Release date: 2016-07-11 Recently, the State Council's Medical Reform Office and other six departments jointly issued the "Guiding Opinions on Promoting Family Doctors' Contracting Services" (hereinafter referred to as "Guiding Opinions"). The "Guidance Opinion" proposes that by 2020, we will strive to expand the family doctor contract service to the entire population, form a long-term stable contractual service relationship with residents, and basically realize the full coverage of the Chinese dilemma of family doctor contract service family doctor contract system. Family doctors are the “gatekeepers†of residents’ health, and the contract service system is a very good system. However, even if you sign, do you make an appointment? --Ideal is full, the reality is very skinny! why? On the one hand, the people's trust in family doctors - the weak ability of medical services, on the other hand, the habit of the people "naturally" to go to large hospitals to see a doctor for medical treatment - lack of strong institutional leverage. Whether in a market-based country or in a welfare state, the family doctor signing system is a basic national policy. In the case of a market-oriented United States, the market mechanism has prompted residents to choose “private doctorsâ€. In the United States, the process of seeing a doctor is actually determined by the patient's form of insurance. There are many forms of insurance in the United States, and the broader ones are HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). The HMO requires the insurer to choose a family doctor. The referral requires family doctors' approval and recommendation. The insurer's visit needs to be carried out within the insurance coverage network. The PPO does not stipulate a family doctor. The referral does not require a family doctor's recommendation, but the insurance company needs to agree; the insurer can jump out of the insurance coverage network to see other doctors, but such self-paying fees will be high. Overall, HMO insurance costs are relatively cheaper than PPO. Therefore, the insured is still "consciously" choosing his own family doctor. The other is "difficult to see a doctor", because I don't know who to look for, so I "consciously" choose my own family doctor. There are 1.2 billion visits per year in the United States, 81% of which occur in family doctors' clinics. In the case of the welfare country of the United Kingdom, they implement a general practitioner (GP) “gatekeeper†system, and all residents must register with the general practice before they can enter the health system. It is a necessary condition for British people to enjoy free medical benefits when they are sick. In addition to emergency department, UK hospitals do not directly receive general outpatients. Because all outpatients in public system hospitals are referred by GPs, the government has purchased the services of general practitioners. Without the referral of general practitioners, patients can't live in hospitals and can't see specialists. Although the administrative department has no rigid requirements for the referral rate of general clinics, the referral rate will be used as an indicator of clinic quality evaluation. Excessive referral rate will also affect the reputation of the general clinic. Therefore, GP generally does not easily refer patients to the hospital (the referral rate is about 10%). Of course, GP is generally not easy to refer to and has its strength. In the UK, GP is required to undergo 10 years of standardized training in order to obtain independent practice qualifications. It has strong clinical ability and can handle common specialist diseases including pediatrics. Even if the GP can't handle it, sometimes it is not necessary to refer the patient to the hospital. Instead, the GP will consult the specialist for treatment and then dispose of it. If you really need a referral, the GP must write a referral letter to the specialist to describe the patient's basic condition and send the referral letter to the specialist through an information system, email or traditional letter. The general practice clinic helps patients to make appointments for check-ups or registrations, and is responsible for notifying patients of specific times and locations, and patients do not need to run by themselves. The patient has the right to request a referral to the designated hospital, but in general, the patient rarely chooses the hospital himself because of his trust in the GP. About 90% of UK outpatient services are provided by general practice clinics, with an average of 5.5 visits per year per year in general practice clinics (5.6 times per year in China). Why is it so difficult for family doctors to sign up in our country? Only in China, there are grades between doctors and hospitals. In fact, grading hospital services is a concept of feudal hierarchy. American hospitals have no grades and a balanced ability. They are based on the standardized operation of medical services and the standardized training of doctors. For example, patients with the same pneumonia enter the general community hospital and go to the Harvard Hospital on the tall, the inspection, diagnosis, medication, hospitalization time, etc. are the same. It is precisely because the same disease is treated in a small hospital in the community that is similar to that in a large hospital. Therefore, it is not necessary for the patient to rush to the large hospital. This is why the American people are willing to see a doctor in a local community hospital instead of smashing their heads to Harvard and