Family doctor: providing personalized service with people as the center
Aunt Xu, a 64-year-old who lives in Suzhou, signed a family doctor six months ago on the recommendation of the community health service center. "The community hospital took the initiative to find me and told me what the family doctor was doing. After I signed the contract, I was also included in the WeChat group of family doctors. I have a headache in my life. I can ask in the group at any time, as long as the doctor has time, no matter how late. " Aunt Xu said with a smile.
According to the data of the former National Health and Family Planning Commission, from May 20 16 to the end of 2017 10, the national family doctor contracting service has covered 500 million people, and the signing rate of the whole population has reached 35%.
It is worth noting that family doctors are not private doctors, and the contract service of family doctors in China is different from that in the west. Family doctors mainly undertake integrated services such as primary prevention and health care, diagnosis and treatment of common diseases and frequently-occurring diseases, referral, patient rehabilitation, chronic disease management and health management. Family doctors take people as the center, take the family as the unit, take the maintenance and promotion of overall health as the direction, provide long-term contract nursing, and integrate individual and group health care.
At the same time, a family only needs to sign up for a family doctor (team), and different family members can customize different services according to their personal situation. General residents can choose the basic service package, including basic public health, basic medical services and health management services, covering the diagnosis and treatment of common diseases and frequently-occurring diseases in Chinese and Western medicine, rational drug use, medical treatment path and referral appointment guidance, as well as the basic public health services and other public health services stipulated by the state. Some special people can choose personalized service packages, including but not limited to the combination of medical care, rehabilitation psychological guidance, family sickbed, home care, Chinese medicine "preventive treatment" service, remote health monitoring, on-site service and other personalized services featuring active services.
Since the introduction of family doctor contract service, local community health service centers in various provinces and cities have first promoted it for key groups. According to the Notice of the National Health and Wellness Committee on Doing a Good Job in the Contract Service of Family Doctors in 20 18, priority should be given to the contract service of key groups such as the elderly, pregnant women, children, patients with chronic diseases such as hypertension, diabetes and tuberculosis, and patients with severe mental disorders, and priority should be given to families with difficulties and families with disabilities.
However, residents other than the above-mentioned people can also apply for signing a family doctor. Based on the principle of voluntary contract signing, residents who are willing to sign a contract and have service needs can choose a family doctor (team) to sign a service agreement in the nearby grassroots health service institutions such as township hospitals, village clinics and community health service institutions. The agreement covers the contents, methods, duration, responsibilities, rights and obligations of both parties. The signing period is one year in principle. After the expiration, residents can renew their contracts or choose other family doctors (teams) to sign contracts.
Contract service: Special patients with affordable prices can provide on-site service.
With the introduction of family doctor contract service, the cost has become one of the most concerned issues for the people. How much does a family doctor with such a comprehensive service charge? Can ordinary people afford it?
The Guiding Opinions on Promoting Family Doctors' Contract Service issued by the State Council Medical Reform Office clearly points out that the family doctors' team collects the contract service fee every year according to the number of contract services, which is shared by the medical insurance fund, the basic public health service fund and the contracted residents' contributions. In addition, the contracted service object is required to collect the annual contracted service fee in accordance with the regulations, and shall not collect other fees through bundling services or hitchhiking sales. The specific standards and sharing ratio are determined by the local health and family planning, human resources and social security, finance, price and other departments through consultation according to the contracted service content, contracted residents' structure, basic medical insurance fund and the affordability of public health funds.
Taking Yantai as an example, according to the Notice on Defining the Payment Standard for Residents of Yantai Family Doctor Contract Service (Trial) issued by Yantai Municipal Price Bureau, Yantai Municipal Human Resources and Social Security Bureau and Yantai Municipal Health and Family Planning Commission, the basic contract service package is free, and the personalized contract service package includes 5 yuan, a child aged 0-6 years, pregnant women and diabetics 10 yuan/year, hypertensive patients and 25 yuan, an elderly person over 65 years old. The probation period is one year, from 2017101; In Nanjing, the price for a family doctor to sign a "basic service package" is 90 yuan for one person per year, of which the basic public health expenses are borne by 75 yuan and the contracted residents 15 yuan. Preferential policies will be implemented for rural low-income groups, "three noes", "five guarantees", low-income groups, key special care recipients and family planning special families among urban and rural residents, which are completely free.
Another issue that attracts the most attention is whether the family doctor must come to the house after signing the contract successfully. The answer is not inevitable.
"Among my signatories, 1/3 is a healthy population, 1/3 is a resident with high health risk factors, and the rest 1/3 is a patient with chronic diseases. For some elderly residents with mobility difficulties, such as some patients who need dressing changes, dying patients and the elderly, the family doctor team provides on-site services, but the number of visits per year does not exceed 50. " Yao Mi is a general practitioner in Beijing Xinjiekou Community Health Service Center. In the past two years, she has received more than 8,000 consultations through the family doctor contract service. With rich practical experience, he said that whether to provide on-site service needs to be evaluated. After all, the door-to-door service takes 1 hour at a time, and a team of six people comes to the door together, so there are very few medical equipment and medicines that can be brought to residents' homes, which is not conducive to the development of diagnosis and treatment.
Beijing Fangzhuang Community Health Service Center has 420,000 person-times a year, only 1 10,000 person-times. Wu Hao, member of the Chinese People's Political Consultative Conference and director of Fangzhuang Community Health Service Center, said that family doctors don't have to provide services. It is estimated that the cost of a door-to-door service is about 286 yuan per person. With the increase of labor costs, door-to-door service will become more and more expensive, and the income level of many residents is unbearable.
Under normal circumstances, patients can go to the contracted family doctor's office by themselves. If they have problems, they can also communicate with family doctors through the community family doctor service APP and WeChat. Family doctors also have a dedicated landline for telephone communication with patients. Only for a small number of patients who can't go to the clinic and need care, provide on-site service.
On April 28th, the General Office of the State Council issued the Opinions on Promoting the Development of "Internet+Medical Health", clearly proposing to use the "internet plus" mode to carry out the contract service of family doctors, and provide online health consultation, appointment referral, chronic disease follow-up, health management, prescription extension and other services for contracted residents. And for some chronic patients with long-term stable contracts, if drugs need to be adjusted or there are no corresponding drugs at the grassroots level, family doctors can give him some prescriptions online and deliver the drugs directly to their homes through third-party distribution, so that patients can enjoy real convenience.
Source: People's Health Network