The Research About The Construction Of Family Doctor System In Shanghai

The family doctor system,which takes the general practitioner as the maincarrier, the community as the service range, the family as a unit, and thecomprehensive health management as the goal,provides continuous, safe, effective,and appropriate medical health services and health management service to the familyand each of its members by the form of contract-service. There are more than50countries and regions implementing the family doctor system in the world. theymake the family doctor system be the target of the health service and health expenses"double-gatekeeper " on the mechanism by signed with the residents, theimplementation of the system of first-diagnosis in community, according to the pollprepaid services funds, what’s more, the system regulates the rational use ofresources for health, reduces health care costs, significantly improve the nationalhealth situation, and meets the personalized health needs of residents.At present, China is conducting a new round reform of medical and healthsystem. And with the constant introduction of the system of national health carereform and community health services reform continue to deepen and improve，establishing a family doctor system has become an inevitable trend in China, in orderto solve the prominent contradictions of “Kan-Bing-Gui”and “Kan-Bing-Nan”indomestic. Shanghai first began the pilot work of the family doctor system in fivedistricts of Xuhui, Minhang, Jinshan etc, in2007.In August2010, shanghai proposedthe strategy that in the next period of time, shanghai would gradually promote thefamily doctor system to the city-wide in order to achieve the equalization of basichealth care. In October2010, the pilot samples were expanded to the five districts,including to the Jing’an, Zhabei, Pudong New Area, etc. In2011, the exploration andconstruct of the family doctor system were written into the new medical reformprogram in Shanghai. Being an important reform of primary health care service system in Shanghai, the research about the implementation of the system of familydoctors in Shanghai, to alleviate the pressure of the aging of the population, controlmedical costs unreasonable growth, the formation of ordered treatment order, and toachieve the Seamless health management, has a special meaning.Based on the systematic review of the domestic and international practice andexploration on the family doctor system, this study found that the key to the smoothimplementation of family doctors system is signing on the first-diagnosis, two-wayreferral, powerful information support platform, a sound incentive and examinationmechanism, scientific Medicare payment. Therefore, this study systematicallyanalyzes the historical evolution of the family doctor system in Shanghai byliterature review, questionnaire, expert interviews, SWOT analysis, Path analysis，medical personnel interviews, case studies and other methods, and also has ananalysis on the status quo of the human resources of the Shanghai basic medical andhealth system, financial input estimation, and other content, and builds the mode ofimplementing the family doctor system in Shanghai by research the connotation ofthe family doctor system, the qualification and training of family doctors, familydoctor services and processes, the family doctor system, performance evaluation andso on. At the same time, the paper discusses some key issues on the implementationof the family doctor system, and gives some the relevant supporting policies for thefamily doctor system in Shanghai,including incentives, compensation mechanisms,monitoring mechanisms, management mechanism in order to provide a package ofpolicy recommendations for the construction and implementation of the familydoctor system in Shanghai.This research was supported by the following main conclusions:（一）Quantitative conclusions1．When the residents need go to the doctor, the proportion of the residentschoosing the community health service centers as the first-diagnosed institution is 65%, and to the proportion of preferred three-level hospital is21%. From theanalysis of the reasons to choose the first clinic hospital, the factor that the residentsgive first value is the nearest convenience, followed by good service attitude, lowcost, medical standards and other factors. The main causes of the residents preferredthree-level hospital are medical technology, advanced medical equipment, medicalenvironment, however, three-level hospital is not preferred by the residents firstlychosen mainly because of long waiting times, high cost of treatment, and thecrowded treatment environment. Similarly, the reasons that the residents preferredthe community health service center and the preferred not to the community healthservice center were also analyzed.2．After matched the health service needs of residents and the ability of themedical staff to provide, it’s is considered that the Shanghai family doctor servicesshould include the following aspects：（1）To carry out the health management ofchronic diseases, the health examination for aged60or older, the guidance of eyecare for aged over70, and other services to special populations, preschools andschool students and nursing homes for the elderly;（2）Carried out6to12times ayear family health counseling and issued health education prescription services;（3）to carry out the assessment on risk factors of the health of residents and family;（4）To carry out the guidance services of the quit alcohol limit, a reasonable diet,psychological counseling and so on;（5）To provide tracking and monitoring andtreatment according to the treatment programs for residents and their familymembers;（6）To provide the services of reporting the patient’s health recordinformation to the supervising authority, the provision of out-patient appointment intwo-level or three-level hospital hospitals, examination, inspection services and soon;（7）To carry out the services of two-way referral and recommending Clinicexperts;（8）To carry out other basic health care and basic public health services.3．