What are the international experiences of medical service delivery models

2019-08-02 00:00

I. specialization of medical services


Traditional medical services, medical services are provided by hospitals and doctors' offices, only from medical, laboratory, diagnosis, treatment to the postoperative rehabilitation, chronic disease management, these two types of institutions almost covers all the functions, the "" large institutions operating cost is high, the main function is not clear, a lot of cost into the daily operations, not for the treatment of patients with; The emerging medical service model is characterized by more specialized division of labor, which distributes multiple functions to various institutions independent of each other, and provides cheaper and more efficient services to patients with the help of constantly improving information technology and diagnosis and treatment technology.




Simply decentralizing diagnosis and treatment to different institutions can dramatically improve service efficiency.




With the help of information technology, patients can upload their test results through the Internet and obtain accurate diagnosis from professional doctors, while treatment can be completed through micro-clinics, specialized hospitals and so on. Based on accurate diagnosis, treatment for many conditions is a controlled, reproducible process that can be performed by a physician's assistant or even a nurse.




There are already a number of dedicated institutions in the us, such as RediClinic and Minuteclinic (bought by CVS in 2007), specialist surgical hospitals such as Shouldice Hospital, as well as eye surgery clinics, heart hospitals and cancer rehabilitation centres. Instead of charging for all services by project, traditional hospitals have started charging patients a flat fee for a single procedure. The process is unified, the risks are controllable, and the medical expenses incurred are clear and clear. In September 2006, the ProvenCare program of Geisinger Health System began charging insurers a flat-rate rate for selected heart bypass procedures, with a 90-day shelf life.




Clayton christensen's research shows that clinics that offer only specific treatments can provide a similar level of care at half the price of a facility that offers both diagnosis and treatment. The same treatment of external abdominal hernia, XiaoErDai hospital were only a few types of external abdominal hernia patients, but all patients using the same clinical pathway, a total of only four days, on the day before yesterday the meal preparation, surgery the next day, the third and fourth days recuperation, total cost is $2300, patient satisfaction approach for the most part, malpractice litigation costs close to zero; In contrast, at a general hospital in North America, the same procedure costs $3,350 and is performed on an outpatient basis, or nearly $7,000 if the patient is hospitalized.




Common frequently-occurring infections of the upper respiratory tract, sinusitis and pharyngitis can also be treated in microclinics, which are mainly nurse practitioners. The micro domain expert clinic Mary Kate Scott statistics, under the correct technical support, a total of about 60 to 100 kinds of diseases can be caused by the micro clinic treatment, although limited categories, but these conditions take up 17% of the U.S. to see the family doctor symptoms, and mini clinic treatment for such symptoms, than to see the family doctor's low cost 32% to 47%. Its convenience, convenience and no queuing also greatly reduce the time for patients to see a doctor, and greatly improve the satisfaction of patients.




Since nursing personnel are sufficient to play a major role in the new medical service model, which greatly reduces the workload of doctors, human resources of doctors can be more invested in professional clinical diagnosis.




American medical center in Cleveland (The time's a-clinic) by restructuring The original center instead features across department experts cooperation institutions, such as in The institute of neurology hired oncologists, radiologists experts, neurosurgeons, psychiatric and psychological experts, etc., and integration of neurology doctors, as accurate as possible in The diagnosis of etiology and different types of patients. The increasingly accurate diagnosis promotes a better division of diagnosis and treatment.




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




In the traditional community, a general practitioner can serve 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 and make diagnosis. Under this new service model, gp teams can expand their services 5-10 times as much as under the traditional model.




The ECHO project at new Mexico state university USES electronic communication technology to provide specialized medical services such as hepatitis c and HIV treatment to rural communities in new Mexico. But the ECHO project is a collaboration between specialists and local health care providers. In the process, the technical capabilities of local health care workers are improved, which indirectly promotes the improvement of local health care services. This is obviously significant for developing countries or less developed regions.




Second, establish a coordination network to promote the self-healing of patients




The rapid development of the Internet, which penetrates into every corner of life, has also brought new possibilities for the treatment and management of chronic diseases.




The therapeutic effect of many chronic diseases is closely related to the lifestyle and daily behaviors of patients. How to improve the compliance of patients with chronic diseases to treatment programs is a headache for many doctors. Relying only on doctors' prescribing, the effect is obviously limited. However, the long-term and huge cost of chronic diseases has increasingly become the main burden of diseases in all countries.




In the United States, the patient network built on the Internet platform enables patients to actively participate in their own treatment, greatly improving the treatment effect and significantly reducing the cost of treatment.




DLife, for example, is dedicated to helping people with diabetes and their families set up an online support network, with TV shows and website navigation to allow registered users to help and encourage each other. Waterfront Media and WebMD are also working on a collaborative network for people with chronic diseases, using vast amounts of patient data so that patients can find others "like themselves". Patients can learn about their treatment progress directly by comparing with other patients, and eventually these patients can communicate and learn from each other.




Such treatment is especially effective for chronic diseases with dependency. In the case of abstinence, for example, the patient network communicates user-generated content. They share their experiences of overcoming their addiction and encourage each other in the process of abstinence. Although many doctors also treat patients with acute alcoholism, alcoholic liver disease or alcoholism, their role in treating chronic diseases as causes is limited.




With online support, such organizations can help patients find similar "patients" using registered private medical records and anonymous medical bills, and some can even provide metrics to compare patients with similar patients. Combined with the model prediction tool, the probability of disease occurrence can be calculated, and corresponding prevention and treatment recommendations can be obtained. As data accumulate, so does the accuracy of matching and diagnosis, creating a virtuous cycle.




This also brings great convenience for the growth of doctors.




In the traditional medical service model, doctors' diagnosis and treatment level largely depends on the accumulation of clinical experience. However, today's big data based on the Internet platform enables doctors to easily browse numerous cases and improve the accuracy of diagnosis.




In the United States, the restless leg syndrome (RLS) foundation helps patients "gain access to cutting-edge treatment options and arm themselves with information to educate doctors about RLS." This becomes a new channel for doctors to learn and improve.