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Academy of Social Sciences | What are the international experiences of medical service delivery mode

1. Specialization of medical services


In the traditional medical service provision, medical services are only provided by hospitals and doctors’ clinics. From medical treatment, laboratory tests, diagnosis, and treatment to postoperative rehabilitation and chronic disease management, these two types of institutions cover almost all functions. ”Institutions have high operating costs and unclear main functions. A lot of costs are invested in daily operations rather than treatment for patients; and the emerging medical service model shows the characteristics of more specialized division of labor and decentralizes multiple functions. To various independent institutions, with the help of continuous improvement of information technology and diagnosis and treatment technology, patients are given cheaper and more efficient services.


Simply distributing diagnosis and treatment to different institutions can already significantly improve service efficiency.


With the assistance of information technology, patients can upload their own test results through the Internet to obtain accurate diagnoses from professional doctors, and treatment can be done through micro-clinics and specialized hospitals. On the basis of accurate diagnosis, the treatment of many diseases is just a controllable and reproducible process, and doctor assistants and even nurses can complete these treatments.


A considerable number of institutions dedicated to this have appeared in the United States, such as the Rapid Clinic (RediClinic) and Minute Clinic (Minuteclinic, which was acquired by CVS in 2007), Surgery Hospital (Shouldice Hospital) and other surgical specialty hospitals, and Many eye surgery clinics, cardiology hospitals, cancer rehabilitation centers, etc. Relative to traditional hospitals that charge for all services on a project-by-project basis, these concentrating institutions have begun to charge patients a fixed fee based on a single procedure. The process is unified and the risks are controllable, and the medical expenses brought about are clear and unambiguous. In September 2006, Gevener Health System's ProvenCare program began to charge insurance companies a fixed fee for selected cardiac bypass operations and also provided a 90-day shelf life.


Clayton Christensen’s research shows that these clinics, which provide only specific treatment services, can provide comparable medical services at half the price compared to medical institutions that provide both diagnosis and treatment. The same treatment for external abdominal wall hernia, Shoredez Hospital only treats a few types of external abdominal wall hernia patients, but all patients use the same clinical path, a total of only four days, the day before the meal preparation, the next day, surgery, On the third and fourth days of rest, the total cost is $2300, the patient satisfaction rate is close to most, and the cost of medical malpractice litigation is almost zero; on the contrary, in a general hospital in North America, the cost of the same operation is $3350, and The operation is done in an outpatient clinic. If the patient is hospitalized, the cost will be as high as nearly $7,000.


Upper respiratory tract infections, sinusitis, pharyngitis, and other common diseases can also be treated in micro clinics mainly practiced by nurses. According to Mary Kate Scott, an expert in the field of micro-clinics in the United States, with the correct technical support, a total of about 60 to 100 diseases can be handled by micro-clinics. Although the types are limited, these diseases account for 17% of the symptoms of family doctors in the United States. The cost of handling these conditions in a microclinic is 32% to 47% lower than the cost of seeing a family doctor. Its convenient and fast, no need to queue, also greatly reduces the time for patients to see a doctor, greatly improving patient satisfaction.


Because the nursing staff is enough to play a major role in the new medical service model, which greatly reduces the workload of doctors, doctors' human resources can be invested more in professional clinical diagnosis.


The Cleveland Medical Center (The Cleveland Clinic) reorganized the original center into an institution featuring interdisciplinary expert cooperation, such as the oncologist, radiologist, neurosurgeon, psychiatry, and psychology at the Institute of Neurology Experts, etc., integrate with neurologists to diagnose the causes and different types of patients as accurately as possible. The continuous precision of diagnosis has promoted a better division of labor between diagnosis and treatment.


In addition, doctors can also use information technology to greatly expand the scope of medical diagnosis.


In the traditional community, the service range of a general practitioner is about 1,000 to 1500 people. In the new medical service model, patients no longer need to rely on the face-to-face medical treatment model. Doctors can use the Internet to provide services to patients in Tiannan and Haibei. diagnosis. In this new service model, the general practitioner team can expand their service range to 5-10 times the original traditional model.


New Mexico State University’s ECHO project uses electronic communication technology to provide specialized medical services, such as hepatitis C and AIDS treatment, to rural communities in New Mexico. However, the ECHO project was completed through the cooperation of specialist doctors and local medical service providers. During this process, the technical capabilities of local medical personnel were improved, which indirectly promoted the improvement of the local medical service level. This is obviously significant for developing countries or underdeveloped regions.


2. Establish a coordinated network to promote patient self-healing


The rapid development of the Internet that has penetrated into every corner of life has also brought new possibilities for the treatment and management of chronic diseases.


The therapeutic effect of many chronic diseases is closely related to the patient's own lifestyle and daily behavior. How to improve the compliance of patients with chronic diseases to the treatment plan is a headache for many doctors. Relying on the prescription of doctors only has obvious limited effects. The long-term and huge cost of chronic diseases has become a major disease burden in various countries.


In the United States, the patient network built on the Internet platform allows patients to actively participate in their own treatment, which greatly improves the effect of treatment and significantly reduces the cost of treatment.


Taking the dLife website as an example, it is committed to helping diabetic patients and their families to establish mutual help on the Internet. By broadcasting TV programs and website navigation, registered users can help and encourage each other. The same organizations are Waterfront Media and WebMD, which are committed to establishing a mutual assistance network for patients with chronic diseases, using a large amount of patient data, so that patients can find other "people like themselves." Patients can directly understand their own treatment progress through comparison with other patients. Eventually these patients can communicate with each other and learn from each other.


For chronic diseases with dependence, such treatment is particularly effective. Taking abstinence as an example, what is communicated on the patient network is user-made content. They shared their experiences of overcoming alcohol addiction and encouraged each other in the process of quitting drinking. Although many doctors also treat patients with acute alcohol withdrawal, alcoholic liver disease, or alcoholism, they have a limited role in treating chronic diseases as the cause.


With network support, such institutions can help patients use registered private medical records and anonymous medical bills to find similar "patients", and some can even provide metrics for patients to compare with similar patients. Combined with model prediction tools, the probability of disease occurrence can be calculated and corresponding prevention and treatment recommendations can be derived. As the data continues to accumulate and increase, the accuracy of matching and diagnosis also continues to rise, forming a virtuous circle.


This also brings great convenience to the growth of doctors.


In the traditional medical service model, the doctor's diagnosis and treatment level depends largely on the accumulation of clinical experience, and now the big data based on the Internet platform allows doctors to easily browse many cases and improve the accuracy of diagnosis.


In the United States, the Restless Legs Syndrome (RLS) Foundation helps patients “access cutting-edge treatment options and arm themselves with information to teach doctors their information about RLS.” This has become a new channel for doctors to learn and progress.


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