀枝花共同富裕试验区建设中的"重头戏"，当地打出一套整合医疗卫生服务体系的"组合 拳"，持续推动优质医疗资源扩容和区域均衡布局。 资源下沉 小年轻变成"大医生" 2002年出生的罗建涛，大学学的是临床医学专业，今年2月到滩脚村入职村医。滩脚村是雅砻江流经的一个彝 族村，也是米易县最偏远的村落之一，村民如果乘班车去县城看病，往返要花6小时。 为了取得村民信任，罗建涛选择了"腿勤"这个笨办法。他每天骑着摩托车入户问诊，大半年来行程已近5000 公里。每次随访结束，他都会认真整理出诊笔记，随时更新村民健康档案。 但 ...

同时，广西积极推进县域医疗资源共享中心建设，目前80%以上的县（市、区）初步建成县域影 像、心电、检验等资源共享中心，今年县域远程医学影像、心电等诊断服务量近100万人次；已基本实 现全区县级医院和大部分乡镇卫生院均有上级医院医师常年驻守；中医药壮瑶医药服务实现县、乡全覆 盖。 在医保方面，广西推进紧密型县域医共体医保支付方式改革，2023年按照"总额预算包干、结余留 用、合理超支分担"的原则，推动医保资源向基层倾斜。监测显示，2023年、2024年，全区县域内基层 医保基金支出占比均超过了31%，县域内基层医疗卫生机构诊疗人次占比均超过了52%，越来越多的农 村群众看病就医优先选择就近便利的基层医疗卫生机构。 据统计，"十四五"以来，广西筹措财政资金249.52亿元，支持基层医疗卫生服务体系建设，推动全 区县域紧密型医共体全面铺开；筹措财政资金1434.11亿元，夯实基本医保、大病保险和医疗救助三重 保障制度，促进基层群众医疗保障待遇不断提升；筹措财政资金259.55亿元，支持实施基本公共卫生服 务和基本药物零差价销售，不断提升基本公共服务均等化水平。（关海芳 罗国威 招垚希） 据介绍，紧密型县域医共体作为 ...

Core Insights - The healthcare reform in Sanming, Fujian, has shown positive results, contrasting sharply with the struggles faced by a county-level hospital in Shandong, where medical staff are experiencing delayed salaries and are forced to take on side jobs to make ends meet [2][3] Summary by Sections Background of Sanming Healthcare Reform - The Sanming healthcare reform was initiated in response to the financial challenges faced by medical institutions, particularly regarding the funding of healthcare services and the sustainability of medical insurance [2] - The government implemented several measures to reduce medical costs, including the cancellation of drug markups and the establishment of a universal healthcare insurance system, which has improved access to healthcare for the public [2] Current Challenges in Shandong - A county-level hospital in Shandong is struggling with delayed performance bonuses and salaries, with some medical staff resorting to side jobs due to financial constraints [3] - The hospital has had to cover a significant portion of medical insurance reimbursements, leading to a financial strain where over 50 million yuan has been paid out of pocket, representing nearly 25% of the hospital's total annual revenue [3] Key Features of Sanming's Reform - The Sanming reform emphasizes a shift from a "treatment-centered" to a "health-centered" healthcare system, which requires a change in the compensation structure for medical staff [5] - The reform has decoupled medical staff salaries from hospital revenue, moving towards a system where fixed salaries are prioritized over performance-based pay [6] Salary Structure in Sanming - The salary structure in Sanming includes a fixed salary component that constitutes 90% of the total, with only 10% linked to performance, effectively reducing the incentive for unnecessary medical procedures [6] - The reform has led to a unified salary system across different levels of healthcare institutions, promoting equity and efficiency in the healthcare workforce [6][7] Financial Mechanisms Supporting the Reform - Sanming's reform relies on two key financial pools: savings from reduced drug prices and surplus funds generated through bundled payment systems [8][9] - The implementation of a bundled payment system allows for more efficient use of medical insurance funds, encouraging hospitals to focus on preventive care rather than excessive treatments [9][10] Overall Impact of the Reform - The Sanming healthcare reform has successfully reduced unnecessary medical expenses, with approximately 9 billion yuan in excess costs eliminated, which has been redirected to support healthcare institutions [9] - The reform's success is attributed to a comprehensive approach that integrates various aspects of healthcare management, ensuring that financial incentives align with patient care quality [11]