About the trust of the resident to family doctor, the results is not very good, and the enthusiasm of the residents contracting with the family doctor is not high.4．About the GP work practice, it’s a lower proportion on very satisfied orsatisfied, for example, there is only5.5%of the medical staff showing a verysatisfied in all aspects of the current situation, respectively32.2%and46.1%of themedical staff express their satisfaction and general, and15.2%of the medical staffare not satisfied with the current state of the various aspects.5． Path analysis on the part items of the medical staff and residents’questionnaire found that the services provided by the family doctor has a positivepredictive effect on the demand and satisfaction for family doctor, and the pathcoefficient reached a significant level; the demand for the family doctor and thedemographic variables of the family doctor had negatively predicted on thesatisfaction of the family doctor, and the path coefficient reached a significant level,p values of0.05and0.04, respectively.（二）Qualitative conclusions1．At present,Shanghai should choose the non-complete family doctor systemservice mode and select only the part of the diseases, part of the population, offeringthe comprehensive service content contained the family doctor system.2．Shanghai family doctor system should adhere to the guiding ideology of theimplementation of health management, promoting the health of residents and takinginto account the actual needs of residents and the existing medical services deliverycapacity, in accordance principles of implementation with the "highlight a core,emphasis on contracted services, focus on a variety of service ways, strengthenpolicy support, make the scientific performance appraisal, health and sustainabledevelopment", adopting the steady progress and progressive reform in order toensure the smooth transition of the primary health care service system from thegeneral practitioner system to the family doctor system.3．According to the survey, the medical personnel think that the that family doctors should be between the ages of31to50,and have a university (includingcollege) education, and also he should be primary or intermediate grade, and be apractitioners in primary health care and health service more than five years.4．This study suggests that the performance appraisal of Shanghai family doctorsystem should include the family doctor and his team’s performance appraisal andthe effect of the family doctor system. Among them, the performance evaluation ofthe family doctor and his team can be divided into family doctors’ workloadassessment, chronic disease management performance appraisal, family doctors’team assessment as well as some additional factors four parts, this study alsodeveloped a family doctor job performance evaluation tables. About the assessmentof the family doctor system, the research refine the absolute and relative values ofthe community health service volume of outpatient services, patients health carecosts, the management rate of infant health, chronic disease self-management rate,patient referral rates, patient care services satisfaction rate, and medical staffsatisfaction rate, the input-output cost-effectiveness assessment indicators by theexperts brainstorming.（三）Policy recommendations1．According to the foreign practice and the survey results, it is suitable toprimary health care services implementing Mixed method of payment, including topay according to the head, supplemented by fee-for-service payment and DRGs inthe mode of implementation of the family doctor system.2．On the basis of the quantitative research and quantitative research, this studyproposes the policy recommendations about the implementation of Family doctorsystem, mainly including the way and content of services of family doctors; chronicdisease management strategy; perfecting family doctors incentives to improve thesocial status of family doctors; increasing the Medicare payment tilt policy efforts tothe grass-roots level, the inclined to prevention and health; developing the medicare payment policies for the aged care home beds and home care; giving full play to therole of the medical and health information; improving the relevant laws andregulations, strengthen the comprehensive supervision; increasing effortscollaborative work and building long-term mechanism etc.The innovation and contribution of this study is to explore the content, process,performance evaluation system of the family doctor system,the gaps of humanresource and the necessary financial investment for the first time when the systemwould be promoted to the city. The study also analyze Medicare payment matchingwith the family doctor system and gives some supporting policies for theimplementation of the family doctor system in Shanghai.the research has theaspirational,and the focus is novel, followed by the health development trend inShanghai. Based on national conditions and Shanghai practical, the conclusions inthis study are scientific, reliable, and operable, and the research findings and policyrecommendations can give the inspiration for the in-depth exploration and practiceof the family doctor system. But limited by the capacity and resources, qualitativeresearch and summarized on certain issues only, not further explored, such asShanghai family doctor system of performance appraisal system is for the lack ofresearch.