By Wang Zhe

SHENZHEN MEDICAL REFORM WORTH A LOOK

By Wang Zhe

Luohu District in southern Chinese city pilots new systems of insurance and local clinics

Over the past year, thousands of medical specialists and industry insiders have visited Luohu District of Shenzhen in southern China’s Guangdong Province to learn about medical reform taking place there. These visits come in light of the district’s efforts to establish a medical community offering affordable and accessible medical services, as part of China’s overall healthcare reform. According to experts, Luohu’s efforts have thus far been highly successful.

Premier Li Keqiang commended the Luohu model of medical community, complete with integration of public hospitals and community health centers. The commissioner of the National Health and Family Planning Commission Li Bin also carried out an in-depth investigation of the model and praised the district’s efforts. Li said he hopes the Luohu model will set a good example for a rollout of comprehensive healthcare reform across the rest of the country.

Reform Program

“We have learned from British Commonwealth countries, including our close neighbor Singapore, to set up a medical support system to meet the needs of the people for medical and healthcare services,”said Xia Junjie, an adviser of the Shenzhen Medical Reform Office, on the vision of the district’s medical reform. “Not all Commonwealth countries are rich. It’s their reasonable medical service system that has provided their citizens with appropriate medical support.”

Having had a good understanding of the medical system setup and relevant rules and regulations, Shenzhen established the Luohu Hospital Group as a brand-new pilot program, which was designed to be a model medical services provider for the district. The most prominent feature of the program is the management of health insurance in individual packages, which encourages residents in the district to save insurance money by staying healthy and away from hospitals.

On Aug. 20, 2015, Luohu Hospital Group, a combination of five district hospitals and 23 community health centers, was officially launched.

“The Board of Directors appoints a president,who is responsible for the operation of the whole group,” said Sun Xizhuo, president of the hospital group. “Six professional resources sharing centers have been set up for the subsidiary hospitals and community health centers to share resources within the group. Most common diseases, which can be treated at community health centers, will be the responsibility of General Practitioners (GPs) or family doctors. The specialist doctors will have more time to focus on more sophisticated cases.”

The reform of health insurance payments is key to Luohu’s medical reform. To curb any unreasonable growth in medical costs and gain access to the best medical services without excessively costly health insurance, Luohu’s medical reform program suggests that the health insurance for all residents in the district be distributed to the hospital group in one package. If there is any surplus in the package after final annual accounting is completed, the hospital group will be entitled to invest the surplus in disease prevention, hospital operation and staf f. In turn, the hospital group will have to invest more in community disease prevention and healthcare services so that the residents can stay healthy and away from hospitals.

GPs, or family doctors, are“doorkeepers” for local residents. In the United Kingdom and Singapore, they provide more than 80 percent of health services. Non-emergency patients are expected to see family doctors first, who will make an initial diagnosis and decide whether they should be transferred to a higherlevel hospital. That’s how a hierarchical medical treatment system works. Singapore has built a comprehensive primary health care system. The city-state has more than 2,000 GPs who work in community health centers, joint clinics, private hospitals or private general practice clinics. Each residential area has access to the services of a few hospitals and clinics, some of which provide home services, a treat for residents with underlying or chronic diseases.

In China, all major hospitals are overcrowded. As a matter of fact, everyday illnesses such as the common cold can be properly treated in community health centers or Grade II hospitals at best. However, many patients choose to start with Grade III hospitals. In Singapore and other countries, there are 10 GPs or family doctors per 10,000 residents. In Shenzhen, there are only 1.9.

GPs in China are now in an awkward position. They are not well paid and not as highly-respected as specialist doctors. It’s very difficult for them to improve professionally. At present, Luohu District is implementing an annual salary system, with a minimum of 300,000 yuan (US$46,000) for GPs. In career planning, the district has also provided GPs with career development platforms. In the future, they will continue to introduce an advanced general medical education system based on systems already in place in Singapore and some other countries.

Effects of Reform

As part of disease prevention and healthcare services, Luohu District has provided free vaccinations covering influenza and pneumonia for the elderly. To protect residents over the age of 60 from risks of injuries due to falling, the district installed handrails and lights within communities. The district has also encouraged local residents to limit their salt intake to five grams per day and their oil consumption to five tablespoons per day.

In the past, local residents tended to choose to see doctors at major hospitals rather than community health centers in their neighborhoods. Today, many people have changed their habits. Last August, local resident Fan Ming signed a contract with a family doctor at Luohu’s East Gate Community Health Center for his wife’s pregnancy examination.

“After signing of the contract, the family doctor has regularly visited my wife,” Fan said. “The doctors and nurses have been very patient and professional. We are happy with that.”

With a hierarchical medical treatment system, patients don’t have to rush to major hospitals whenever they are not feeling well. So far, Luohu has established nearly 300 teams of family doctors. Local residents can enjoy 26 different types of medical and healthcare services at the community health centers, including electronic health records management, chronic disease management, free physical examinations, integrated medical and healthcare services and gene disease screening.

“The vision of our medical reform is providing accessible and effective healthcare for people throughout their lives, without the risk of them being reduced to poverty due to illness,” said Xia Junjie of the Shenzhen Medical Reform Office.

The ultimate goal of Luohu’s medical reform is accessible and affordable medical and healthcare services for all local people. That is also what local residents are expecting from the reform. However, for a country with a large population, regional disparity and limited medical resources, implementing such reforms nationwide remains an arduous task.

The most prominent feature of the program is the management of health insurance in individual packages.