Medical network on April 17 - April 14, the state council information office held a policy of the state council routine briefing, deputy director of the national health development planning commission and the state council reform office director Wang Hesheng specially on the strengthening the construction of medical association and development guidance about the solutions, couplet of medical is destined to be in 2017 was a hot word in the field of medical treatment. 

 

And formal medical couplet body building for a policy of national level is rising in March 5, premier li keqiang made the government work report points out, "a comprehensive start construction experimental unit of various kinds of medical association, all tertiary public hospital to participate in and play a leading role." 

 

After after more than a month, li keqiang, the prime minister on a state council executive meeting, for promoting the construction of medical association has carried on the deployment, pointed out to break the administrative area, financial investment, health care payments, personnel management, as well as the barriers, adjust measures to local conditions to explore the medical couplet body construction. 

 

The indications are that the medical couplet style construction is not only the trend of the trend of The Times, is also must be direction of health reform. Although medical conjoined in domestic is not new things already, but in the new environment and the policy under which the medical couplet style is more suitable for their own development, presumably every medical practitioners in the thinking of problem. The blossoming of couplet of medical construction, exactly which model be respected? What are the problems in the process of development and? 

 

City of couplet of medical 

 

City medical couplet body (i.e., medical association), divided into close and loose, 1 in tertiary hospitals as the lead unit, combined several city secondary hospital, rehabilitation hospitals, nursing homes and community health service center, build a couplet of "1 + X" medical, vertically integrated medical resources, resource sharing and collaboration management mode. 

 

Advantage: "the first diagnosis, classification of diagnosis and treatment at the grass-roots level, slow partition, two-way referral" mode of medical treatment, convenient for patients with diagnosis and treatment, reduce the burden of the patients; Joint in other hospitals technology levels increase, can attract more patients in the clinic, so as to reduce the burden of "leading" hospital, "leading" hospital can better service for critically ill patients, incurable diseases; Two-way referral mechanism of joint in the body to reduce the patient's diagnosis and treatment cost, also for the country save a lot of money. 

 

A potential problem: the capital and technology security demand higher; Policy level exist problems, such as health care, referral hospital starting line, different compensation mechanism, influence the enthusiasm of patient referral; Could further aggravate medical market monopoly status, resulting in a decline in the medical service efficiency. 

 

City of couplet of medical in shenzhen lo wu medical group close couplet of medical representative. By integrating district public hospital, a hospital group, realizing the maximization of resource sharing. Group divided into districts under the people's hospital, district hospital, district maternity care hospital, rehabilitation hospital, medical hospital of division of gerontology and area tumor hospital, social health center in 35, and at the same time set up the nine resources management center. Within the group set up by the inspection, image diagnosis, nine centers such as financial management, mutual recognition of test results, as a whole fund management, subordinate hospital resources. For hospital within the group, is their "main" the original key subject, dislocation development, strengthen its specialist program. And implement hospital group "management office separation", establish modern hospital management system, set up the board of trustees, the board of supervisors. 

 

D a total body 

 

Medical body (that is, the medical community), the main mode of couplet of rural is to develop the medical construction, through the medicare payment reform and medical combining the construction of the body, from the prevention, treatment, rehabilitation, integration service, the county, township and village. 

 

Advantages: effectively control unreasonable medical expenses, the waste, reduce the medicine proportion; Area the size of the hospital to become "the family", break past competition relations; Effective integration of county and township government, two levels of medical institutions resource optimization of grassroots medical and health resources, improve the treatment of grassroots health workers and service ability. 

 

Potential problems: medical performance assessment and profit distribution is complicated in the body; Health technical personnel resources in the county county medical total body may be restricted by lack of operation and development; Grassroots medical service ability is weak, hinder the hierarchical diagnosis and treatment of efforts to promote; County hospitals of driving and leading role is limited by own ability and level. 

