May 19 is the 8th World Family Doctor Day. Recently, the State Council decided to develop "Internet+Medicine and Healthcare" as a favorable policy for the people, and the contracted services of family doctors will be further enhanced through the "Internet+" method.
Family doctors: people-centered personalized services
Aunt Xu, 64, who lives in Suzhou, has signed an appointment with a family doctor six months ago on the recommendation of a community health service center. "The community hospital took the initiative to find me and tell me what family doctors are all about, and when I signed up, they even pulled me into the family doctor WeChat group. I have a headache in life, at any time can ask in the group, as long as the doctor has time no matter how late will reply." Auntie Xu said with a smile on her face.
Data from the former National Health and Planning Commission shows that China's family doctor contracting service was launched in May 2016, and as of the end of November 2017, the nation's family doctor contracting service had covered 500 million people, with the contracting rate for the entire population reaching 35 percent.
It is worth noting that family doctors are not private doctors, and China's family doctor contracting service is different from that of the West. Family doctors are mainly responsible for preventive health care, diagnosis and treatment of common diseases, referral, patient rehabilitation and chronic disease management, health management and other integrated services at the grassroots level. Family doctors provide long-term contracted care and integrate individual and group health care in a human-centered, family-oriented, and overall health maintenance and promotion direction.
At the same time, a family only needs to sign up for one family doctor (team), and different services can be customized for different family members according to their individual conditions. General residents can choose the basic service package, including basic public **** health, basic medical services and health management services, covering Chinese and Western medicine diagnosis and treatment of common and multiple diseases, rational use of medication, guidance on pathways to medical care and referral appointments, as well as the national basic public **** health service program and other public **** health services stipulated. Some special groups can choose personalized service packages, including but not limited to health care integration, rehabilitation and psychological guidance, home hospital beds, home care, Chinese medicine "treatment" services, remote health monitoring, door-to-door services and other personalized services featuring active services.
Since the introduction of the family doctor contracting service, local community health centers in various provinces and cities have been promoting the service to key populations. According to the Notice on Doing a Good Job of Family Doctor Signing Service in 2018 published by the National Health and Health Commission, priority is given to the signing service for key groups such as the elderly, pregnant women, children, and patients with chronic diseases such as hypertension, diabetes, tuberculosis, and patients with severe mental disorders, and priority is given to covering families in difficulty, families of people with disabilities, and so on.
However, residents other than those mentioned above can also apply for signing a contract with a family doctor. Based on the principle of voluntary signing, residents who have the willingness to sign a contract and the demand for services can go to nearby township health centers, village health offices, community health service organizations and other grass-root level health service organizations to choose a family doctor (team) to sign a service agreement, which covers the content, mode, duration and the responsibilities, rights, obligations, and other matters of the two sides of the contracted services. The agreement covers the content, mode and duration of the contracted services, as well as the responsibilities, rights and obligations of both parties and other matters. In principle, the contracting period is one year, and after the expiration of the period, residents can renew the contract or choose other family doctors (teams) to sign.
Contracted services: affordable prices, home services for special patients
With the introduction of family doctor contracted services, the cost has become one of the people's most concerned issues. How do family doctors charge for such a comprehensive service, and can ordinary people afford to see them?
The State Council Healthcare Reform Office issued the "Guiding Opinions on Promoting Family Doctor Signing Service", which clearly states that the family doctor team will collect the signing service fee on an annual basis according to the number of people signed up for the service, which will be shared by the medical insurance fund, the basic public ****health service funds and the contracted residents' payment **** the same way. And it is required that, in addition to the annual contracted service fee charged to the contracted service recipients in accordance with the regulations, no other fees shall be charged by way of bundled services or ride-along sales. Specific standards and sharing ratio by the local health planning, human resources and social security, finance, price and other departments according to the content of the contracted services, the structure of the contracted residents as well as the basic medical insurance fund and public **** health funding affordability and other factors to determine the negotiation.
Taking Yantai City as an example, according to the "Notice on Clarifying the Payment Standard for Contracted Residents of Yantai Family Doctor Contracted Services (Trial)" issued by the Yantai Price Bureau, Yantai Bureau of Human Resources and Social Security, and Yantai Commission of Health and Family Planning, the basic contracted service package is free of charge, and the individualized contracted service package Children aged 0-6 years old are 5 yuan/year, pregnant women and diabetic patients are 10 yuan/year, hypertensive patients are 25 yuan/year, and 30 yuan/year for seniors over 65 years old. Since October 1, 2017 on a trial basis, the trial period of one year; in Nanjing, the family doctor contracted "basic service package" price for one person a year 90 yuan, of which the basic public **** health funds to bear 75 yuan, contracted residents to bear 15 yuan. For the rural filing card low-income people, urban and rural residents in the "three noes", "five guarantees", low-income insurance, key preferential objects, birth control special families and other difficult groups to implement preferential policies, completely free of charge.
Another issue that has attracted the most attention is that after signing a contract, does the family doctor have to make house calls? The answer is not a given.
"One-third of my signatories are healthy people, one-third are residents with high health risk factors, and the remaining one-third are patients with chronic diseases. For some residents with limited mobility and advanced age, such as some patients who need trauma dressing changes, terminally ill patients, and elderly people, the family doctor team only provides door-to-door service, but the number of visits does not exceed 50 times a year." Yao Mi is a general practitioner at the Xinjiekou Community Health Center in Beijing, and has received more than 8,000 visits through the family doctor contracting service in two years. Practice experience, he said, to provide door-to-door service needs to be assessed, after all, door-to-door service once to take up an hour, and is a team of six people to go door-to-door, can be brought to the residents' homes of the medical equipment, medicines are very few, and is not conducive to the diagnosis and treatment of the development.
Beijing's Fangzhuang Community Health Center has 420,000 visits a year, with only 1,000 visits. Wu Hao, a member of the National Committee of the Chinese People's Political Consultative Conference (CPPCC) and director of the Fangzhuang Community Health Service Center, said that a family doctor doesn't always have to make house calls to provide services. It is estimated that the cost of a door-to-door service is about 286 yuan per person, and as labor costs rise, door-to-door services will become more and more expensive, which is difficult for many residents to afford at their income level.
Generally, patients can go to their contracted family doctors on their own, and they can also communicate with their family doctors through the community's family doctor service APP and WeChat, as well as special landlines used by family doctors to communicate with patients on the phone. Only for a small number of patients who are unable to come to the clinic and need nursing care will home services be provided.
On April 28, the General Office of the State Council issued the "Opinions on Promoting the Development of "Internet + Healthcare"", making it clear that "Internet +" should be utilized to carry out family doctor contracting services and provide online health consultation, appointment referral, chronic disease care and other services for contracted residents. It is clear that the "Internet Plus" method should be utilized to carry out family doctor contracting services, providing the contracted residents with online services such as health consultation, referral appointment, chronic disease follow-up, health management and extended prescription. And for some long-term stable chronic disease contracted patients, if they need to adjust the medicine or the grassroots level does not have the corresponding drugs, family doctors can give him some online prescriptions, and through the third party delivery method directly to the home delivery of drugs, so that patients can enjoy the real convenience.
Source: People's Health Network