For most families in China, family doctor services are still a strange concept. On June 6, the "Guiding Opinions on Promoting Family Doctors' Contracting Services" jointly formulated by the State Council's Medical Reform Office and the Health Planning Commission were officially released. According to the opinion, by 2017, the coverage rate of family doctors' contracting services will reach more than 30%, and the key population contracting services will reach more than 60%. By 2020, we will strive to expand the family doctors' contracting services to the whole population, and form a long-term stable contractual service relationship. Realize the full coverage of the family doctor service system.
Before the joint publication of the seven departments, the Central Deep Reform Group meeting has formulated quite specific guiding principles and action roadmaps for promoting family doctor contracting services. From the launch of the family doctor service pilot in 2011 to the introduction of comprehensive implementation advice today, this is the traditional “routinum†for safe and decisive advancement in key areas. This means that family doctor services have risen to a national level strategy and are an important part of a new round of health care system reform. So, what is the family doctor service? Can you shoulder the heavy responsibility of a new round of medical reform? Can many contradictions in the public health field be resolved? How can the people feel the reform dividend? These "indicators" will determine the progress of the family doctor service, and also determine the progress and efficiency of the medical reform.
What are the connotations of family doctor services?
For family doctor services, Chinese families who have not been in contact with each other usually take a picture of a family private doctor in a foreign film and television drama. In fact, from the experience of family service pilots in Shandong, Shanxi, Beijing, Shanghai and other places, the two are not the same. In Shanghai alone, during the four years from 2011 to 2015, the number of permanent residents in the pilot area reached 10.273 million, and the signing rate was about 44%. The contracted resident is not entitled to the treatment of a family private doctor's on-site service. In fact, even if you sign a contract, in most cases, you still need to make an appointment to see a doctor. Usually, the family doctor will not come to the door.
From the composition of the family doctor, the general practitioners in the primary health care institutions, the competent township health doctors and the retired clinicians in the public hospitals are the main subjects of the family doctors. From the perspective of the clients, the family doctors focus on the infants and pregnant women. , chronic diseases patients and the elderly population; from the perspective of medical programs, family doctors mainly provide prevention of common diseases and basic medical services. In other words, primary diseases, common diseases, basic prevention and treatment are the main services of family doctors.
So, where are the benefits of family doctors? From the point of view of the contracted residents, since the family doctors correspond to a relatively fixed group, the patient's medical records are relatively complete, and a more accurate prevention and treatment plan can be given to control the patients and the patients. The waste of medical resources caused by repeated consultations and repeated medical examinations at different doctors avoids delays caused by blindly choosing hospitals and doctors. Judging from the rational distribution of medical resources, at present, because there is no distinction between basic medical resources and major disease resources, people usually choose to go to a large hospital for medical consultation, which leads to overcrowding in large hospitals, expensive medical treatment, and difficulty in seeing a doctor. However, doctors have too much work load, and they have to receive consultations for both large and small diseases. They also disperse medical resources that should be concentrated on major diseases and reduce the level of treatment. In addition, in the case of tension between doctors and patients, some doctors may consider taking over-medical means such as no disease or treatment, small illness or major treatment, or refuse to receive patients with complicated conditions, either for the sake of interest or for self-protection. As a result, the contradiction between doctors and patients has further intensified, and medical insurance costs cannot be used reasonably. The family doctor system allows minor illnesses to be resolved in primary health care institutions, which provides a reasonable distribution and guidance of medical resources. At the same time, it can prevent excessive medical treatment from the source and establish another fence for medical insurance control fees.
It can be said that the value-added of the family doctor system lies in many aspects: the contracted residents can solve the prevention and treatment needs of the basic diseases in close proximity, and purchase the whole process of health management services through the market mechanism; the primary health care institutions can play the primary and common diseases. The role of prevention and treatment, the implementation of prevention-oriented health work guidelines, while improving income and work enthusiasm, to prevent brain drain; the medical resources of large hospitals can be more rationally distributed, reducing excessive work pressure, will Focus on the treatment of major illnesses and improve the level of cutting-edge medical care. This grading treatment pattern has expanded the path of a new round of medical reform.
Can the family doctor system incite new medical reform?
The reform of the medical system involves a complex level. Behind the two main propositions of the medical and health management system and the drug production and circulation management system, it involves how to define the public attributes and market attributes of medical and health institutions, the research and development, circulation, and price mechanism of drugs. How can we call the surname "public", whether private hospitals can become a benign competition subject, and a series of topics from macro to micro.
Under this circumstance, the grading diagnosis and treatment pattern of “community first diagnosis, two-way transfer, rapid division and treatment, up and down linkage†is proposed to neutralize various contradictions in the field of medical and health, optimize the environment for medical reform, and deepen the next round of medical reform. Create good conditions. The implementation of the family doctor system - the establishment of a grading diagnosis and treatment pattern - to promote a new round of medical reform, clearly presented the steps of a new round of medical reform in the decision-making level. It can be said that the implementation of the family doctor system is the first step of a new round of medical reform, and it is a precondition that must be created.
Then, can the family doctor system play the expected role of inciting medical reform? First, it depends on whether the family doctor system has enough human resources to promote public health care. At present, there are more than 2.8 million registered doctors nationwide. According to the proportion of doctors per 1,000 population, it has reached 2.06 in 2013. This ratio is lower than that of the United States and the European Union, but compared with the global average, it is not low. According to the statistics of the Chinese Medical Doctor Association, in recent years, it is still growing at a rate of 4.4%. In other words, it basically has the conditions for implementing the family doctor system. However, since family doctors mainly look at primary diseases and basic diseases, they mainly need all-tech technology rather than specialized technology, so it is necessary to look at the proportion of general practitioners. In the past, the training of general practitioners was not taken seriously, so the gap was large. According to the goal of 2-3 general practitioners per 10,000 people by 2020, the current gap is as high as 100,000 to 300,000 people, and talent construction needs to be strengthened.
Secondly, it depends on whether the family doctor system can be mobilized and the medical team is actively joined. The “Guiding Opinions on Promoting Family Doctor Contracting Services†has introduced a number of incentives to help medical teams join in response to the growing need for family doctors.
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