Today, the health community learned from the official website of the National Medical Insurance Administration that the six ministries and commissions of the National Health and Health Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, the National Medical Insurance Administration, the State Administration of Traditional Chinese Medicine, and the National Bureau of Disease Control and Prevention Jointly issued the “Guiding Opinions on Promoting the High-quality Development of Family Doctor Contracting Services” (hereinafter referred to as the “Guiding Opinions”).
“This is the fundamental document for changing the service model,” said Huang Erdan, a researcher at the Health Service System Research Department of the National Health Commission’s Health Development Research Center.
Huang Erdan analyzed the health industry that most of the documents in the past were based on the operation mode, management mode and development mode of medical institutions, and further pushed the “disease treatment” to the extreme. The “Guiding Opinions” this time is a continuation of the “Notice on Printing and Distributing the Guiding Opinions on Promoting Family Doctor Signing Services” in 2016. It is a real transformation to health-centered, with family doctors as the starting point, and further implementing the primary medical service model.
It is understood that the “Guiding Opinions” follow the “Guiding Opinions on Establishing a General Practitioner System” issued by the State Council in 2011, and “About Printing and Distributing Promoting the Signing of Family Doctors” issued by seven ministries and commissions in 2016. The “Notice on Service Guidance” and the “Guiding Opinions on Regulating the Management of Family Doctor Contracting Services” issued by the two ministries and commissions in 2018 and the “Notice on Doing a Good Job in Family Doctor Contracting Services in 2018” issued by the National Health Commission document.
After more than 5 years of exploration, promotion and experience summarization, the release of the “Guiding Opinions” means that the family doctor contract service model is about to usher in high-quality development!
“In the future, physicians in the hospital will gradually change to family doctors, because under the current payment method, it is difficult for general inpatient hospitalization to meet the cost requirements of the hospital, and family physicians, as medical specialists, have new income and The supplementary service is already waiting for a seat.” Huang Erdan thinks.
How to make up for shortcomings?
In the past, the family doctor contract model mainly had three “shortcomings”: the contract was untrue, the contract could not be undertaken, and there was no benefit.
This is manifested in the fact that the content of the contracted service is not true and the service content is not clear; the number of primary-level family doctors is insufficient, the ability is not strong, and the role is not prominent; the benefit mechanism is not perfect, and it is difficult to promote the health-centered approach transformation.
In Huang Erdan’s view, the release of the “Guiding Opinions” is precisely the response and supplement to the above-mentioned issues.
In terms of clarifying the connotation of services, the “Guiding Opinions” not only set clear requirements for medical service capacity and service quality, but also clearly proposes to ensure rational drug use and carry out door-to-door service. , optimize referral services, strengthen traditional Chinese medicine services and other specific requirements. And it is connected with the medical reform policies such as essential drug list management, long-term prescription, medical alliance, medical community and so on.
In terms of improving service supply, the “Guiding Opinions” further clarified the contracted objects and the scope of contracted doctors.
On the one hand, support family doctors and residents to sign service agreements with families as units, and encourage local governments to explore functional communities such as party and government organs, enterprises and institutions, industrial parks, commercial buildings and other functional communities as contract objects. Sign a service agreement.
On the other hand, family doctors can be general practitioners, other types of clinicians (including traditional Chinese medicine) practicing in health care institutions, rural doctors, and retired clinicians.
Huang Erdan analyzed that the transition of family doctor contracting from “single-based” to “family-based” not only helps to increase the speed of contracting, but also improves service efficiency. The expansion of the source of family doctors will help solve the problem of insufficient talent in the past.
In terms of establishing mechanisms, the “Guiding Opinions” call for a sound incentive system and a guiding role for basic medical insurance.
On the one hand, in principle, no less than 70% of the contracted service fee will be allocated to the salary distribution of the contracted service personnel participating in the family doctor, and the contracted service fee will be paid after the assessment;
On the other hand, promote the per capita payment of outpatient services in primary medical and health institutions, improve settlement methods, strengthen performance evaluation, and improve the incentive policy for surplus retention.