Core Viewpoint - The article contrasts the successful healthcare reform in Sanming, Fujian, with the struggles faced by a county-level hospital in Shandong, highlighting the financial challenges and the impact of healthcare policies on medical staff and institutions [3][4]. Summary by Sections Background of Sanming Healthcare Reform - The Sanming healthcare reform was initiated to address the financial difficulties in the healthcare sector, focusing on reducing medical costs through various measures such as eliminating drug markups and establishing a comprehensive medical insurance system [5][6]. - The increasing demand for healthcare services due to chronic diseases and an aging population has led to rising healthcare costs, putting pressure on medical insurance funds, particularly in rural areas [6]. Key Issues in Healthcare Financing - A county-level hospital in Shandong has faced severe financial strain, with doctors reporting unpaid performance bonuses and resorting to side jobs to make ends meet. The hospital has had to borrow nearly 300 million yuan to maintain operations [6][7]. - The core issue stems from the medical insurance payment system, where hospitals are often left to cover the shortfall between what patients pay and what insurance reimburses [6][7]. Sanming's Innovative Compensation Model - The reform in Sanming emphasizes a shift from a "treatment-centered" to a "health-centered" healthcare system, requiring a change in the compensation structure for medical staff [7][8]. - The new compensation model significantly increases the fixed salary component for healthcare workers, reducing their reliance on performance-based pay linked to patient volume [8][9]. Integration of Healthcare Services - Sanming's reform has led to the establishment of a tightly integrated healthcare system that unifies county, township, and village medical institutions, promoting shared responsibilities and benefits [9][10]. - The integration aims to streamline operations and improve healthcare delivery, ensuring that resources are allocated efficiently across different levels of care [10][11]. Financial Mechanisms Supporting Reform - The success of the Sanming reform relies on two key financial pools: funds generated from reducing drug prices and surplus funds from bundled medical insurance payments [12][13]. - The implementation of a bundled payment system allows for more efficient use of medical insurance funds, incentivizing hospitals to focus on preventive care rather than excessive treatments [13][14]. Challenges and Future Directions - Despite the successes, the article notes that many county-level hospitals still face limited financial resources, making it difficult to sustain the reforms without ongoing funding support [12][15]. - The article emphasizes the need for a comprehensive approach to healthcare financing that aligns incentives with patient care quality, moving away from a purely treatment-focused model [15].

Core Insights - The proportion of outpatient visits at grassroots medical institutions in counties reached 63.4% in 2024, an increase of 0.5 percentage points from the previous year, indicating a growing preference among rural residents for local healthcare services [1] - The National Health Commission (NHC) emphasizes the importance of building county-level medical communities to enhance the tiered diagnosis and treatment system, which aims to improve healthcare accessibility and resource sharing [1] Group 1: Policy and Implementation - The NHC adheres to the policy of "strengthening counties and grassroots," continuously enhancing the service capacity of county medical communities to better meet the demand for convenient healthcare [2] - Key measures include strengthening the capabilities of leading hospitals, with over 10,000 clinical key specialties established in city and county hospitals, significantly improving previously weak specialties such as oncology and psychiatry [2] - The NHC has implemented a tiered support system, with urban hospitals sending approximately 180,000 personnel to support 1,750 county hospitals in 2024, and over 70,000 personnel have been stationed in grassroots facilities for more than six months [2] Group 2: Technological and Resource Development - The NHC promotes the integration of "artificial intelligence" in grassroots healthcare, with 80% of counties having established resource-sharing centers for imaging, ECG, and laboratory tests, leading to over 68 million remote medical imaging diagnoses this year [3] - The establishment of unified drug lists and collaborative medication use across county, township, and village levels has improved access to medications, with nearly half of the counties having set up central pharmacies that stock 800 to 1,200 types of drugs [3] - Over 97% of administrative villages with health stations are now covered by medical insurance, facilitating easier access to medications and reimbursements for rural residents [3]

Core Viewpoint - The health services in Xuecheng District have significantly improved, focusing on enhancing the quality and accessibility of medical resources, thereby increasing public satisfaction and health outcomes [1][2][3]. Group 1: Healthcare Infrastructure Development - The district has established 2 regional medical sub-centers, 4 community hospitals, and 10 grassroots medical institutions that meet the "Quality Service Grassroots Action" standards [2]. - A total of 32 model village health rooms have been constructed, and 147 village health rooms have been renovated according to the "Five Guarantees and Three Enhancements" standards [2]. - The district has implemented a tightly-knit medical community model, integrating various healthcare facilities to improve service delivery and patient management [2][3]. Group 2: Health Services and Community Engagement - The district has launched initiatives to enhance family doctor services, forming 246 service teams with a general population signing rate of 64.13% and a key population signing rate of 75.56% [3]. - Free screenings for cervical and breast cancer have reached over 19,000 women, achieving a coverage rate of 93.07% for the target population [4]. - The district has established 38 institutions providing infant care services, with a total of 2,365 available spots for children under three years old [4]. Group 3: Patient-Centric Initiatives - The district has introduced various convenience measures, such as "one registration for three days" and weekend outpatient services without registration fees, benefiting over 100,000 people [5]. - Remote medical services have been established, providing over 16,000 remote consultations to grassroots communities [5]. - The district has implemented a comprehensive medical insurance service network, with 346 insurance service stations created to facilitate access to healthcare [6]. Group 4: Quality Control and Compliance - The district has strengthened medical ethics education and conducted special rectification actions to ensure compliance among healthcare workers [6]. - A total of 360 medical institutions have been supervised, with 12 cases of non-compliance being investigated [3][6]. - The district has established a patient feedback mechanism, achieving a 100% processing rate for public complaints [6].