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Family doctors reduce pressure at hospitals
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IN Shanghai’s major hospitals, long queues fill the corridors and waiting rooms are full.
Some people wait for hours to see a doctor about something as minor as the common cold, while others come to pick up medicine for chronic diseases. The congestion often fosters tensions between doctors and patients.
To address the problem, the city has been promoting a tiered health-care system for years, which includes the “1+1+1” pilot project initiated 16 months ago.
Under that project, residents sign up with general practitioners in local community health centers, listing the district-level or city-level hospital of choice in case they need referrals to specialists. To grease acceptance of the system, the project opens swifter channels to city-level hospitals, offers lower-cost medicines and pays GPs higher salaries.
As of mid-March, 89 percent of the city’s 241 community health centers had introduced the program, covering more than 1.6 million residents, including 1.3 million aged 60 or older.
Li Feng, 71, a Minhang District resident who suffers from heart disease, used to have to travel for at least an hour to Huashan Hospital in the downtown area twice a month to get his regular medicines, which were only available in city-level hospitals. “But now, I can get two months’ supply from my family doctor at the local health clinic,” said Li, “In the past, the hospital would give me only two weeks’ supply.”
The program allows for medicines, particularly those prescribed to elderly patients, to be delivered to community health centers, relieving the need for long trips to hospitals. Li said his heart medicines used to cost 511 yuan (US$74) a month in Huashan Hospital, and he had to pay 30 percent of the cost. The same medicines, obtained at the community health center, cost him 416 yuan and he has to pay only 10 percent.
The program also opens more hospital appointment slots for patients referred from the family doctor system.
Yang Jianling, a GP at Longbai Community Health Center in Minhang, said one of her patients once tried unsuccessfully to make a return appointment at a major hospital. She tried various means of overcoming the hurdle, including asking her daughter to try to snatch an appointment slot online. In the end, the family doctor that she didn’t want to bother came to her rescue.
“I told her that she can easily register for an appointment via the referral system here,” Yang said. “The appointment at a city-level hospital was made with just a few clicks.”
Thirty-five city-level hospitals have opened 10,000 more appointment slots for family doctors referring patients to some 7,700 specialists. “The new system is more effective,” Yang said.
For elderly patients, a close relationship with family doctors in local community clinics can be comforting.
“When I go to big hospitals, I am assigned to see one doctor one day and another doctor next week,” Li said. “They barely know me from a name on the computer. But my family doctor knows my health situation very well.”
Shen Debin, 75, is a Jiading District resident enrolled with a local family doctor. “I have had diabetes for 35 years,” Shen said. “My family doctor is familiar with my medical history and with my other problems related to my heart and blood pressure. So he can adjust my medicines accordingly and keep close tabs on how I am doing.”
Weng Lili, 32, is Shen’s family doctor. He became a GP in Malu Town Community Health Center and a registered family doctor in 2015. He said the pay for primary care physicians has improved in recent years. “My income was some 120,000 yuan in 2014, but it rose to 170,000 yuan in 2015,” Weng said.
In 2016, the average yearly income of the health center family doctors reached 191,700 yuan, with the highest earners at 254,200 yuan. “We are improving the pay for family doctors to attract and retain more professionals,” said Wu Jinglei, director of the Health and Family Planning Commission of Shanghai.
“With the tiered system, different medical institutions will have clearer functions,” Wu said.
“Community hospitals are responsible for common ailments and health maintenance, while the big hospitals will focus resources on specialist treatment and critical diseases.”
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