The Implementation Status And Development Strategy Of Ambulatory Surgical Procedures Based Supply-side Reform

Objective: Explored the characteristics of national and provincial ambulatory surgery policies and the use of policy tools,investigated the practical experience and shortcomings of ambulatory surgery in Sichuan Province,and provided suggestions for promoting ambulatory surgery.Methods: Time and sequence analysis,policy tool analysis,policy tool content analysis,progressive decision model and comparative analysis were used to analyze national and provincial ambulatory surgery policies.The empirical analysis and comparative analysis were used to evaluate the practice of ambulatory surgery in Sichuan general hospitals.Results: Less research was conducted on day surgery policies.The ambulatory surgery policy can be divided into policy blank period(before 2012),exploration period(2012-2014)and promotion period(after 2015).The use of ambulatory surgery policy tools accounted for more than 70% of environmental policy tools,supply-based policy tools accounted for 10-20%,and demand-based policy tools accounted for less than 7%.From the perspective of policy tools,the content of environmental policy tools lacked financial support,the content of supply-oriented policy tools lacked land use guarantees,and the content of demand-based policy tools only had pilot/demonstration projects.The provincial-level policy of ambulatory surgery was based on national policies and has developed national policies.It emphasized the concept of team building,research and development information platform,and strengthened the training of medical personnel.However,some provinces had policy gaps or shortcomings.A total of 38 general hospitals in Sichuan Province carried out daytime operations,and 12 established independent ambulatory surgery centers.The total number of ambulatory surgery operations exceeded 60,000,and the proportion of ambulatory surgery accounted for 7.42%.Most medical institutions carried out fewer diseases,and one-third of hospitals had an ambulatory surgery rate of less than 1%.West China Hospital’s access system and emergency plan were perfect and enforced,and were at the leading level in China.Deyang People’s Hospital and Mianyang Central Hospital actively strengthened the daily supervision of ambulatory surgery,and the ambulatory surgery was better developed.There are still some areas where medical technology was weak in daytime surgery,especially in county and district medical institutions.It had not been carried out because it had not been included in medical insurance reimbursement.Some medical institutions had no motivation because their bed occupancy rate was not high.Conclusion: The supply-oriented policy tools in the ambulatory surgery policy tools were used less,the environmental-based policy tools were used more,and the policy tools were not perfect.In the practice of ambulatory surgery,there was a huge gap in the medical technology of different levels of medical institutions.The medical insurance support policies vary from region to region,and the relevant departments didn’t pay enough attention to them,resulting in large regional differences in ambulatory surgery.During the development of ambulatory surgery,ambulatory surgery needs to be released as an independent policy.Further strengthen the use of supply-oriented policy tools,plan and train surgeons in advance,and strengthen team building.Focus on medical quality,strengthen the supervision of ambulatory surgery,and develop a list of diseases and surgical recommendations for ambulatory surgery that meet the provincial conditions.Strengthen linkages with the medical insurance department and promote payment by disease type.Innovative ambulatory surgery extension service to build an ambulatory surgery model of “big illness in hospital,rehabilitation in the community”.