Inearly2018,theChinesegovernmentannouncedplanstotrainmorequalifiedgeneralpractitionersandexpanddeploymentofcontractedfamilydoctors.InChina,generalpractitionersarephysicianswhodiagnose,treatandmanageawidearrayofpatientconditionsandprovidemedicalservicesrangingfromearlytreatmentofregularillnesses,prevention,healthcareandrehabilitationtochronicdiseasemanagementatcommunitylevelaswellasroutine,integratedandcustomizedhealthcareservicesforindividualsorfamilies.AccordingtotheNationalHealthCommissionofChina,lessthan200,000community-levelgeneralpractitionersareprovidingservicesacrossthecountry,whichisonlyabouthalfofthenumberneeded.
In2015,asapilotzoneforcommunity-levelhealthcarereforminChina,Shenzhen’sLuohuDistrictbegantoimplementageneralpractitionersystemwhichhasprovenverysuccessful.
GatekeepersforCommunityHealthcare
WenhuaCommunityinLuohuDistricthasapopulationof25,000,ofwhommanyaremigrants.Thecommunityhospitalisstaffedwith10generalpractitionersand12nurses.WuTianlongisageneralpractitionerpostedthere.
BeforeshemetWu,communityresidentXuYanyanpreferredtoseedoctorsatprestigiousHongKonghospitalslikemanyhigh-incomeShenzhenresidents.Aboutsixyearsago,hertwo-year-oldsoncamedownwithacoughthatpersistedevenafterconsultingseveraldoctorsinHongKong.Soshedecidedtotryherluckatthecommunityhospital.
“Frankly,seeingDoctorWuwassoyoung,Ididn’thavemuchconfidenceinhisexpertise,”Xurecalled.Tohersurprise,threedayslaterherson’scoughwascuredaftertakingmedicineWuprescribed.
Twoyearslater,Xu’syoungersoncamedownwithacough.Thistime,Wurecommendedaverycheapdrug.“Eachbottlecontainssixgramsoftablets,andthey’reveryaffordable,”Xusaid.“DoctorWuhelpsmyfamilysavealotofmoneyonmedicalcare.”
Backthen,thecontractedfamilydoctorsystemhadyettobeimplementedinShenzhen.But,wheneverhersonsgotsick,XuhabituallyconsultedWuoverthetelephone.“EverytimeIcalled,heaskedindetailaboutmysons’symptomsandthendispensedusefuladvice,”shesaid.“Heknowskeyphysiologicalinformationabouteverymemberofmyfamily,evenourheightsandweights.”
Comparedtospecializedphysiciansatlargehospitals,community-levelgeneralpractitionersnotonlytreatillnesses,butalsofocusonindividualpatients’health.
“Youshouldn’tinterruptpatientswhentheytalktoyoubutencouragethemtoaskwhatevertheywant,”explainedZhangXiaoxiao,adoctorattheHealthServiceCenterofLuohuCommunity.“Byconversingwithpatients,yougetinformationthatcanbeveryhelpfulfordiagnosis.SometimesIfeellikeadetective.”Inhereyes,howgeneralpractitionerscommunicatewithpatientsistotallydifferentfromspecializedphysicians.
Once,aboysufferingfromfrequentstomachachescametoseeDoctorZhang.“Inmostcases,aspecializedphysicianwouldsuspectgastricdiseasesandorderagastroscopyorhelicobacterpyloriinfectionexamination.”Zhangsaid.
Aftertalkingwiththeboy,sherealizedthathisstomachachesoccurredonlyinthemorningfromMondaytoFriday,butneverintheafternoonsorevenings.Onpressingfurther,shelearnedthattheboywaswalkingquitefartoschoolsincereachingmiddleschool,sohedidn’thavetimeforbreakfast.Andhisstomachacheusuallysubsidedafterthefirstmorningclass.
Zhangdiagnosedthattheboyhadtemporalabdominalcrampingandsuggestedhegetupearlierinthemorningtoeatbreakfastbeforegoingtoschool.Followingheradvice,theboyneveragainhadsuchpains.Whentheboycamebackforafollow-upvisit,Zhangonlytalkedwithhiminsteadofperforminganexaminationororderingtests.
InZhang’sopinion,generalpractitionersusuallyprovidemedicalservicesthroughheart-to-heartcommunicationwithpatients,ratherthanwithmedicineandprocedures.
