Development Of Triage System Is A Long Way To Go

In the new crown pneumonia outbreak, the "old trouble" recidivism with weak primary health care has again attracted the attention of the development of the triage system.

"The lack of triage system in the epidemic has given us great lessons. Our medical triage system has yet to be perfected. Primary health care is not perfect, and there is no effective diversion of patients. In the early stage of the epidemic, a large number of patients rushed to hospitals in Wuhan, which greatly increased the possibility of cross infection in hospitals. Liu Mulong, executive partner of fairy pupil capital, told reporters on twenty-first Century economic report.

Through this "epidemic", the short board exposed by the domestic medical system is worth pondering. The development of the triage system is still a long way to go.

Grassroots medical short board exposure

"Community hospitals in the early stage of the epidemic do not accept fever patients, and hospitals with fever clinics will accept them." A doctor from a third class hospital in Shanghai told the economic news reporters twenty-first Century that after the outbreak of the outbreak, the number of fever clinics in his hospital increased greatly, and even the equipment of other departments needed to be mobilized.

? ? Hospital fever clinic overcrowding is actually not a special case that has been spawned in this outbreak. Even during the annual influenza season, the problem of limited ability to treat and cure fever patients in primary medical institutions will be exposed. Most primary health care institutions do not have fever clinics, and generally suggest that fever patients should go to grade two or three hospitals for further treatment or community service. Service Center for referral. A large number of patients also rushed to the fever clinic of large hospitals, but increased the chance of infection of patients with common cold. There seems to be a limited role for such a large classification system.

Hierarchical diagnosis and treatment system is internationally recognized as a relatively efficient medical service mode. Popularly speaking, different levels of medical institutions bear different diseases. Triage therapy can not only improve the utilization efficiency of medical resources, but also greatly extend the carrying capacity of medical service system in daily operation. The core of the construction of grading diagnosis system is to enhance the ability of general family medical service in basic level community medical institutions.

In the ten spring and Autumn period, the "new health care reform" did make great progress in the primary health care system. The subsidy standard for basic public health services in the country increased from 15 yuan in 2009 to 69 yuan in 2019, and the service items gradually increased. But the basic medical institutions in the triage system is still a "short board".

According to the data compiled by Bain&Company, the number of out-patient services in primary health care institutions in China has declined continuously in the past 2012-2018 years, from 63% in 2012 to 57% in 2018.

The supply of primary medical services in China is insufficient, and patients run to large hospitals. The number of hospitals in grade two or three is small but the load is high. According to the data provided by Guoxin Securities, in 2018, the number of visits to hospitals in three hospitals in China reached 727 thousand and 900, and the number of patients in two hospitals reached 142 thousand and 500, while the clinics in community health service centers and township hospitals were only 22 thousand and 800 and 30 thousand and 600.

The role of primary health care institutions is small, and domestic hospitals still face enormous pressure of diagnosis and treatment. Some medical resource runs are unavoidable during the epidemic.

Investment and talent constraints

What is the development of grassroots medical care?

In March 1st, the CPC National Health and Health Committee published the "perfect epidemic prevention and control system and mechanism, and perfect the national public health emergency management system". It clearly pointed out that the infrastructure construction of grass-roots prevention and control institutions in some parts of China is lagging behind, and the loss of public health personnel is more serious.

From the perspective of medical input, the financial input to primary health care is not much. In 2018, the fiscal expenditure in China's health sector was about 1 trillion and 600 billion yuan, accounting for 1.7% of GDP. If combined with local investment and personal consumption, the total expenditure of medical care was about 6% of that of GDP. According to WHO statistics, the average level of medical input to GDP in the world has reached 10% in 2017. Specific to the domestic primary health care construction, the financial investment is even more modest. By 2017, the direct subsidy of our financial to primary medical institutions was 180 billion 800 million yuan, although the figure steadily increased at 14.3% per year, but only 12.5% of total medical expenditure. There was still a lot of room for increasing the input of primary health care. Eyebrows.

From the perspective of talent development, the loss of primary health personnel is obvious. The total number of primary health care personnel decreased from 40% in 2010 to 32.2% in 2018. From the point of view of the graduation of medical students, from 2009 to 2017, the number of new health technology hospitals in China accounted for 74.9%, while the grass-roots level accounted for only 19.5%.

Hu Lin, an Applied Health Research Institute of University of Birmingham School of medicine, once said in an interview with the media that medicine is an experiential science. If more people choose to see a doctor at the grassroots level, the level of disease will increase.

However, the level of primary health care is not up to standard. People's lack of trust in primary health care institutions and the "medical treatment of diseases running to large hospitals" are hard to rectify, and in turn, to curb the improvement of primary medical care level. This seems to be a "dead circle".

In fact, the call for strengthening primary health care input and talent development has always been there. Peking University Shougang Hospital President Gu Jin once mentioned that in addition to widening the gap between the reimbursement of medical insurance in primary medical institutions and large hospitals and giving play to the guiding role of medical insurance policy, it is necessary to enrich the professional strength of primary medical care through expert sinking and subject sinking. On the one hand, experts will sink into the community to facilitate people to see a doctor while guiding the training community. District doctors enhance the service ability of general practitioners, and on the other hand, they should sink common disease and frequently occurring departments to grass-roots units, and strengthen the construction of discipline level at the grass-roots level.

Liu Mulong told the twenty-first Century economic news reporter that the medical resources of the hospital are limited. We must do a good job of guiding the patients and let some of the resources sink, so that the grass-roots level really takes the role of triage.

Primary health care starts again

Post epidemic era is the right time to make up for the shortage. Therefore, the construction of primary health care system should also become the focus of public health infrastructure in the future.

Medical infrastructure is lagging behind. In the future, investment in basic medical institutions, bed equipment and financial subsidies is essential. The new trend of medical infrastructure will become one of the opportunities for primary health care development. But at present, the "new infrastructure" dividends that can be allocated in the medical field are still very few. Data from Guotai Junan report show that in the PPP project with a total investment scale of 17 trillion and 600 billion in 29 provinces, the traditional iron public foundation (railways, highways, ports, wharves, airports, tunnels, etc.) accounted for 41%, and real estate and soil storage accounted for about 20%. In the epidemic situation, people's concern for medical and health, only about 300 billion of the project, accounting for 1.7%, this proportion is not optimistic. However, with the increasing emphasis on public health services in the country, this proportion will be expanded.

On the other hand, the "Internet + medical care", which shows a bright eye in the epidemic, is expected to help the development of primary health care. The most important significance of Internet health care is to promote the implementation of grading treatment and enhance the efficiency of the medical system by relying on the powerful information and resource integration capabilities of the Internet. The hierarchical diagnosis and treatment mechanism requires that patients be allocated among different levels or categories of medical institutions according to the type and priorities of the disease, and the referral between different medical institutions should be carried out according to the development of the patient's condition. Medical institutions need to share the medical information and medical resources to some extent. The "Internet + medical" can promote the integration of medical resources, guide the quality of medical subsidence, and promote the construction of hierarchical diagnosis and treatment system.

? ? ? CEO Luo Lin, a good neighbor doctor, believes that the basic medical institutions can improve the ability of diagnosis and treatment with the help of all kinds of supporting facilities, including the further construction of the medical community, the further improvement of medical data, the upgrading of remote diagnosis and treatment, the digitalization of health records and the construction of cloud computing.

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