To Explore The Family Doctor Model Based On The Concept Of Prevention And Treatment

1.Background and ObjectivesThe disease spectrum and the medical model have changed,which requires our medical mode shift from disease treatment to health management, from "take the patient as the center" to "take the health as the center. With family doctors (GPS) as the main provider,community health service, is the most basic and universal service mode,and it provides full control of individual, family and community health. It is consistent with the require of the change of disease spectrum and the medical model.Family doctor, the general medical practitioner, is a major provider of community health service and the ideal carrier of this new medical model. It can reduce the incidence of a disease and improve the health of residents by the combination of prevention and treatment.China’s family doctor system is still in the primary stage, it still have many problems.Most family doctor came from clinical doctor, they do not have enough preventive medicine and other aspects of knowledge and skills because of lack of systematic medical education, and their treatment of the disease is still partial service.Furthermore, because of the excessive marketization of medical service, most doctors focus on medical service,and ignore those preventive services with less income. They prefer to prescribe more drugs, more check, which presents serious waste. On the whole, family doctor tends to take the patient as the center and lack of enthusiasm for prevention, which makes prevention seriously disjoint with cure. The function of public health service implementation of the family doctor and Community Health Service Center is still not optimisticThe lack of financial investment and effective assessment and incentive mechanism is an important block for the use of health management concept. On the premise of insufficient financial investment in basic health institutions, health agencies have to focus on medical services from which they can gain more to maintain the operation and personnel income, which makes "low income" public health prevention and health care project be ignored. In the new medical mode, the smooth progress of The family doctor system wants to be proceeded smoothly, and the concept of "giving priority to prevention, combining prevention with control wants to be put in practice, they both need to explore effective assessment and incentive mechanism,with the ensure of necessary financial investment. Considering the phenomenon of "take more medicine, do more checks" in the current community health service center, we can try to change the payment method to change the tortous community waste medical behavior, to guide the community health service organization to reduce costs, reduce waste. Furthermore, explore to build w incentive and community development fund with the saved money for family doctors carrying out health management, to establish a set of effective assessment and incentive mechanism to arouse the enthusiasm of community prevention work and implementation of community health management.In addition, the smooth implementation of assessment and incentive mechanism still depend on the family doctors working mode, the family doctor service content, the family doctor information system construction, and the family doctor service definition and specification etc.The family doctor system of developed countries have developed for a long period, and have got a considerable foundation in both quantity and quality of family doctors. The system mode is mature, the working mechanism, the family doctor service and referral, compensation and incentive, management level has gradually formed a set of relatively perfect system.Our family doctor system started late, even researches for work contents, work mode and work evaluation have been carried out, but mostly aimed at certain aspects of system model. A comprehensive introduction to all aspects of the system. Introduction for how to use the assessment mechanism to implement the motivation of health management, and how to realize effective compensation and expenses of family physician system is still rare. And there is no research carrying out the family doctor system with prevention and combining prevention with control system as the starting point of consideration. But the existing exploration and research, will also provide an important reference for constructing a complete family doctor system.In order to build a complete family doctor system model, this research wants to design a set of working mechanism which reflect "prevention first, combining prevention with control" of health management, and can fully guarantee the implementation of the concept.By preliminary application and evaluation of the working mechanism of the pilot areas, the theoretical will be improved.2. Materials and Methods(1) In this study, medical insurance payment principle, three grade prevention principle, incentive theory are used as guide theory. The "prevention first, combining prevention with control" mode of family doctors is designed and perfected through literature review and focus group interview.(2) Through the investigation of the results, the comparative analysis of system mode pilot "before" and "after" pilot, the research have also evaluated the effect in practice, including the existence of the system goal and disadvantages.3. Main Results(1) Design of the mode and work content of family doctorsBased on the summary of domestic and international family doctor service system, and the existing pilot community family doctor system and the ability level of the team of physicians, the research has defined the family doctor’s 11253 service mode embodied "combining prevention with control theory and the principle of prevention", and put forward the family physician model hardware and manpower allocation specification. Focus group discussion and brainstorming were also organized during the research.On this basis of systematically collect and analyse the basic public health project and the function definition of family doctors of the state and Shanghai, the research has identified the pilot community family doctor basic medical and public health services with theory and practice experts’repeatedly focus group discussion and brainstorming. Considering restricted practical condition, the research has designed suitable planning and procedure for proceeding in the near future, medium and long-term promotion.(2) The design of incentive and examination mechanism for family doctorManagement and supervision for family doctors work is necessary as to clear the system implementation effect and service mode and content. Therefore, based on the existing comprehensive evaluation index system in the pilot institutions, the study has established a new evaluation index system involved the family doctor service quantity, unit of service quality and service effect with the help of focus group interviews and brainstorming of many experts.As to the detailed way of examination, the study has build a method considering individual to the family doctor service team, the service unit to three-dimensional whole community health service center level.Based on this and use the thought of payment reform, the study has also build an incentive mechanism that promote the family doctor to carry out prevention.(3) Auxiliary conditions the family doctor system requiredAs to the definition of auxiliary conditions of family physician system, the study has build a requirement include both the economical compensation mode of joint and medical insurance to make sure the effective operation of payment reform and assessment and incentive mechanism based. Besides, support of data and a timely, convenient community management, information, decision analysis system are also necessary.(4) Preliminary evaluation of the family doctor system modelThe family doctor system scheme has achieved good results in practice. The pilot institutions has got faster growth in business income and service people. In the first three quarter of 2013 compared to 2012, business income increased from 429.4 million yuan to 502.3 million yuan, with an average increase of 17%; service people has increased from 287988 to 321066 with a growth rate of 11.5%.Public health services gained progress too:pilot community’s health care for the elderly, chronic disease management, child care, health education and promotion, health records management work have made a great growth, such as the number of health guide for the elderly aged 65 and above increased from 975.5 to 2127.9, with the growth rate as high as 118.13%.Good service brings residents’compliance improvement, the total contract compliance in pilot community had rase and gradually stabilized at around 30%, which is far more than the same district residents contract compliance.In addition to the services attract bring business income and total medical income increase, the pilot community’s all medical expenses has increased faster than the average growth rate over the same period in Hongkou District community health service center. The result means that the hope of saving behavior is not clear, and also indicates that the reforms need to system a payment system reform which may be the main focus in the next step.4. Conclusion(1) The study has used the concept of "prevention first, combining prevention with control" and control the growth of medical expenses in carrying out the family doctor system practice as the guiding ideology.Besides, introduction of medical insurance payment reform in the compensation mechanism makes sure that the concept of "giving priority to prevention, combining prevention with control" get long-term implementation.(2) The study has designed a set of family doctor system including the service mode service unit and hardware configuration, the service content and standard, assessment and incentive measures, effect evaluation idea and mechanism. According to the various details in system development,the research explored detailed conditions required for the auxiliary system.