Interpretation of the policy of "grading diagnosis and treatment"

Some people in the OFweek medical network are counting on medical insurance. For example, if they go directly to a large hospital, they will pay less or not compensate. However, this is not a question of coffee prices, and everyone has a drink every week. Everyone wants to find a trusted doctor first.

There are both the people’s wishes and the trillions of blessings. Why is the policy still difficult? Is it because the means are not strong, or is the direction wrong? The Arterial Network edited this article written by Xiong Xianjun, a medical reform expert and secretary general of the China Medical Insurance Research Association, to comprehensively interpret the connotation, problems and reform paths of the graded diagnosis and treatment system.

For the role and significance of grading diagnosis and treatment, there is almost no objection to the whole society, that is, the optimal allocation of medical resources can produce the best cost-effectiveness. In the face of the current situation of China's medical system reform, everyone believes that "graded diagnosis and treatment" is a good medicine for the treatment of the medical system. It should be established as a "system" under the government's leadership, except for the relevant departments to issue documents at all levels. In addition to the business scope of medical institutions and the functions of medical institutions at all levels, the “three medical linkages” are also emphasized, requiring the medical insurance department to increase the proportion of payment for insured patients at all levels of medical institutions. Some scholars even suggested that administrative regulations should be made by the medical insurance department, requiring patients to go to the grassroots first consultation and then referral, otherwise they will not be reimbursed. The reason is that this is an internationally advanced experience, and the United Kingdom is stipulated in this way.

There is no denying that in the United Kingdom, Germany or Taiwan, the basic medical services provided by general practitioners account for the majority of medical services. Patients usually go to the general department first, and then go through the referral (not to go) specialists or Hospitalized. This orderly service model is indeed advanced and efficient, and it is something we are eager for. However, the formation of such a good grading medical order is not as simple as the imitation of imported products, and the same products can be produced by taking foreign drawings. “Knowing it” but not “knowing it” is the most common mistake in the foreign experience of medical and health system reform in recent years, such as the basic drug system, the GP signing system, the national drug negotiation system, and the national free medical system. Wait. The “East Effect” has become a story that has been repeated for many years in the reform of China's medical and health system. At present, it seems that this trend also exists in the promotion of graded diagnosis and treatment.

What is the graded diagnosis?

The first visit in the community, referral to specialist hospitalization is a procedural description of graded diagnosis and treatment, not the nature or attributes of graded diagnosis and treatment. Is grading diagnosis and treatment a "system" for some people? Is it a "management system"? Is there really someone who said, "I have established a grading diagnosis and treatment system before the reform and opening up?" the author thinks:

First, grading diagnosis and treatment is not a separate system, but the result of a good medical system operation and a benign state of the medical service system.

Whether it is to inspect the United Kingdom or Germany, it has not found that there is a special law to standardize the diagnosis and treatment as a system to regulate, but to grading diagnosis and treatment as the goal of the medical service system management system and medical security system. In other words, grading diagnosis and treatment is the result of the system of all medical and medical insurance systems, not the system itself. The results of the grading diagnosis and treatment in the United Kingdom and Germany are based on an open and competitive physicians' free practice management system and an open clinic management system for private clinics. The government's regional medical planning is not a mandatory choice of ownership. The functional grading of medical institutions and the orientation of patients' medical treatment are the result of long-term natural formation under these management systems.

In the United Kingdom, pay-per-head payments for clinic doctors and pay-per-item points for clinic doctors in Germany are not designed to support a “graded diagnosis and treatment system”, nor are they intended to force patients to go to the primary care system. It is because the medical system has produced a benign result of grading diagnosis and treatment. According to such a benign result, medical insurance adopts a suitable payment method to achieve the best cost-effectiveness. We must be clear about this causal relationship and internal logic.

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