| BackgroundIn 2010—2017,China’s health care spending increased from 1998 billion Yuan to 4756.1 billion Yuan,far exceeding the gross national product(GDP)growth.The huge number of elderly medical groups,the rising number of chronic diseases and the increasing demands of ordinary people for health make the government and the medical system face enormous challenges.The situation in other countries and regions is not much better than in China.For example,the national health care system implemented in Canada and the United Kingdom,the medical insurance budget restrictions make people need to wait a long time to get specialist services and high-tech diagnosis and treatment.Canada’s universal free medical insurance has put the medical system in trouble.Although the UK’s universal health service system(NHS)has shortened the waiting time for patients to seek medical care,it cannot offset the sharp increase in medical expenses.This is a problem for all medical systems around the world,and we are looking for answers that seem to have not been given.In August 2016,President Xi Jinping listed the "hierarchical diagnosis and treatment system" as the first in the construction of basic medical and health systems that required key breakthroughs at the National Health and Wellness Conference.In July 2017,the Chongqing government took the joint medical alliance as the focal point,actively constructed the system of hierarchical diagnosis and treatment of chronic diseases,and planned the first treatment of 50 urgent and chronic diseases at the grassroots level.Only when medical resources are effectively shared in the region and the ability of primary medical services is further improved can a hierarchical diagnosis and treatment model at the basic level,dual referral,rapid division and treatment,and upper and lower linkages be formed.ObjectiveThis study explores the essence of hierarchical medical system by analyzing the management modes of chronic diseases in China and other countries.Based on the current situation in Chongqing,this study takes chronic disease management as the entry point for the construction of hierarchical medical system,and takes the medical alliances as the starting point to make suggestions on the operation status of different modes of medical alliances,the key points of chronic disease management,and the difficulties in the construction of hierarchical medical system.In order to sum up the experience,it is expected to provide reference for the construction of China’s chronic disease management and hierarchical medical system ContentsFirst,the contents of division of labor and cooperation in hierarchical diagnosis and treatment were sorted out,and the relevant modes of chronic disease management at home and abroad were summarized.Second,from the perspective of disease management,chronic diseases are reclassified into intuitive chronic diseases and rule-based chronic diseases by identifying different mechanisms of disease pathogenesis and recovery.Through the innovation of the technology of diagnosis and treatment of chronic diseases,self-management mode and the mode of medical association,the theoretical framework of chronic diseases management is proposed.Thirdly,the status,problems and causes of hierarchical diagnosis and treatment of chronic diseases in Chongqing medical alliance were analyzed.Fourthly,it provides countermeasures and Suggestions for China’s graded diagnosis and treatment of chronic diseases.MethodsIn this study,in addition to the literature research method to sort out the domestic and foreign chronic disease management modes,a comparative analysis method was used to compare the two-way referral modes: the compact mode,the semi-compact mode and the loose mode.A questionnaire survey was conducted on the medical care intention of 9 first-grade hospitals in Chongqing city and 8 districts and counties with chronic diseases,as well as the awareness and attitude of two-way referral.Based on game theory and asymmetric cooperation model,as well as the development and changes of disease management,the methods and experience of graded diagnosis and treatment of chronic diseases are extracted.ResultsFirst,the national policies level emphasizes the establishment of hierarchical medical treatment system,but does not put forward effective theoretical framework to support it.The management of chronic diseases in Chongqing is short of national guidance.Only under the leadership of local governments,a multi-form hierarchical medical treatment model is established.In addition to public hospital services,other social health management teams and commercial medical insurance companies have not actively participated in the management of chronic diseases and have not established long-term effective cooperation.Second,the management of chronic diseases in Chongqing is centered on community first diagnosis.However,over 20 chronic diseases are demanded going to primary hospital first.It is a huge test for the service capacity and service level of primary medical and health institutions.In Chapter 3,research results suggest that in addition to patients with chronic respiratory diseases(COPD),more than half of the patients with chronic diseases prefer to choose large public hospitals for the first diagnosis,and about one-third of the patients have never been exposed to graded diagnosis and treatment.There are no specific rules for two-way referral within medical service institutions or medical associations,and two-way referral becomes a problem of benefit distribution.Thirdly,there is no team model or efficient information platform for health management organization to assist self-management.Countermeasures1.Improve the chronic disease management system,and transform from "treating disease as the center" to "health management as the center".2.Improve the hierarchical medical system,guide people to seek medical treatment at the grassroots level through medical insurance policies,formulate evaluation standards for hierarchical medical system,encourage the expansion of the implementation scope of the compact medical association,improve the basic health service function,and correct traditional stereotypes.3.Improve the construction of health information platform. |