 

D has the most famous representative is anhui tianchang "unity of four segments, community service, community of interests, responsibility, community, common development) county community. The integration of urban and rural medical institutions, respectively to form three county medical body, take the lead in the hospital for medical body of people, goods, unified management deployment, in medical, valuing the capitation amount shall be paid in advance, overspend shall be borne by the county-level hospitals, balance by county-level hospitals, township health centers, village clinics are allocated by 6:3:1 proportion. At the same time, determine the public hospitals at the county level 122, township health centers, 50 kinds of ensure that were planted catalog, clear under the county-level hospitals 41 disease to plant diseases and 15 convalescence turns list, directory not outside diseases, medical total body internal personnel flexible flow, strengthen the counterpart support, to promote information sharing, achieve grassroots first option and two-way referral. 

 

The specialized subject of cross-regional coalition 

 

The specialized subject of cross-regional alliance refers to the medical institutions for specialized collaboration between bond to form a consortium, give priority to with a characteristic specialized subject of medical institutions, other medical institutions joint same specialized technical force, form several characteristic specialized subject center area, promote to solve the major disease treatment in ability, form a development mode. 

 

Advantage: transverse revitalize the existing health resources, fragmentation resources integration into a system, solve the hospital a specialist area and discipline construction; Promote quality resource sink, mysterious illness more convenient to the patient. 

 

Potential problems: union hospital may appear unfair competition, resulted in the erosion of hospital public welfare; Grassroots medical staff training cycle is long, led by large hospital support deficiencies, such as manpower, material resources and financial resources; Grassroots medical institutions for ZhuanBing master degree is not high, influence the junior league of two-way referral sustainable level. 

 

The specialized subject of cross-regional alliance represented by the Beijing children's hospital pediatric alliance. Selection and provincial children's hospital of Beijing children's hospital set up a strategic alliance, and also asked that the members of the coalition must be in their respective provincial health alliance of form a complete province. Drive the municipal, provincial children's hospital, children's hospital again the following county-level hospitals and community hospitals are driven. Through the inspection, if the common frequently-occurring disease indicators such as not dropped at the grass-roots level, probably next year, the, it is not a member of the group. Group by conducting academic communication, build scientific research platform, implementing department building, such as remote consultation, expert team to patrol around the operation way, improve the comprehensive level of the hospital group. At present has formed "the first option, complicated cases at the grassroots level remote consultation, difficult urgent patient referral barrier-free" service pattern. 

 

Telemedicine network 

 

Telemedicine network is led by the unit and grassroots medical institutions, remote and undeveloped area, remote medical service network is established. With longitudinal flow informatization technology to promote medical resources, improve the high quality medical resources availability and efficiency of medical service as a whole. 

 

Advantage: help patients at the grass-roots level and remote areas nearby go to a doctor, make up the lack of rural health resource; Effectively avoid duplication of inspection, the phenomenon such as repeat prescriptions, reduce local health care expenditure. 

 

Potential problems: basic-level hospital patients may be big hospital suck; Remote video now can only solve visits in medical history collection, but for a lot of auxiliary inspection data which are not available immediately; For patients by phone, email or video to your doctor about the costs of health problems, health insurance companies is difficult to obtain evidence, there is no relevant policy support to submit an expense account. For this type of remote medical app can't specification limits, of the doctor-patient relationship of the misdiagnosis and missed diagnosis cannot be held accountable; Remote medical doctor cannot provide attentive care, and even some institutions lack of relevant business license. 

 

Telemedicine network to china-japan friendship hospital telemedicine network as a representative. China-japan friendship hospital through remote medical information management platform, unified management and application of remote diagnosis based on soft video, high-definition video terminal remote consultation, 3 d surgery live and teach such as distance education and training system, adopting digital line, international VPN and Internet access to a variety of ways. Has carried out the clinical and pathologic consultation, image consultation consultation, teaching training, 3 d surgery teaching, case discussion and ward round of multiple disciplines, academic conferences and other remote medical treatment activity. 

 

At present, although the medical couplet body has proliferated, but about which type of couplet of medical better discussion has never stopped. National health development planning commission TiGaiSi chief priests Liang Wannian said: "in the long run, if the medical couplet of various medical institutions have a clear division of responsibilities, clear positioning, adapted to medical couplet body set up evaluation mechanism, close couplet of medical effect will be better. We are currently is to encourage the construction of close medical couplet body, do not do hard requirements, can be a variety of forms." He added that the medical couplet style construction of the most important principle is to by the emphasis on the efficiency of a single medical institutions, to emphasize the overall efficiency of the whole medical service system.