What are the international experiences of healthcare delivery models?

2019-09-03 17:41

1. Specialized division of labour in medical services



In the provision of traditional medical services, medical services are only provided by hospitals and doctor clinics, from seeking medical treatment, testing, diagnosis, and treatment to post operation rehabilitation and chronic disease management. These two types of institutions almost cover all functions. These "large and comprehensive" institutions have high operating costs, unclear main functions, and a large amount of costs are invested in daily operations, rather than targeted treatment for patients; The emerging medical service model exhibits more specialized division of labor, dispersing multiple functions into independent institutions, and providing patients with cheaper and more efficient services with the help of constantly improving information technology and diagnosis and treatment technology.



Simply distributing diagnosis and treatment to different institutions can significantly improve service efficiency.



With the assistance of information technology, patients canupload their test results through the Internet and obtain accurate diagnoses from professional doctors, while treatment can be completed through micro-clinics and specialized hospitals. Based on accurate diagnosis, the treatment of many conditions is only a controllable and replicable process, which can be completed by physician assistants and even nurses.



A considerable number of institutions dedicated to this have emerged in the United States, such as RediClinic and MinuteClinic (acquired by American pharmacy chain CVS in 2007), surgical hospitals such as Shouldice Hospital and many eye surgery clinics, heart hospitals, cancer rehabilitation centres, etc. Instead of traditional hospitals charging an itemized fee for all services, these treatment-focused institutions have begun charging patients a flat fee based on an individual procedure. The process is unified, the risks are controllable and the medical expenses incurred are clear and definite. In September 2006, Geisinger Health System's ProvenCare program began charging insurers a flat rate for select heart bypass procedures, along with a 90-day warranty.



Clayton Christensen's research shows that clinics that only provide specific treatment services can provide comparable medical services at half the price compared with medical institutions that provide both diagnosisand treatment. The same treatment of external abdominal wall hernia, Shordales Hospital only treats a small number of patients with external abdominal wall hernia, but all patients follow the same clinical path, a total of only fourdays, the first day of meal preparation, the next day for the surgery, The third and fourth days of recuperation, the total cost was $2300, the patient satisfaction rate was close to the vast majority, and the cost of medical malpractice litigation was almost zero; in contrast, in a general hospital in North America, the cost of the same operation was $3350, and The procedure is done on an outpatient basis, and if the patient is hospitalized, the cost can run up to nearly $7,000.



Common frequently-occurring diseases such as upper respiratory tract infection, sinusitis, and pharyngitis can also be treated in micro-clinics mainly operated by nurses. According to Mary Kate Scott, an expert inthe field of micro clinics in the United States, with the correct technical support, a total of 60 to 100 diseases can be treated by micro clinics. Although the types are limited, these diseases account for 17% of the diseases seen by family doctors in the United States, while Fees for these conditions in micro-clinics are 32% to 47% lower than the cost of seeing a family doctor. It is convenient and fast, and there is no need to queue up, which also greatly reduces the time for patients to seek medical treatment and greatly improves patient satisfaction.



Since nursing staff are enough to play a major role in thenew medical service model, this greatly reduces the workload of doctors, and more human resources of doctors can be devoted to professional clinical diagnosis.



The Cleveland Clinic in the United States has restructured its original center into an institution characterized by interdisciplinary expert collaboration, such as hiring oncologists, radiologists, neurosurgeons, psychiatrists and psychologists at the Institute of Neurology, to integrate with neurologists and diagnose patients' aetiology and different types of patients as accurately as possible. The continuous refinement of diagnosis has promoted a better division of labor between diagnosis and treatment.



In addition, doctors can also use information technology to greatly expand the scope of providing medical diagnoses.



In a traditional community, a general practitioner serves about 1,000 to 1,500 people. In the new medical service model, patients no longer need to rely on face-to-face medical treatment. Doctors can use the Internet to provide services and make diagnoses to patients from all over the world. Under this new service model, the general practitioner team can expand its service scope to 5-10 times that of the original traditional model.



NMSU's ECHO program leverages cutting-edge electronic communication technology to deliver specialized medical services, including treatment for hepatitis C and HIV, to underserved rural communities in New Mexico. The key to the success of the ECHO project lies in the collaboration between specialist doctors and local medical service providers, resulting in enhanced technical capabilities among local medical staff and improved overal lhealthcare services. This is particularly valuable for developing countries and underprivileged regions.



2. Create a network for coordination to enhance the self-healing process of patients.




The rapid development and penetration of the Internet into every corner of life have also brought new possibilities to the treatment and management of chronic diseases.



The successful management of chronic diseases is heavily influenced by a patient's lifestyle and daily habits. However, encouraging patients to adhere to their treatment plans remains a major challenge for healthcare providers. Simply relying on medical prescriptions has proven to have limited effectiveness, and the exorbitant costs associated with long-term chronic disease management have become a significant burden on health cares ystems worldwide.



The Internet-based patient network in the United States enables patients to take an active role in their treatment, leading to enhanced treatment outcomes and substantial cost savings.



The dLife website serves as a prime example of a platform dedicated to supporting individuals with diabetes and their loved ones inbuilding a community on the internet. By offering TV programs and user-friendly navigation, registered members can provide mutual assistance and encouragementto one another. Similar institutions such as Waterfront Media and WebMD are also devoted to creating a support network for chronic illness patients, utilizing extensive patient data to connect individuals with similar conditions. Through comparing treatment progress with others and engaging in dialogue, patients can gain valuable insights from one another. Ultimately, these platforms enable individuals to connect and support each other in their shared journey towards improved health.



When it comes to chronic diseases that involve dependence, this treatment method is particularly successful. In instances of alcohol withdrawal, the patient network shares user-generated content that communicates their triumphs over addiction and provides support throughout the recovery journey. While doctors may treat patients with acute alcohol withdrawal, alcoholic liver disease, or alcoholism, their effectiveness is limited in addressing the root cause of the chronic disease.



With the support of the network, such institutions can helppatients find similar "patients" using registered private medical records and anonymous medical bills, and some even provide metrics for patients to compare with similar patients. Combined with model prediction tools, the probability of disease occurrence can be calculated, and corresponding prevention and treatment recommendations can be drawn. As data continues to accumulate and increase, the accuracy of matching and diagnosis also increases, forming a virtuous circle.



This also brings great convenience to the growth of doctors.



In the traditional medical service model, the level of diagnosis and treatment of doctors largely depends on the accumulation of their clinical experience, but now based on the big data formed on the Internet platform, doctors can easily browse a large number of cases and improve the accuracy of diagnosis.



In the US, the Restless Legs Syndrome (RLS) Foundation helpspatients "access cutting-edge treatment options and arm themselves with information to teach their doctors about RLS." This has become a new channel for doctors to learn and progress.