Appointment with the future

Shanghai is developing family doctor system, grading care according to severity of problem

In a bid to reform medical care with the support of big data and information technology, Shanghai is trying to develop a family doctor model and build a graded diagnosis system.

The city has been developing the family doctor model since 2011. So far it covers all the residential communities in the city. About 10.27 million citizens have signed up with family doctors.

Focusing on senior citizens and chronic disease patients, Shanghai started to push its so-called 1+1+1 integrated medical system, under which residents can contract with a community healthcare center, a district-level hospital and a city-level hospital at the same time. Patients who use family doctors, or are referred by family doctors to hospitals, get priority with appointments and prescriptions.

By the end of 2016, 215 community healthcare centers in Shanghai - about 90 percent of their type - had adopted the integrated system. More than 1.3 million citizens and over 30 percent of people aged above 60 signed the contracts. About 80 percent of the citizens who signed the healthcare contracts and used the 1+1+1 model received medical treatment within the integrated system. More than 60 percent of them received treatment from contracted institutions. This means a preliminary grading diagnosis system has been formed in Shanghai.

We have worked on three fields to build the grading diagnosis model.

First is strengthening labor division and cooperation at various levels of medical institutions, healthcare centers and hospitals. Community hospitals and healthcare centers are able to provide treatment for common ailments and care for some chronic problems. Improvements have been made to public hospital services for local communities and to the functioning of community healthcare centers.

Community healthcare centers provide basic medical services and a base for general practitioners. There has also been an increase in cooperation between healthcare centers, family doctors and public hospitals to ensure the doctors and their patients get priority when registering with hospitals.

Second is promoting the scientific management of community healthcare centers and creating regulations on such matters as salaries, performance evaluation, investment compensation, resource allocation and budget management to stimulate development.

Service standards were split into six categories, with 141 services provided by community healthcare centers, and formulated to evaluate service quality.

Third is using big data technology to build an information support system. Shanghai has completed two fundamental databases - for health files and medical records. Records can be shared by public healthcare institutions and hospitals. More than 20 billion treatment records have been collected at the city's data center.

Big data technology can also be used in community healthcare. Community health care centers will be able to develop a system of chronic disease screening and create a continuous healthcare management model.

The author is the vice-director of theShanghai MedicalReform Office.