Release date: 2015-08-12
The report of the RAND Corporation is called "The Role of Health Care Reform in the 'Chinese Dream'." According to the report, compared with Western countries, China's medical reform is less hindered by vested interests and has the opportunity to establish an innovative world-class medical system. The report recommends that China not copy the Western medical system, but should adopt the principle of “population health management†and build an innovative medical system based on mature health and information technology. This will not only help to cope with the needs of an aging society, but also increase employment opportunities in the service industry, liberate household savings to expand consumption, and even realize the export of medical system services.
China can seize the opportunity of model innovation
The report was co-authored by RAND Corporation senior scientist, health advisory service director Zelen Matko and researcher Liu Hangsheng.
According to the report, from the data of infant survival rate, life expectancy and medical insurance coverage, China's medical services have greatly improved since the reform and opening up, but China's health care system still cannot keep up with the speed of economic development. . With the development of the economy and the improvement of people's living standards, industrialization has brought about changes in lifestyles, such as reduced exercise time and increased intake of junk food. The proportion of Chinese smokers has even reached twice the world average. Coupled with the aging population, all these factors have led to the epidemiological shift from acute to chronic diseases, which has brought a heavy burden to the society.
According to the report, there is a gap between China's existing health care facilities and manpower and the people's demand for medical services, and the gap is widening. The growth of chronic diseases, combined with China's huge population base, means that it is not enough to expand the existing medical service system and train more medical service workers. Therefore, China's medical system reform cannot rely on slow incremental reforms. It must take the path of thorough reform and change the status quo that relies too much on hospitals and doctor services.
The report believes that despite the enormous challenges facing China's healthcare system, China has the advantage to turn it into an opportunity to create a world-class model of innovative healthcare systems. Compared with other developing countries, China has a solid economic foundation and can provide economic security for the reform of the medical system. Compared with developed countries, the old medical system is very little drag on China. The medical system in western developed countries has long been criticized, and the call for reform has been very high. However, Western countries have already formed a path dependence on the old medical system, and the obstruction of vested interests makes medical reform difficult. The establishment of China's health care system has not yet reached a point enough to form a path dependence, and the accumulation of wealth and the demand for health care means more opportunities in the medical service sector. China can redesign the medical system without having to go through Western medical reform. The old road.
The report said that this is like the "economic miracle" that took place in Germany in the 1950s. World War II basically destroyed Germany's important industrial bases, but it also allowed Germany to start from scratch, keep up with the latest technological trends, design its industrial system as a whole, and quickly surpass countries such as Britain that are plagued by traditional infrastructure. If China seizes the opportunity to create an innovative medical system, it will stimulate economic development potential, increase employment opportunities in the service industry, liberate household savings to expand consumption, and even achieve medical service exports.
China can create a “population health management†model
According to the report, medical institutions in various countries have their own characteristics, and countries have different needs for medical services. Therefore, China should not copy the Western medical reform model. China should create a new medical service model that has never been seen before, avoiding the wrong path that other countries have gone through, thus providing better medical services and patient experience, enabling the public to spend less and enjoy a higher level of health.
RAND said that China's future medical service system reform can abide by two design principles: In response to the shortage of medical service personnel, the new medical service system can optimize the process through advanced information management technology to enable high-skilled medical service personnel resources. Optimize the configuration and assign some tasks to health care workers with relatively low skills; adopt the “Population Health Management†(PHM) model, focusing on the overall health of the entire population and on the satisfaction of individual medical needs.
The PHM model blueprint portrayed by RAND for China's healthcare reform has six interrelated factors:
First, advanced IT technology. A solid, scalable IT infrastructure is at the heart of the PHM model, as IT technology will provide data and decision support for other factors. The IT infrastructure should have the following characteristics: 1. Structured text. Structural text allows critical data to be stored as encoded variables. 2. Highly practical. Mainly to support data entry and information retrieval, as well as support for outpatient decision-making, such as drug-related drug alert, diagnostic algorithms. 3. Allow data to be exchanged between different agencies and different information systems. 4. Safety standards. Information security must be ensured in the acquisition and delivery of data. 5. Role-based data acquisition. The access rights to the data should vary from user to user. For example, the outpatient doctor can see the overall condition of the patient, the hospital executive can see the overall hospital treatment information every day, and the person in charge of the medical service system can see the operation status of the medical institution in the entire jurisdiction.
In the process of using IT technology to reform the medical service system, a new profession may be created, called “health navigatorâ€. Health navigators should play an important role in the PHM model, given the shortage of Chinese nurses and the difficulty of collaboration between different medical institutions. Health navigators can be employed by health care professionals with basic skills to use IT technology to rationally divert people with medical needs to different health facilities. Health navigators can also provide counseling services to help patients understand the treatment options they face and their consequences.
Second, data-driven treatment process optimization. The move will synthesize big data from outpatient practice and provide a prescription for treatment.
Third, performance assessment mechanisms at all levels. For example, setting up a baseline to evaluate the performance of similar institutions; investigating the reasons for poor performance of the organization, and designating improvements; identifying the best and worst performing institutions and promoting best practices. To achieve these goals, a set of assessment indicators, such as treatment technology, treatment outcomes, patient experience, resource utilization, etc., must be set. Performance monitoring systems can be made available to the public to encourage patients to make optimal choices and to introduce competitive incentives for health care providers.
Fourth, effectively deploy medical staff. The current situation in China is a shortage of medical staff, but it is not appropriate to take the Western path of relying too much on doctors. More appropriate practices include breaking down tasks, divesting tedious routines from highly skilled health care workers, assigning them to low-skilled health care workers, and automating some of the work with IT technology.
Fifth, the salary incentive mechanism is consistent with the policy objectives. A compensation system that encourages quantity rather than value in Western medical systems is a system that China can consider avoiding. China can use IT technology to create a compensation incentive mechanism for medical systems that is consistent with policy objectives. This mechanism should be reflected in the whole process of disease prevention, disease treatment, patient care, etc., and should not focus on the treatment; it can encourage value rather than just pay attention to quantity; it should encourage strict decision-making.
Sixth, the patient intervention mechanism. In the traditional medical service system, patients are passively treated. In the PHM mode, patients should use IT technology to fully understand their condition, treatment options, and consequences, and participate in the entire treatment process. Patients can become “experts†who understand their condition and make treatment choices with their doctors.
The report says that the PHM mode is a full process model. From health advocacy and disease prevention to acute disease, treatment of chronic diseases, and hospice care, the PHM model should always run through. If policy makers can recognize the innovation of the PHM model, research and implementation, China's medical service system is expected to "turn over the road", surpassing the stagnant medical reform in the West and helping the realization of the "Chinese Dream."
Source: Sina Think Tank
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