Academy of Social Sciences | What are the international experiences of medical service delivery mode

1. Specialized division of labor in medical services

In the provision of traditional medical services, medical services are only provided by hospitals and doctor's clinics. From medical treatment, laboratory tests, diagnosis, treatment to postoperative rehabilitation, and chronic disease management, the above two types of institutions cover almost all functions. This "large and comprehensive "The operating cost of institutions is high, the main functions are not clear, and a large amount of cost is invested in daily operations, rather than treatment for patients; while the emerging medical service model shows more characteristics of specialization and division of labor, and multiple functions are dispersed. To various institutions that are independent of each other, with the help of constantly improving information technology and diagnosis and treatment technology, they can provide patients with cheaper and better services.

Simply distributing diagnosis and treatment to different institutions can significantly improve service efficiency.

With the assistance of information technology, patients can upload their test results through the Internet and obtain accurate diagnoses from professional doctors, while treatment can be completed through micro-clinics and specialized hospitals. On the basis of accurate diagnosis, the treatment of many diseases is only a controllable and reproducible process, which can be completed by physician assistants and even nurses.

A considerable number of institutions dedicated to this have emerged in the United States, such as RediClinic and Minuteclinic (acquired by American pharmacy chain CVS in 2007), surgical hospitals such as Shouldice Hospital, and Many eye surgery clinics, heart hospitals, cancer rehabilitation centers, etc. Instead of traditional hospitals charging an itemized fee for all services, these treatment-focused institutions have begun charging patients a flat fee based on an individual procedure. The process is unified, the risks are controllable, and the medical expenses incurred are clear and definite. In September 2006, the Geisinger Health System's ProvenCare program began charging a flat-rate fee for selected heart bypass procedures with a 90-day warranty.

Clayton Christensen's research shows that clinics that only provide specific treatment services can provide comparable medical services at half the price compared with medical institutions that provide both diagnosis and treatment. The same treatment of external abdominal wall hernia, Shordyce Hospital only treats a small number of patients with external abdominal wall hernia, but all patients follow the same clinical path, a total of only four days, the first day of meal preparation, the next day for surgery, The third and fourth days of recuperation, the total cost was $2300, the patient satisfaction rate was close to the vast majority, and the cost of medical malpractice litigation was almost zero; in contrast, in a general hospital in North America, the cost of the same operation was $3350, and The procedure is done on an outpatient basis, and if the patient is hospitalized, the cost can run up to nearly $7,000.

Common frequently-occurring diseases such as upper respiratory tract infection, sinusitis, and pharyngitis can also be treated in microclinics mainly practiced by nurses. According to Mary Kate Scott, an expert in the field of microclinics in the United States, with the correct technical support, a total of 60 to 100 diseases can be treated by microclinics. Although the types are limited, these diseases account for 17% of the diseases seen by family doctors in the United States, while Fees for these conditions in microclinics are 32% to 47% lower than the cost of seeing a family doctor. It is convenient and fast, and there is no need to queue up, which also greatly reduces the time for patients to seek medical treatment and greatly improves patient satisfaction.

Since nursing staff are enough to play a major role in the new medical service model, this greatly reduces the workload of doctors, and more human resources of doctors can be devoted to professional clinical diagnosis.

The Cleveland Clinic in the United States changed the original center into an institution featuring interdisciplinary expert cooperation through reorganization, such as employing oncologists, radiologists, neurosurgeons, psychiatry and psychology in the Institute of Neurology Experts, etc., are integrated with neurologists to diagnose the etiology and different types of patients as accurately as possible. The continuous precision of diagnosis has promoted a better division of labor between diagnosis and treatment.

In addition, doctors can also use information technology to greatly expand the scope of providing medical diagnosis.

In a traditional community, a general practitioner serves about 1,000 to 1,500 people. In the new medical service model, patients no longer need to rely on face-to-face medical treatment. Doctors can use the Internet to provide services to patients from all over the world. diagnosis. Under this new service model, the general practitioner team can expand its service scope to 5-10 times that of the original traditional model.

NMSU's ECHO program uses electronic communication technology to provide specialty medical services, such as hepatitis C and HIV treatment, to rural New Mexico communities. However, the ECHO project is completed through the cooperation of specialist doctors and local medical service providers. In the process, the technical capabilities of local medical staff have been improved, which has indirectly promoted the improvement of local medical service levels. This is obviously of great significance for developing countries or underdeveloped regions.

2. Establish a coordination network to promote self-healing of patients

The rapid development and penetration of the Internet into every corner of life has also brought new possibilities to the treatment and management of chronic diseases.

The therapeutic effect of many chronic diseases is closely related to the patient's own lifestyle and daily behavior. How to improve the compliance of patients with chronic diseases to the treatment plan is a headache for many doctors. Only relying on doctors to prescribe, obviously has limited effect, and the long-term and huge costs of chronic diseases have increasingly become the main burden of disease in various countries.

In the United States, the patient network built on the Internet platform allows patients to actively participate in their own treatment, which greatly improves the effect of treatment and significantly reduces the cost of treatment.

Take the dLife website as an example. It is committed to helping diabetic patients and their families to establish mutual aid on the Internet. Through broadcasting TV programs and website navigation, registered users can help and encourage each other. The same institutions also include Waterfront Media and WebMD, which are committed to establishing a mutual aid network for patients with chronic diseases, using a large amount of patient data, so that patients can find other "people like themselves". Patients can directly understand their treatment progress by comparing with other patients, and finally these patients can communicate with each other and learn from each other.

Such treatment is especially effective for chronic diseases with dependence. In the case of alcohol withdrawal, what is communicated in the patient network is user-generated content. They share with each other their experiences of overcoming alcohol addiction and encourage each other through the recovery process. Although many physicians also treat patients with acute alcohol withdrawal, alcoholic liver disease, or alcoholism, they are of limited use in treating the underlying chronic disease.

With the support of the network, such institutions can help patients find similar "patients" using registered private medical records and anonymous medical bills, and some even provide metrics for patients to compare with similar patients. Combined with model prediction tools, the probability of disease occurrence can be calculated, and corresponding prevention and treatment recommendations can be drawn. As data continues to accumulate and increase, the accuracy of matching and diagnosis also increases, forming a virtuous circle.

This also brings great convenience to the growth of doctors.

In the traditional medical service model, the level of diagnosis and treatment of doctors largely depends on the accumulation of their clinical experience, but now based on the big data formed on the Internet platform, doctors can easily browse a large number of cases and improve the accuracy of diagnosis.

In the US, the Restless Legs Syndrome (RLS) Foundation helps patients "access cutting-edge treatment options and arm themselves with information to teach their doctors about RLS." This has become a new channel for doctors to learn and progress.