Signing a family doctor, it just looks beautiful?

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On June 6, the State Council's Medical Reform Office took the lead in issuing comprehensive signing services for family doctors. Shenzhen, as a pilot, issued the “Implementation Plan for Comprehensive Promotion of Family Doctor Service in Shenzhen” as early as April. This will be a two-way contractual approach based on the principle of voluntariness of residents. It plans to reach a contracting rate of more than 50% next year and strives to enhance the management of the elderly and chronically ill patients. What happened to the family doctor after several months?

Internet closed loop?

With the increasingly close integration of the Internet and medical care, payment and appointments for consultations, these redundant offline links can also be gradually transferred to the line, leaving only the offline treatment link. In the “Shenzhen Implementation Plan for Promoting Family Doctor Services in Full Scale”, it was emphasized that the Family Doctor Service App system should be completed by June 2016:

It provides a service platform for signing residents and family doctor service teams to communicate information online and pay for medical and health services. Through this platform, the performance of the family doctor service team is evaluated.

Supports docking of wearable devices, portable home medical equipment, and telemedicine systems with family doctor service App systems, facilitating family doctor service teams to track and control the health status of contracted residents in real time, and improve health management capabilities.

However, according to the person in charge of the Ministry of Public Security, residents are still required to sign a contract with the community health center or the publicity center of the community and health center. “District Guardian Bureau, hospitals, and community health centers are located in newspapers, websites, and community health centers. The family doctor service is widely publicized in the community, and each family doctor’s mobile phone is advertised. Residents can contact the family doctor or call a contract appointment service during the publicity campaign, in community health center clinics; residents can choose their own family doctor.” In other words, the entire model has not yet formed a closed loop between online and offline.

If you don't go to the hospital, if the elderly people in your family have some minor illnesses and pains, they will generally tend to ask doctors online. This also gives a group of online doctors platforms ample opportunities for development. At present, the implementation of family doctors does not require any fees for signing the contract, but it also allows you to choose a home visit. This is not unhelpful for some elderly people: on the one hand, it reduces the cost of learning online, and on the other hand, the face-to-face approach enables older people to more clearly express their physical problems. Will the implementation of family doctors affect the development of some online clinic Q&A platforms?

The doctors asked the drug nets to Lei Fengwang, said that at present, they still follow the use of money mode, providing doctors with paid answers, and users can get free advice. This point has advantages for family doctors. A person in charge of Donghua Software stated that there is little conflict between family doctors and online clinics, and they can even complement each other. If you can cooperate with the hospital, you can even use the online clinic to build a good platform for doctors to “always online”.

What is an old doctor?

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According to the policy of the Shenzhen Municipal Health and Family Planning Commission, general practitioners registered at primary health care institutions can take up posts, while at the same time encouraging retired clinicians to participate in family doctor services. If it is possible for the retired old doctors to share some of the pressures of medical treatment, it must be said that it is a very meaningful thing. However, according to Lei Fengwang’s understanding of the person in charge of the public health department of the Shenzhen Hospital of Guangzhou University of Traditional Chinese Medicine, at present, as far as Shenzhen hospitals are concerned, 100% of family service doctors are serving doctors.

Although the state encourages retired clinicians to provide services, even if they are formerly serving doctors, they must also pass the training and examinations of general practitioners in Guangdong Province and the service training of family doctors before they can take up posts. The complexity of the process is not easy to say, but at least from the current doctor's point of view, the majority of the community doctors are serving, and there is no retired physician "out of the mountain" situation.

Therefore, the situation of the "really looking" retired doctors who had been on the job for the time being has not yet appeared.

The sign is signed, then what?

A number of reports pointed out that there are now 1.87 million residents who have signed up for family doctors. This figure sounds a bit scary, and the policy mentioned that the number of contractors for each team needs to be controlled under 2,000 people, that is to say, there are currently nearly 1,000 family doctor teams in Shenzhen.

But in fact whether the family doctor can really play a role, will there be a situation of “signing without agreement”?

Ju Yan’s healthy Liu Xinhai believes that at least he does not need to sign a family doctor. This is not only because he is a relevant practitioner, but more importantly, he lacks confidence in family doctors.

The level of family doctors can actually help users. In fact, people still hold the concept of "big hospitals are better." The introduction of a three-tiered medical system actually requires a high threshold for access to technology. Low-level grass-roots hospitals lack good resources in technology and medicine, and natural disease patients will tend to run large hospitals.

In recent years, the implementation of a grading diagnosis and treatment system has not actually allowed the patient to believe in a community hospital. In a community hospital in Shenzhen, Chen Jie, who lives nearby, told Lei Fengwang that she had just recently signed a family doctor, but she was only doing a “guarantee.” Whether she can really play a role, she is not sure. "Simple diseases can also be solved at the community health (hospital). Once an acute illness is introduced, let alone we dare not go to the community and the general hospital still dare not to accept you. Now that the doctor-patient relationship is not good, everyone is It's better to do more than one thing. Yes, big hospitals need to line up, but at least people hang a top-three brand, and at least they can take responsibility if something goes wrong."

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Domestic family doctors look somewhat similar to foreign private doctors. However, the difference is that the U.S. medical system is mainly linked to insurance and is divided into two categories. One is HMO. The insurance company will directly match a doctor for the user. If you want to refer, you need a private doctor and insurance. The company agrees. The other is PPO, self-selected insurance, users can choose their own private doctors, the advantage of this approach is that private doctors will be more familiar with family history.

However, such a difference fundamentally determines that domestic family doctors need to follow the line of national conditions. Under the system of hierarchical diagnosis and treatment, how does the community health hospital obtain the trust of the surrounding residents is also a question that needs to be considered.

In this regard, the person in charge of the Public Health Department of Shenzhen Hospital of Guangzhou University of Traditional Chinese Medicine pointed out to Lei Fengwang (searching for the "Lei Feng Net" public number) that the hospital has gradually made it possible for more residents to realize that minor illnesses remain through the health education of the signing parties. Community diagnosis and treatment can save time and medical expenses, and reduce the general health problems of overdrawing hospitals with limited resources. The family doctor can also make a timely referral once he has received a complex medical condition.

“At present, our hospital has started 'grading diagnosis and treatment'. When dealing with residents with high blood pressure and diabetes, the procedure is more standardized and smoother, which further brings convenience to residents and ensures medical safety.”

The starting point of family doctors is to improve the level of comprehensive medical and health services provided by citizens. It can be said that governments at all levels are exploring primary medical services. This is a preliminary attempt. If you want to allow users to reduce the cost and time to go to the hospital, the government must not only build a good Internet platform, more importantly, let users focus on prevention, increase investment in public health protection. Whether or not the family doctor can really be implemented in the future depends on how the relationship between the government, the hospital, and the patient is coordinated.