Huang Erdan believes that the establishment of the family doctor’s benefit mechanism should not only pay attention to the “Guiding Opinions”, but also pay attention to the close medical community and other medical insurance payment documents issued in recent years.
“Most documents propose to implement packaged payment for the close medical community, which will inevitably be decomposed down to primary care.” Huang Erdan said that in the end, out of concern for health management and primary care The emphasis on medical services will gradually shift to family doctors.
Healthcare leverage highlighted
It is worth noting that this is the first time that the National Medical Insurance Administration has released documents related to family doctor contract services.
This may mean that after five years of exploration, the National Medical Insurance Administration will play a greater role in the contracting services of family doctors. After all, the establishment of an interest mechanism is obviously an important driving force for the high-quality development of family doctor contracted services.
There has always been a potential “chain of contempt” among doctors, and primary GPs seem to be at the end of the chain.
“Similar medical students, after graduation, go to the grassroots to be a general practitioner and stay in a large hospital to be a specialist. After 5 years, not to mention income, his career development may face There is a big difference.” In the health industry brand column “Jianke Confrontation”, a medical insurance expert once said bluntly.
In fact, this unequal relationship is precisely due to the incomplete understanding of family doctors.
As early as 2016, the “Notice on Printing and Distributing Guiding Opinions on Promoting Family Doctor Contracting Services” has made it clear that family doctors are “health gatekeepers” centered on maintaining the health of the people.
Therefore, if family doctors still rely on per-item payment and obtain high income from surgery, prescribing medicines and examination items, it is difficult for their service model to truly be implemented.
Huang Erdan believes that a reasonable benefit mechanism is to achieve no illness, less illness, and nearby treatment through health interventions for key populations, thereby saving medical expenses.
He shared a set of calculation data he had done for a prefecture-level city:
Family doctors’ income sources mainly include financial income, public health service income, and medical income, which are all basic income. The bulk of it is bonuses for managing health insurance funds. Based on the per capita fundraising of 2,000 yuan for medical insurance, a family doctor can manage at most 2,000 residents, which is equivalent to 4 million yuan in medical insurance funds. If managed well, the annual income of a family doctor will be around 200,000-300,000 yuan, with a good social status and practice environment, and is not on duty like a large hospital, and faces internal examinations such as professional title exams.
“At this time, the task of the family doctor has become to establish a trusting relationship with the family and key patients, which will far exceed the sense of achievement and satisfaction obtained from working in the township health center and village clinic. Economic returns,” Huang Erdan explained.
Of course, this doesn’t happen overnight.
In 2016, the “Notice on Printing and Distributing Guiding Opinions on Promoting Family Doctor Contracting Services” proposed that by 2020, strive to expand contracted services to the entire population, form a long-term and stable contractual service relationship, and basically Realize the full coverage of the family doctor contract service system.
In the latest 2022 Guidance, the main objectives have been adjusted to:
From 2022, on the basis of the existing service level, the coverage rate of contracted services for the whole population and key populations will increase by 1 to 3 percentage points every year.
By 2035, the coverage rate of contracted services will reach more than 75%, basically achieving full coverage of households,
The coverage rate of contracted services for key groups is over 85%,
Satisfaction is around 85%.
The requirements for the number of contracted people have been narrowed, but higher requirements have been placed on contracting and service quality.
Analysis of Huang Erdan, “The “Guiding Opinions” emphasizes the authenticity, effectiveness and necessity of signing the contract. Completing the goal is not a problem, the key lies in what kind of services can be provided after the signing, Is it possible to give the family doctor an appropriate return of benefits?”
This again comes back to the issue of making up for the shortcomings of the family doctor system. This is precisely the more far-reaching significance behind the release of the “Guiding Opinions”.
Source | Health Community
Writing | And Stars