"Small" the doctor driven by the "big" cure

--Shanghai medical observation ()

Healthday reporter zheng cao made the king

Shanghai, this one of the most prosperous city in China, is toward internationalization metropolis of goals. In a few months ago the Shanghai edition published medical scheme, also revealed that ambition. Although the national provincial administrative region in the last of the announcement, but Shanghai version still got outside medical plan consistent high praise.

In a series of digital index, Shanghai medical scheme set a higher goal. For example, from this year, the worker of Shanghai medical insurance plan as a whole fund is top pay limitation increased from $70000 to $280000, highest pay limitation above more than 80% of medical expenses. Medical residents and new farming and policy range charge of be in hospital average reimbursement ratio of about 70% respectively, and the proportion of the national average at present only 50%, 43%.

In addition to these goals, the Shanghai still in silently doing more infrastructure work. Through these work, even if it is not hard to find in China is the most developed city, in the most basic medical advance still need hard exploration and hard work.

QiuHongLiang the "important identity"

June 29,, a common working days of afternoon, the reporter in Shanghai xuhui district long lane met is the community visit the domestic sickbed family doctor QiuHongLiang. 10 when watching every day after outpatient service, he will carry yellow bag, take a stethoscope, riding a bicycle, go back and forth between in several community.

If put aside all kinds of professional to cure of discussion and analysis, just make long the community the shade fang several are enjoy cool air of the aunt to talk about their most intuitive cure, feel is see QiuHongLiang more often, and he tube things become more and more.

"Said to provide" six one 'service, in fact and residents of health related to pipe." QiuHongLiang said, from disease diagnosis and treatment to public health, from entering a follow-up to chronic disease management, even on the side of the road meet aunt buy food, he will come back from the point of view of the nutrition give advice.

By Shanghai health bureau deputy director of the policy research FuChen introduction, from the current situation, the cure of the provisions of the state scheme, Shanghai has many tough to achieve even more than in advance. And to solve the present problems of Shanghai, must do some pioneering work.

Therefore, the Shanghai medical scheme implementation explore five basic work, including the perfect regional health planning, optimize medical resources, especially high quality medical resources allocation of equilibrium; The establishment of regional medical association, improve basic medical and health services institute of technology's level; Carry out standardized training of resident doctors; Large-scale information construction; A family doctor system.

The five basic work, known as Shanghai in "four beam under eight column" playing five layers "ramming foundation". While the area the allocation of resources and medical association is the foundation of family doctors, hospital doctors standardized training is training part of the family doctor, the informatization construction in community service main body is family doctor. And as QiuHongLiang silently in Shanghai DuoGe 200 community health service center of the family doctor, be work in Shanghai medical most foundation is also the most important one of the carrier.

Health services, director of the center for consideration

According to the Shanghai medical scheme, planning for every 2000 people to 3000 people equipped with a family doctor. QiuHongLiang immediate superior, xuhui district those streets of community health service center director YiChunTao said of each family doctor service radius is not completely according to delimit the number, but "to the residents response" and "natural selection" for the principle, basic limit in 15 minutes walking and range of.

The family doctor in Shanghai development with a unique advantage. Since 2003, Shanghai began to establish by the all-around doctor, public health doctors, nurse practitioners of general services team, and a thorough communities grids agreed service. From the model look, now family doctor system service is general service team "upgrade".

YiChunTao said, now the family doctor qualification raised, are mostly the attending physician, in the community have more than 3 years work experience, or from the community health service center of the selection of backbone. Secondly, in the service content, besides basic health care, also covers the health management, public health, including the door also visiting, family sickbed service, in the primary and middle schools in infectious disease control, etc. "The family doctor system implemented two months time, now nearly 30%, the rate of signing another few months, it can be covered completely community key crowd."

In order to let the family doctor better role, YiChunTao good friend, XieTu community health service center director WuKeMing designed support system: first is a family doctor team support platform, the team of mutual by family doctors, nurses, public health staff. Among them, the nurse to help the family doctor completed public health, health management work part.

In addition, the center for family doctor's hiring and promotion set up incentive mechanism. Be employed for the family doctor, title assess when can add cent; Under the same conditions, advanced and excellent staff when the family doctor has priority; Study abroad or out of the study also have preferred the recommended opportunity.

