If you are not feeling well, have a headache and brain heat, first think of going to a community health center near your home or calling a doctor to go to the doctor, instead of going to the train station at the time of the Spring Festival travel time. The top three hospitals can solve the pain. For everyone who has been waiting in the big hospital for a long time and seeing a doctor for less than five minutes, why not do such a good thing?
Family doctor signing
Recently, the State Council's Medical Reform Office and the State Health Planning Commission and other seven ministries and commissions issued the "Guiding Opinions on Promoting Family Doctors' Contracting Services." The "Opinions" pointed out that this year, 200 public hospitals in the comprehensive reform pilot cities will carry out family doctor signing services; next year family doctors sign up Service coverage reached more than 30%; by 2020, we will strive to expand the contract service to the entire population. And the "Opinions" pointed out in detail: "The family doctor contract service preferentially covers the elderly, pregnant women, children, the disabled, etc., as well as chronic diseases such as hypertension, diabetes, tuberculosis and patients with severe mental disorders. By 2017, the family The coverage rate of doctors' contracted services has reached more than 30%, and the coverage rate of key population contracted services has reached more than 60%."
Family doctors have been practicing in Europe and the United States for many years. They are the double gatekeepers of residents' health and medical expenses. They must not only undertake basic medical and public health services, but also conduct health management for residents, promote healthy lifestyle development, and guide reasonable medical treatment. The family doctor system is characterized by long-term, fixed-point, and its core is not only to provide medical services, but also to give patients humane care.
Therefore, if the policy of signing a family doctor really falls, it is believed that it will help to alleviate the crowded and difficult patients in large hospitals and promote the grading diagnosis and treatment. Regarding the introduction of the "Opinions", everyone agreed that the direction of this policy is good. In recent years, the new medical reform has also attached importance to the investment and development of primary health care. However, due to the development of the "inverted pyramid structure" of our national medical and health system in the past, It is no small challenge to change the coverage of primary doctors and improve the service capacity of primary care institutions in a short period of time. Therefore, at present, there are still some "satisfaction" in the model of signing a family doctor.
General practitioners have low incomes
In fact, before the introduction of the "Opinions", some places in Beijing, Shanghai, Guangdong and other places have begun to develop pilot programs for family doctors a few years ago. Shanghai started piloting the family doctor system in Xuhui, Changning, Minhang and Pudong in 2011. As one of the most developed first-tier cities in the domestic economy, Shanghai has experienced many typical families after five years of pilot exploration. The community health center with better doctor system development.
As one of the most developed and developed regions in the country, although Shanghai's family doctor system is ahead of the country, like other places, Shanghai faces some objective situations that are commonly encountered throughout the country. According to Tang Ziou, the chairman of Good Life Group, to the health point reporter, the general situation of general practitioners is that there are not enough people and insufficient coverage; there are not enough family doctors who can meet the requirements, and the medical service capacity is insufficient; the family doctors have low income. In addition, the "1+1+1 mode" patients who have been promoted in many places can enjoy the referral green channel through this mode. Not only does it not promote the development of primary medical care, but it leads patients to large hospitals, which aggravates the siphon effect of large hospitals.
China introduced the concept of general medicine in the late 1980s. After more than 20 years of development, it has initially established a general medical education system and a qualification access system, and the team of general practitioners has also expanded. However, compared with European and American countries, the construction of the Chinese general practitioner system is still in its infancy. On the one hand, the number of general practitioners is seriously insufficient, the quality is not high, and the brain drain is serious. The proportion of general practitioners is only about 5%, far below the international average; On the other hand, the general training system is imperfect, and the standardized training for general practitioners has just started. Most of them are mainly on-the-job training, and the quality of personnel is difficult to guarantee. In addition, continuing medical education is in the form of a general practitioner with low status and low income, and the general profession is unattractive.
Improving the proportion of reimbursement at the grassroots level does not solve practical problems
In order to guide patients to the primary medical institutions for medical treatment, the past medical insurance will give a tilt on the proportion of reimbursement. The "Opinions" was released, and some insiders said that they should first introduce some supporting policies to promote the implementation of the "Opinions", which recommended increasing the proportion of medical insurance reimbursement for primary medical institutions.
In this regard, Tang Ziou believes that the policy of multi-reimbursement of medical insurance does not effectively solve the trend of patients choosing large hospitals and good doctors, because people can buy discounted clothes, but people's health can not be discounted. And this is not realistic. Because, as a medical insurance institution, a large amount of medical insurance funds have been invested in large hospitals, and patients are also staying in large hospitals. At present, there are relatively tight medical insurance funds everywhere. If the patients are not addressed, they will be guided from the big hospital to the grassroots. The problem of continuing to stay in a large hospital is to make the medical insurance funds tilt to the grassroots level. From the perspective of the medical insurance management organization, it will not allocate too much medical insurance funds to the grassroots.
For the current situation of primary health care, a statement from a grassroots doctor from the suburbs of Shanghai confirms the viewpoint of Tang Ziou. The doctor said with some pessimism that at present, in order to encourage patients to go to community medical institutions for medical treatment, the proportion of medical insurance reimbursement is higher than that of the upper-level hospitals, but there are still not many patients who are willing to go to the primary medical institutions for medical treatment. In the long run, he does not know this. The reimbursement of one hundred dollars is also very attractive to patients and doctors.
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