In 2015, Yichang built hierarchical diagnosis and referral collaboration platform by dint of “Internet-plus” to break information block, form price leverage, lead in the third-party services and make a firm base, which aroused a case for some fairly radical responses in the Second National Summit Forum for the tertiary public hospital development and has drawn great concerns of the State Council.
“Internet-plus” - Best Technical Support
January 17, Lu Zhikai from Yuxi town, Dangyang city, was in a coma and sent to the township health center, first diagnosed as cerebral hemorrhage, but the doctors didn’t know for sure cerebral blood vessels hemorrhage or infarction. Zhang Lifeng, the hospital chief physician, decided to transfer him to Dangyang People’s Hospital.
Zhang Lifeng logged in the “hierarchical diagnosis and referral collaboration platform”, filled in an electronic referral and passed it to the Dangyang People’s Hospital and the NRCMS center for synchronize audits. 10 minutes later, the NRCMS management agreed on referral. In addition, the message of related arrangements from Dangyang People’s Hospital for examination and treatment was sent to the phone of Lu Zhikai’s daughter.
Liu Guanbing, vice-president of Yuxi Town Health Center in Dangyang city, told reporters, before building the “hierarchical diagnosis and referral collaboration platform”, the patients family members need to go to community or township referral first by a doctor filled paper referral because of no unified referral collaboration platform system, then to the NRCMS for approval. Approved agreement, the patient can transfer to a major hospital, which at least stamps 4 and takes half a day. With a cumbersome process, many masses abandon referral directly go to major hospitals due to fear for delaying the disease. “With the collaboration platform, it changed greatly , saving patients’ time running back and forth and going through treatment procedures in 10-minute.Now, more and more patients are willing to referral from our hospital, and our beds are full.”
By the “Internet plus”, Yichang built “hierarchical diagnosis and referral collaboration platform”, docking City County and Township tertiary medical institutions information system and realizing medical information exchange. Also it opened up an appointment, referral-hospital guide, electronic signature and so on, which combines referral collaboration platform with the NRCMS management platform for simultaneously the patients’ referral and the NRCMS reimbursement transfer. Currently, Yichang 774 public hospital medical institutions have all entered the hierarchical diagnosis and referral collaboration platform.
Speaking of the benefits of “hierarchical diagnosis and referral collaboration platform” to the patients, Xiong Guibin, the deputy director of Dangyang Health Family Planning Commission, makes an apt and vivid metaphor: “we were driving tractor on dirt road before; with this platform, we are driving a Mercedes-Benz on the highway.”
Price Lever Matching the Green Channel
Lu Guihua had one year of education and could not read many words. Initially, the doctor said her father need to transfer to a large hospital, still a little nervous: “So large hospital, where to go and who to find?” She learnt later that her fears were all for none.
Dangyang People’s Hospital sent a special ambulance to pick Lu Zhikai in the afternoon of 19. Meanwhile, Lu Guihua also received a message that there will be someone waiting for them in front of the hospital for the treatment. Sure enough, there is a young lady help them with the formalities when they arrived at the hospital, and she did not leave until sending them to the ward.
By “hierarchical diagnosis and referral collaboration platform”, it’s very convenient for the patients to transfer to the major hospital, and they will enjoy more benefits when transfer to the lower. Lu ZhiKai has enjoyed the preferential policies of turning back to base with rehabilitation.
On 21, Lu Zhikai is presently hospitalized in stable condition. Two more days in city hospital ICU, they paid 3,000 yuan, only 75% reimbursement, but back to the town hospital, it can be reimbursed 90%, plus the medical bills reliefs of 200 Yuan pay line of the patients who transferred from the superior hospital. After careful calculations and with doctor\'s permission, Lu Guihua made her father back to the town hospital to convalesce.
