Ningbo: "small doctor" move big changes

The 2016-08-05

Source: health

Chief journalists - Our reporter moves Shui-gen li correspondent Zheng Chunsheng -

The family doctor, is one of the key words of health reform this year. Sign in ningbo city, zhejiang province, the family doctor service is not an isolated propulsion system, but is embedded in the health chain, and become one of the crucial link. As family doctors become the gatekeeper, residents' health and medical and health resources allocation and the costs of health administrator, the system has become extremely important gripper, is leveraged bigger change.

S "1 + 8" farewell fragmentation

About ningbo by contract of family doctor system services, the city health and family planning commission director of China think that the biggest bright spot is that this reform led to the whole reform the exploration of deep water area, USES a set of combination, from the end of 2014 to April 2015, to support the family doctor system of "1 + 8" file intensively. At the same time, the medical triplets widely established, promoted the resource sink, enhanced the grass-roots style. Conditions mature, only family doctor comprehensive.

Reporters found that in the combination of "1 + 8" files, "1" is on the top floor of the family doctor system design, "8" looked at the grassroots medical institutions are slow disease outpatient medication management, community health service price, shall be the implementation of the family doctor service health policy and the family doctor service content, service specification, performance appraisal, etc., these contents are basically involved in each health related government departments. Ningbo city for example, the family doctor service is temporarily set at 150 yuan per person per year, by the medical insurance fund, for the basic public health services and to sign individual citizens share the 50 yuan each, individual to assume part of the disadvantaged groups paid by social assistance special funds. In the future to raise the level of financing, mainly borne by the medical insurance fund. China says, if not the government vigorously promote and get the support of so many department, can't imagine the family doctor system could be leveraged health-care reform important fulcrum.

To make the infrastructure contract services for patients and attractive, the administrative departments for public health and community health service institutions to establish scientific and reasonable evaluation system, arouse the enthusiasm of the family doctor is crucial.

Haishu district doctor Simon street community health service center, Mr. Wu told reporters that nearly 400 slow signing for his patients, he was obliged to provide medical expert outpatient service, door-to-door visits, reservation booking, arrange in turn, to set up the domestic sickbed, health consultation and other services. Center also encourage family doctors with superior doctors to turn on signing for joint operation, in order to health of residents to carry out the whole course management. And each service is also endowed with the corresponding score, he will depend on the signing of performance evaluation scores.

The reporter understands, ningbo has established the city and county, institution three-level evaluation system of performance appraisal, signing, emphasis family doctor residents first diagnosis rate, referral rate, XuQianLv, slow disease control effect, such as index, the family doctor service fee is not included in the total unit performance salary, independently by each unit allocation. Simon street community health service center, for example, the center takes out from inside the contract service charge 50% for incentive gp team, according to the basic medical and public health service, personalized service module, item by item, inspection, etc. Says Lin Ping, director of the center to participate in the signing service family doctor income can be increased by 20% on average, 120000 / year.

"To make reform with long heart." In China, once appear, go after signing quantity, ignoring the people demand, financing channels for a single, lack of incentive and evaluation mechanism, policy can easily lead to become a mere formality. "When we started, just want to be able to avoid fragmentation reform."

S point grading diagnosis and treatment of acupuncture points

Yao, a 65 - year - old old man with diabetes. Before, he'll run downtown hospital every time. Since last year and tzu town center hospital family doctor Huang Meifang signed up, old man yao the effort. "The doctor is looking for the yellow doctor, no appointment, etc. Used to go to large hospital to take medicine, community has now, medical expenses is much lower, and a 2 months can match good medicine. Need a doctor to come can call, if you want to go to large hospital, the doctor huang will contact for me."

Ningbo health and family planning commission, deputy director of the guo-ping zhang thinks, if the family doctor is the people to solve the common disease, frequently-occurring disease, so the family doctor system to cure is the medical service system. "Point the meridians, constructs the hierarchical diagnostic order would be easy to follow."

Grassroots service ability is short board, is a common problem across the face. Guo-ping zhang said, at present, the city's urban grassroots health institutions establish regional medical institutions with urban tertiary hospital all consortium, grassroots, a total of 52 fixed city-level experts of community clinics. Relying on municipal general hospital in chronic disease clinical guide training base in training, the family doctor of common chronic diseases disposal ability. 11 counties (cities) in the city, the area was built in the county as the unit image consultation center, medical examination, ecg consultation center, disinfection supply center, a total of 40, for family doctors to carry out the medical test to check the building unified platform. These aspects of homogeneity, the family doctor system question also gradually disappear naturally. Turn (version 2) on (version 1)

Relying on the wisdom "couplet of online medical health security system is built, ningbo also not far behind. The city has been basically completed, interconnection and resource sharing of regional health information platform, and establish the platform cloud hospital since 2014, from "the cloud" for outpatient, hospital, two-way referral business inspection check. Secondary and tertiary hospitals in the city on cloud platform set up a remote medical service center hospital, to establish "cloud office" community health service centers, patients can enjoy medical service within the community.

Announced the end of December 2015, the Chinese academy of social sciences in China urban basic public services force evaluation blue book, according to the medical and health satisfaction in 38 cities in China's overall rankings, ningbo ranks second, rose four places than in 2014.

S to the "health centered" transformation

Is Liu Dashu signing of jiangbei Kong Pu street residents, but also a chronic disease. "Family doctor asked the condition of my health so carefully, also I made out a list, list what to eat, what to eat less, so smart." Health management files, like Liu Dashu Qian Ying community doctors office has prepared hundreds in the computer. Each report is tailored according to individual condition. To go out for the inconvenience of patients, the traditional telephone, emerging WeChat is the method of doctor-patient communication.

Ningbo China said the construction of "health" is a big target, and the family doctor system is pushing medical and health service system from "to the disease as the center" to "on health as the center". The original is given priority to with public hospitals, focus on diagnosis and treatment of acute disease, service system, has been difficult to meet the challenges of the aging society and chronic diseases morbidity a trend of blowout of the reality. Effective public health services, disease prevention in the first place, don't get sick, sick less and less complications, is to improve the residents' health level of the main path.

With the guidance of "health centered" concept, the family doctor and perfecting performance evaluation indicators. Jiangbei health family planning bureau deputy director Yang zhenyu, jiangbei family doctor service performance evaluation method on the basis of ningbo file has carried on the elaboration, clear in the effect index, high blood pressure patients blood pressure control rates of 40% or higher, high blood glucose in patients with blood sugar control 35% or more, signing residents satisfaction 85% or higher. Also require focus groups (the elderly, patients with chronic diseases, 0 ~ 6 years old children, maternal, disabled) signed service rate of no less than 50%.

Guo-ping zhang said that the city was the first to move across the country medicare pay for signing the family doctor service, is to promote transformation of medical insurance to health insurance. "Based on disease" of the traditional medical model and medical model is given priority to with advanced treatment, to improve the health level limited, waste the limited resources. Will tilt to prevention and basic health care funds, not only can promote health and reduce disease, on health care itself is also a worthy of the name "savings plan". Way individuals to paid in addition, defined the responsibilities of individuals is a healthy body, help to achieve both doctors QuanZeLi supervise each other, for self management made positive attempts to reduce health costs.