April3,2018:ZhaoSheng,aphysicianatErqibeiCommunityHealthcareCenterinFengtaiDistrict,Beijing,conductsaphysicalexaminationofalocalresident.VCG
June19,2017:LocalresidentssignserviceagreementsforfamilydoctorsatcommunityhealthcarecentersinLuohuDistrict,ShenzhenCity,GuangdongProvince.courtesyofthewebsiteofthelocalgovernmentofLuohuDistrictLuohuExperience
Threeyearsago,beforethegeneralpractitionersystemwasintroducedtoLuohu,ZhangXiaoxiaodidn’tgetmuchsatisfactionfromherwork.Atthattime,second-andthird-tierhospitalsandcommunityhealthcarecentersinShenzhenlaggedfarbehindhospitalsinGuangzhou,capitalofGuangdongProvince,intermsofmedicalresources—nevermindinstitutionsinBeijingandShanghai.ManylocalpatientspreferredtoseedoctorsinBeijing,Shanghai,GuangzhouorevenHongKongandSoutheastAsiancountries.Shenzhenbecameknownasa“healthcaredesert.”
Thenewhealthcarereformthatbeganin2015quicklybecameagame-changer.Thatyear,withitsLuohuDistrictasapilotarea,Shenzhenlaunchedareformfocusingoncommunity-levelhealthcare.Luohumergedfivehospitalsand23communityhealthcarecentersintoLuohuHospitalGroup.
SunXizhuo,presidentofLuohuHospitalGroup,andhishealthcarereformteamcommittedtoensuringlocalresidentsaccesstoquality,effectivehealthcareserviceswithina15-minutewalk.Thehospitalgrouppaysgreatattentiontodiseasepreventionandhealthmanagementto“freeresidentsfromillnessesandhospitalization,cuttheirhealthcareburdensandenablethemtoenjoyhigh-qualitymedicalservices.”
Since2015,aseriesofnewmedicalreformpolicieshavebeencarriedoutinLuohuDistrict.
Amobileappdevelopedbythedistrict,HealthyLuohu,isnowusedbyeverylocaldoctor.Withtheapp,patientscanmakeanappointment,payformedicalservicesandconsultcontracteddoctors.EveryhospitalandhealthcarecenterunderLuohuHospitalGroupcanshareinformationviatheapp.Moreover,ithelpsdoctorsregularlymonitorthehealthoflocalresidents,diagnoseillnessesearlierandreducediseaseprevalencerates.Ifapatientneedstobetransferredtoanotherhospital,hisorhermedicaldatacanbeimmediatelydeliveredaccordingly.Transferredpatientsneednotregisteratthenewhospital.
InLuohu,medicalinsurancefundsadoptamanagementapproachcalleda“cappedbudget.”Localresidentsarefreetochooselocalhospitalsorclinicsastheircontractedmedicalserviceinstitutions.Eachyear,themedicalinsuranceadministrationpaysLuohuHospitalGroupacertainamountofmoneyaccordingtothenumberoftheinsuredwhochoseitastheircontractedmedicalserviceinstitutionthepreviousyear.TheamountisbasedonpercapitamedicalinsuranceinShenzhenplustheannualgrowthrateofmedicalinsuranceinthecity.Iftheamountdoesnotcoverthemedicalexpendituresofthecontractedpatientseachyear,LuohuHospitalGroupwillbearthelossitself.Ifthereisasurplus,thehospitalgroupwillkeepit.
Undertheseterms,thehospitalgroupcanmaximizeitsprofitsinonlytwoways:oneistoensurecontractedresidentsarehealthyandreducetheirmedicalspending,andtheotheristoattractmorecontractedresidentsbyimprovingservicequality.
AccordingtoSun,Chinastilllacksacompleteacademicandassessmentsystemforgeneralpractitioners,andsomeoverlappingservicesaffecttheefficiencyofcommunity-levelgeneralpractitioners.“Forinstance,publichealtheducationsuchasteachingchildrenhowtowashtheirhandsshouldbeoverseenbycentersfordiseasecontrol,leavingcommunityhospitalstofocusontreatmentofchronicdiseasesandprovidingbasicpublichealthcare,”headded.
“Idon’tthinkourpracticeshouldbecalledthe‘LuohuModel’becauseit’smerelyareform,”Sunnoted.“Ihopemoremedicalinsurancecategorieswillbeintroducedtopromotecommunity-levelmedicalservicessothatlargehospitalscanconcentrateonmedicalteachingandresearchaswellastreatingacuteandseverediseases.ThatwouldhelpChinaformabettermedicalservicesystem.”