“We have done enough in policy first, hoping guide medical habits through economic levers.”Cao yuan said and introduced, after implementing hierarchical diagnosis, Yichang made a medical insurance compensation policy reform, the patients seek medical advice first at the grassroots level with up to 90% reimbursement, referral to county hospital, city hospital respectively up to 75%, 65%. If it is not diagnosed first through grassroots and went to the higher-level hospital directly, the reimbursement ratio would be reduced by 40 percent.
“Apart from the policy, we also introduced the social resources to help the civilian to receive the hierarchical medical system happily by providing green channel and all-around services,” said Cao Yuan. And the resource mentioned by Cao Yuan is to give guidance to the service personnel from the Young Lady Lu Guihua- the Road to Health (China) Information Technology Co. Ltd. The municipal government and the company jointly establish a sound landing service system and build a green service channel for referral treatment. At present, all of the county-level and above public hospitals in Yichang are equipped with relative service personnel to resolve the referral problem. However, what deserves to be mentioned is that the company shall take the responsible for the expenses and the financial burden is zero.
The only thing that can change people’s habit of medical treatment is good service with preferable policy. The data shows that by the end 2015 the receiving treatment rate of county-level hospital reached 90 percent, the hospitalization rate of the township hospital rose 20 percent than that of the last year and the per capital hospitalization fees firstly declined.
The hierarchical medical system indirectly helps the realization of resource optimization.
The reporter raised several questions, like “Are the grass-root medical institutions able to deal with the problem when there are many patients?” and “what kind of diseases need to be treated in the grassroots?” as well as the questions about the treatment ability of the institutions and so on, Cao Yuan the deputy director of the municipal Health and Family Planning Commission said that the hierarchical medical system promoted the reshuffle of the medical resources in a certain degree, indirectly helped the realization of the optimization layout of medical resources, made the medical resources using in a reasonable way, advanced the function identification of different level medical institutions and improved the service ability of the grass-root medical institutions.
The first thing for the hierarchical medical system is classification. Cao Yuan said that in order to encourage the patient to receive the first treatment in the primary-level hospitals and build their confidence in the grass-root institutions, the city gradually accelerates the upgrading of the basic medical institution by taking some active activities. To strengthen the team construction of the basic level medical institutions, in accordance with the standard subsidy of 10,000 yuan every person per year, the municipal Financial Bureau initially launched the activity of cultivating free village doctors in a directional training way in the prefecture level city around the country, which effectively solve the problem of the doctors’ shortage in the village. Cao Yuan said that the strengthening of the basic construction provided a good support for the building of the hierarchical medical system.
Cao Yuan said that the first basic treatment doesn’t mean to receive treatment in the township health institution. He explained that according to the three-level function positions of the medical institution Yichang has set up 324 catalog standards for the disease referral. For example, if the patient must receive treatment in city-level hospital, the hospital he hospitalized is a primary-level hospital and the patient can receive the municipal reimbursement ratio with the NCMS policy.
Cao Yuan introduced that since the implementation of the hierarchical medical system, the number of people receiving treatment rose in primary-level hospitals but declined in superior hospitals, which to some extent reduced the huge pressure of superior hospitals. At the same time, the competitions between the superior hospitals and the primary-level hospitals changed from monopoly form to the quality competition of medical services and also from homogeneous competition to diverse development and so on. In addition, he said that the rate of the patient transformed from the city to the outside is controlled within 10 percent, forcing the hospitals take concerted efforts to improve their own technology to ensure the quality of the medical services. Meanwhile, the number of people who receive treatment at the primary-level hospitals will decline and these primary-level hospitals have to compete in a different way with the comprehensive hospitals which have strong strength by their transformation.
“Up to now, Yichang has realized the universal coverage of the three-level referral service system, which helps medical institutions of different levels to realize the standardization of referral process, the electronic information of treatment, the refinement of referral reception and the activity should be prompted in a wider range,” said Cao Yuan. (Reporter Liu Jingjing, Correspondent Wei Jixuan)