What are the international experiences of medical service provision models

I. Specialized Division of Labor in Medical Services

In the provision of traditional medical services, medical services are only provided by hospitals and doctor's clinics. From medical consultation, laboratory tests, diagnosis, treatment to postoperative rehabilitation and chronic disease management, the above two types of institutions cover almost all functions. This kind of "large and all-inclusive" institution has high operating costs and unclear core functions. A large amount of cost is invested in daily operation rather than treatment for patients; while the emerging medical service model shows more characteristics of specialized division of labor, dispersing multiple functions into various independent institutions. With the continuous progress of information technology and diagnosis and treatment technology, it can provide patients with cheaper services.

Only dispersing diagnosis and treatment into different institutions can significantly improve service efficiency.

With the assistance of information technology, patients can upload their test results via the Internet and get accurate diagnoses from professional doctors, while treatment can be completed through micro-clinics, specialized hospitals and other institutions. On the basis of accurate diagnosis, the treatment of many diseases is just a controllable and replicable process, and physician assistants and even nurses can complete these treatment work.

Quite a number of institutions dedicated to this have emerged in the United States, such as RediClinic and Minuteclinic (acquired by CVS, the American chain pharmacy, in 2007), surgical specialized hospitals such as Shouldice Hospital, as well as many eye surgery clinics, heart disease hospitals, cancer rehabilitation centers, etc. Compared with traditional hospitals that charge for all services by item, these institutions focusing on treatment have begun to charge patients a fixed fee based on a single procedure. With unified procedures and controllable risks, the medical expenditure is thus clear and definite. In September 2006, the ProvenCare program of Geisinger Health System began to charge insurance companies a fixed rate for selected coronary artery bypass grafting surgeries, and also provided a 90-day warranty.

Clayton Christensen's research shows that, compared with medical institutions that provide both diagnosis and treatment, these clinics that only provide specific treatment services can provide medical services of the same level at half the price. For the treatment of the same external abdominal hernia, Shouldice Hospital only admits a few types of external abdominal hernia patients, but all patients adopt the same clinical pathway, which only takes four days in total: dietary preparation the day before yesterday, surgery on the second day, and recuperation on the third and fourth days. The total cost is 2,300 US dollars, the patient satisfaction rate is close to 100%, 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 surgery is 3,350 US dollars, and the surgery is completed on an outpatient basis. If the patient is hospitalized, the cost will be as high as nearly 7,000 US dollars.

Common and frequently-occurring diseases such as upper respiratory tract infection, sinusitis and pharyngitis can also be treated in micro-clinics mainly run by nurses. According to statistics from Mary Kate Scott, an expert in the field of micro-clinics in the United States, with correct technical support, a total of about 60 to 100 types of diseases can be treated by micro-clinics. Although the variety is limited, these diseases account for 17% of the diseases seen by family doctors in the United States, and the cost of treating these diseases in micro-clinics is 32% to 47% lower than the cost of seeing a family doctor. Its characteristics of convenience, speed and no queuing also greatly reduce the patients' medical treatment time and greatly improve patients' satisfaction.

Since nursing staff are sufficient to play a major role in the new medical service model, this greatly reduces the work burden of doctors, and doctor human resources can be more invested in professional clinical diagnosis.

The Cleveland Clinic in the United States has reorganized and transformed the original center into an institution characterized by cross-departmental expert collaboration. For example, the Institute of Neurology employs oncologists, radiology experts, neurosurgeons, psychiatrists and psychology experts, etc., and integrates them with neurologists to diagnose the cause and different types of patients as accurately as possible. The continuous refinement of diagnosis in turn promotes a better division of labor between diagnosis and treatment.

In addition, doctors can also greatly expand the scope of providing medical diagnosis with the help of information technology.

In traditional communities, a general practitioner serves about 1,000 to 1,500 people, while in the new medical service model, patients no longer need to rely on the face-to-face medical treatment mode. Doctors can provide services to patients from all over the world and make diagnoses via the Internet. Under this new service mode, the general practitioner team can expand their service scope to 5 to 10 times that of the original traditional mode.

The ECHO project of New Mexico State University uses electronic communication technology to provide specialist medical services for rural communities in New Mexico, such as the treatment of hepatitis C and AIDS. But the ECHO project is completed through the cooperation between specialist doctors and local medical service providers. In this process, the technical capabilities of local medical staff have been improved, which indirectly promotes the improvement of local medical service level. This is obviously of great significance for developing countries or underdeveloped regions.

II. Establishing a Coordination Network to Promote Patients' Self-healing

The Internet, which is developing rapidly and penetrating 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 patients' own lifestyles and daily behaviors. How to improve the compliance of chronic disease patients with treatment plans is a problem that bothers many doctors. Relying only on doctors' prescriptions obviously has limited effect, and the long-term and huge expenses caused by chronic diseases have increasingly become the main disease burden in various countries.

In the United States, patient networks built on Internet platforms allow patients to actively participate in their own treatment, which greatly improves the therapeutic effect and significantly reduces the cost of treatment.

Take the dLife website as an example. It is committed to helping diabetic patients and their families establish online mutual assistance. Through broadcasting TV programs and website navigation, it allows registered users to help and encourage each other. There are also similar institutions such as Waterfront Media and WebMD, which are committed to building mutual assistance networks for chronic disease patients. Using a large amount of patient data, patients can find other "people like themselves". Patients can understand their own treatment progress by directly comparing with other patients, and eventually these patients can communicate and learn from each other.

For addictive chronic diseases, this kind of treatment is particularly effective. Take alcohol abstinence as an example. The content exchanged in the patient network is all user-generated content. They share experience in overcoming alcohol addiction with each other and encourage each other in the process of quitting drinking. Although many doctors also treat patients for acute alcohol withdrawal, alcoholic liver disease or alcohol poisoning, their role in treating the chronic disease that is the root cause is limited.

With the support of the network, such institutions can help patients use registered private medical records and anonymous medical expense bills to find similar "fellow patients", and some can even provide measurement indicators for patients to compare with similar fellow patients. Combined with model prediction tools, it can calculate the probability of disease occurrence and obtain corresponding prevention and treatment suggestions. As the data continues to accumulate, the accuracy of matching and diagnosis continues to increase, forming a virtuous circle.

This also brings great convenience to the growth of doctors.

In the traditional medical service model, a doctor's diagnosis and treatment level largely depends on the accumulation of clinical experience, but now the big data formed based on the Internet platform allows doctors to easily browse a large number of 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 knowledge about RLS". This has become a new channel for doctors to learn and progress.