The term "graded diagnosis and treatment" is familiar in the industry, but so far there are still many scholars do not recognize the concept of graded diagnosis and treatment, in fact, graded diagnosis and treatment does originate in China, and there is no such concept in the world. In foreign countries, continuous medical care and integrated medical care are often talked about academically, but due to the influence of China, the World Doctors Organization began to use the concept of hierarchical diagnosis and treatment after China proposed it. The World Health Organization has also affirmed the influence of China\'s hierarchical diagnosis and treatment to the National Health and Family Planning Commission, but from an international point of view, the world does not have this national condition of China, and there is indeed no precedent for such up-down hierarchical treatment like China.
Chinese hierarchical diagnosis and treatment
Developed countries have questioned our medical field, the process of medical treatment should be effective management of patients, where patients go to see a doctor should be regular, can not rush to the doctor, but there is no traffic light on the way to see a doctor in China, if you have money to go where to go, which is unthinkable in foreign countries. This situation is like when we go to a city, there are many cars on the city road but there is no traffic light, in fact, medical treatment is also a reason. From an international point of view, the better medical system, there are primary medical institutions or family doctors, so we believe that the so-called hierarchical diagnosis and treatment is to establish a managed continuous service, of course, the establishment of this managed continuous service needs a series of policies, supporting support, is hierarchical diagnosis and treatment.
Hierarchical diagnosis and treatment was suddenly accelerated in 2014, because the statistical yearbook of 2014 reflected that the average bed utilization rate of tertiary general hospitals in 2013 reached 103%, that is to say, the number of hospitalized patients in the national statistics was far greater than the number of beds from the perspective of utilization rate, and extra beds were the norm in tertiary hospitals, resulting in overcrowding. This is very abnormal, our grassroots patients announced to rush to the big hospital, behind the big hospital\'s talent, capital, technology are all crowded into the top three hospitals, but this is not sustainable. Therefore, from 2014 and 2015, the intensity of graded diagnosis and treatment was increased. In 2016, graded diagnosis and treatment became the primary task of medical reform, and graded diagnosis and treatment led the overall situation.
Diagnosis and treatment according to disease classification
In 2013, the medical insurance revenue of a province failed to meet the expenditure, and it took the lead in implementing graded diagnosis and treatment, which was also questioned by many different people. Then, through continuous adjustment and improvement of the policy in successive years, graded diagnosis and treatment by disease was implemented in the whole province at the beginning, and after 2015, graded diagnosis and treatment were implemented. That is, each county determines a number of diseases according to its own medical level and ability, for example, the county can see 99 diseases, then these 99 kinds of management, requirements, assessment according to hierarchical diagnosis and treatment, as for other diseases do not require hierarchical diagnosis and treatment. As the regional gap is relatively large, the level of medical differences between central cities and pastoral areas is relatively large, the use of a one-size-fits-all approach is difficult to adapt to all, after reform has a strong adaptability, which is valuable experience.
If we want to send patients to the grass-roots level, we cannot use coercive methods, so we must enhance the service capacity of the grass-roots level. In order to cooperate with graded diagnosis and treatment, payment standards should be dynamically adjusted, and finally, the supply guarantee ability of drugs should be strengthened, so that the distribution rate of drugs can reach more than 97%.
Hierarchical diagnosis and treatment means that many patients in the primary diagnosis and treatment, medicine is the doctor\'s tool, if the medicine is not in place, there will be more problems. Therefore, from the perspective of development, the pharmaceutical industry should find its own positioning, adapt to the reform phase, and transform and grow.
Hierarchical diagnosis and treatment and chronic disease management
Graded diagnosis and treatment should start with chronic diseases and use incentive methods rather than coercive methods. For example, many patients want to find a big expert to see a doctor, the expert prescribes medicine, a few years later the patient comes back, the complications of diabetes are very serious, the expert is diagnosed and found that the prescription is still in use a few years ago. Experts can only make a clear diagnosis and give a treatment plan, but the usual inspection, monitoring and guidance need to be done, so the combination of big experts and grassroots.
A community director said that they do graded diagnosis and treatment even real estate companies will go, because they are concerned about the future of the combination of medical care and real estate, in fact, the real graded diagnosis is the adjustment of the layout of the entire medical service system, the entire patient flow, capital flow, policy flow of re-gathering, re-shuffling, many people have seen this sign. Three teams have been set up at the grassroots level. Each team has a larger number of specialists, a general practitioner in the community, and a health management department, which is dedicated to developing such a position. There are nurses, including those who go to the grassroots system, and some doctors who are rehired to take special examinations and issue certificates after the examination. Specialized in the daily management of chronic patients.
Chronic disease patient management can be done to some communities that we often go to, all the doctors are managed, and there are problems at any time. There is an example, in a place where many nurses have the key of the contract to serve the target, many people give him the key of the home, so that he can often come to the home to serve. This hierarchical diagnosis and treatment in the local area before not want to doordoor service, because the door can not be knocked, the people do not believe him, sarcasm, sarcasm, and even scold them, so they look for streets, communities, find ways to find acquaintances to bring them in to do work, and now there are problems in the streets and communities, there is a petition to solve the problem, please the general practitioner, because the general practitioner takes good care of the residents, everyone trusts.
The relationship between graded diagnosis and treatment and drugs
There is a two-director system, the first director is the expert of each big hospital corresponding to the following community, responsible for looking at difficult diseases, technical guidance. Responsible for business management, for example, there is a patient in this community who wants to see a specialist, but can not hang up the number, the director sent down by the hospital will help you contact, he is responsible for contacting well, so the director plays the role of uploading and transferring. There is also a director in charge of the CDC, the CDC used to mainly do prevention publicity, now directly send a director to the community to guide them to carry out prevention work, so this thing is very real, and the most important problem of medication, a city did not use any mandatory measures, until today, many people have gone to the grassroots, In particular, they do high blood pressure and diabetes, many large hospitals are less and less outpatient, outpatient some closed, some adjustments, no longer needed. Because the first chronic disease at the grassroots level can take two months of medicine, high blood pressure and diabetes as an example, later these drugs can not go to the tertiary hospital to get. Second, make an appointment, people are willing to go to the grassroots first, because if you want the best experts on the market, if you come to the community, the community can prioritize about the best experts, if you go to hang, regardless of any channel, up to 7 days in advance, the community is 10 days in advance, of course, everyone is willing to come, which in the "thirteen five" period of the flow of the entire patient, Including medical use has a big impact,
In terms of hierarchical diagnosis and treatment, minor illnesses are in the community, serious illnesses are admitted to the hospital, recovery is returned to the community, and health is admitted to the family. Do not need to be treated by large hospitals, send experts to the grassroots, where many beds are idle, experts and grassroots joint to do, while giving general practitioners head fees. After testing, patient satisfaction is higher than the hospital, and the disease control rate is getting higher and higher. In addition, the future payment of medical insurance must be in the community to increase the family bed, increase the annual contract service, and increase the per-capita payment, which is the direction of reform. Coupled with the payment of medical insurance, a large amount of funds will be invested in this place, and this will be a new growth point in the future, and funds will gather in this place. As a result, nearly 70% of the people are treated at the primary level. In developed countries, take the UK as an example, 80% of the medical services are solved at the primary level.
With the implementation of hierarchical diagnosis and treatment, the "13th Five-Year Plan" after the implementation of 100%, in this case we have reason to say that the future of common diseases, especially chronic diseases, basically have to be solved at the grassroots level. The organization management and service model will also change, so the support of distribution, service and information technology are also put forward high requirements.
Information Source: Chinese Pharmacy