Mayo. However, homogenized, high-level general practitioners are precisely the weakness of China. China’s tertiary medical system is in name only, but its administrative access is strict. The technology access system, the basic drug system and the hospital grade review restrict the development of primary health care institutions. The level of primary medical institutions is low, the technology can't be developed, the medicines are incomplete, the patients go to the big hospitals, the primary medical institutions want to keep the patients "heartless"; the same doctor at different levels of medical institutions, the value is different, the doctors go to the big hospital, Primary medical institutions want to keep doctors "intentional". The patient ran away, the experience accumulated less, the development platform of the primary medical institutions was also small, how can the doctor not run? The doctor ran away. I don’t want to go to the hospital right away. The difference in medical insurance payment is not big. How can the patient not run? Primary medical institutions are caught in a vicious circle of both doctors and patients. After all, we are not "ready". The government's guidance and market promotion are not organically combined, and even the two are confrontational. First of all, if it is government-led, it should not forget the "initial heart" of medicine - prevention is the mainstay, try to make residents less sick. So, how can we do this by providing the basic medical services from the current meager public health funds and community doctors/general practitioners who would otherwise be unable to perform their skills? If it is in the market, it should abolish the technical access and hospital grade so that the doctors do not have different values ​​in different hospitals or clinics, and the technology and doctors go, the basic drugs are also decoupled from the hospital level. Second, develop a contracted basic medical service package to link its services to prices, and the quality of service is linked to key core indicators (KPIs). This is the basis for packaged payment and assessment of family doctors. Third, do a good job of propaganda and let residents understand the value and significance of family doctors. This is the first step in building a family trust for residents. Fourth, medical insurance and insurance companies should follow up and establish a payment system to encourage patients to choose a family doctor, rather than encouraging patients to stay in hospitals and go to large hospitals to see outpatient clinics. Whoever pays, whoever has the right to speak, does not want to "offend" the insured, and "good husband" will eventually have to pay the price. It is necessary to give full play to the leverage of the payment system. Fifth, actively promote the transformation of the functions of large hospitals and control the expansion of public hospitals. At present, the lack of financial compensation has led the hospital to become bigger and stronger in order to survive and develop, and even "tolerate the size." The high dam built by this solid monopoly system is filled with huge medical resources, but it cannot be released under the dam. Doctors should be promoted to practice more, allowing doctors in large hospitals to open doctors' workshops at the price of labor value and encourage them to sign contracts with residents. Sixth, fundamentally strive to cultivate general practitioners and make them respected by society and peers. Most of the foreigners, residents and specialists are very respectful to the general practitioners, and the income will not be so bad as our country. In the United States, GPs have a higher social status, specialists respect them, and GPs work with specialists, community care programs, clinical support, and patient and medical teams are an interaction. Seventh, actively promote Internet + community medical care, combine traditional community medical care, public health and the Internet, and make family doctors sign up to become network-signed general practitioners. Network GPs are a viable path, and there are currently no legal barriers, only conceptual barriers. The network-signed general practitioner system is a form of multi-win organization under "Internet +". It not only rationally divides and divides patients, reduces the blindness of patients' treatment, but also improves public health literacy, making medical insurance funds more reasonable and achieving "doctor wins." , residents win, the government wins." Therefore, if the government signs up for the government's expenditures on the network, the government must make reasonable expenditures. Here, I would also like to mention that China has not yet established a scientific chronic disease management model. In the United States, 80% of diseases are resolved in outpatient clinics, and general practitioners are the main force. This chronic disease management has formed a system and is supported by organization and policy, such as chronic disease care mode, peer support management mode, and professionals. The group communication management mode, self-management ability training program, peer counseling, etc., are basically out of touch in China. Therefore, in order to comprehensively promote the family doctor contract service system, the government must adjust from the aspects of policy support, salary support, and task design. Source: Liao Xinbo's blog Micro Capillary Tube,Vacuum Micro Capillary Tube,Micro Blood Collection Tube,Micro Blood Collection Vessel Ningbo Siny Medical Technology Co., Ltd , https://www.sinymedical.com