Community health service center director were willing to spend time in the family doctor, is behind the strong government investment guarantee. The bureau chief, said the LiuShiJiang xuhui district in 2009, xuhui district financial investment to community health service fees as high as $140 million. Have the financial TuoDe community health service center, need not worry about the bonus and income, you can really turned to provide secure family doctor type service.

The problem of short of hands

However, the family doctor system of the implementation of the first two months, some problems still exposed to complain about most, is still short of hands. Especially the family doctor promised health advice, inspired residents great enthusiasm. QiuHongLiang said every day, received dozens of a phone call, regardless of the day or night. Some family doctors really could not support, have to every night when it had a 10 turn your cell phone off.

Fortunately YiChunTao has thought about the transition way, he sought to a secondary qualification with country of psychological consultant in community establish hotline, family doctors not convenient to connect the phone can transfer the hotline. B the BBS and open community micro bo, using the Internet to provide services. Tools

However, these are just take temporary solution of policy, the fundamental problem is still excellent all-around doctor resources exist at present big gap. In addition, the community doctors age structure too large, is also the family doctor type service for future development of a hidden danger.

Facing the general practitioner of the gap, the relevant departments have to make up for in. Shanghai is according to each year hundreds of standardized training speed training of general practitioners, a including training center, clinical base, the base of the community, the general practitioner of the construction of the training system also.

KeJiaoChu by Shanghai health bureau, deputy director of the XuTieFeng introduction, begin from 2000, Shanghai and in the national spearheaded a four-year general practitioner standardization training pilot job, by the community health service center to select new distribution of university undergraduate course graduates to zhongshan hospital to participate in standardization training of general practitioners.

"At that time, send out training a all-around doctor, a year cost about $80000 in 10 years ago, it's not a small figure." Health bureau deputy director of XuShunGen said, the first training accounts for 1/8 of the number. He remembers deciding was not think too much, just think community needs to such talented person, "now, this road is picked the right".

Shek mun 2 streets of community health service center, deputy director of ZhengWenTao is one of the training college students. He told reporters at the beginning of the students, after 10 years from the community only 1 person, other people on the community management positions, or become business backbone.

However, this by unit appoint to participate in training the way also shown the limitations. In view of the existing problems, "engineering contradiction" by Shanghai health bureau decided to use "socialization management" mode of general practitioners, namely the standardization training for nationwide recruit fresh and nearly two years of graduation scale medical colleges clinical medicine undergraduate and professional graduates, to the standardization training. During the training of personnel, labor management socialization by professional management, training funds by city, area (county) level 2 government is collective burden.

In July 2010, Shanghai start residency standardized training, general practitioner be 27 training one of discipline. "We are considering will residency training and standardization of clinical medicine master's degree, and the combination of the future, and complete the standardized training through the master degree of course and assessment requirements, there is opportunity for professional master's degree." XuTieFeng said, "this means that, in the future, Shanghai community work in the all-around doctor most likely is master degree."

Higher requirements

TanChunHua after standardization of the general practitioner is after the training, came to ZhouGuQiao community changning district. For now, her family doctor in addition to the class, and it will continue to "charge".

Her colleagues ChenHua is persuaded by the family doctor a flag of the work, she even opened in their own name studios. "For people, the studio is not just a consulting condition places, it is more like a warm home, to give residents physical, psychological comprehensive attention." ChenHua said.

In order to better and community residents, ChenHua exchange of it over the psychology, also attended self-study the health management division and nutritionists certificate. "Force", she said, in the work at first she comes actively provide health education, and even eat in your face. Outfit that was setback after she and residents' committees, the request in each contact residents activities at the end of 10 minutes to spare time, do a little science, residents "have a neighbourhood committees old people go to a tour, I'd apply for follow DaBaChe when health care doctor. In the car I to take the opportunity and residents communication, understanding each family, so I didn't know DuoGe 20 people have chronic diseases."

The bureau chief GeMin introduction, changning district changning district in a few years ago made community groups, and family, but because of the contract to provide services limited, workers also not fixed, so residents sign is not high rate. Now has persuaded by the family doctor requirements, in addition to improve clinical general medical training, but also get nutrient division, a counselor and health management division of qualifications.

GeMin said: "the family doctor to do big hospital, can the residents can't do in the community. Only the somebody else willing to come, health management, two-way referral to carry out work such as possible."