1、 Specialization of medical services
In the traditional provision of medical services, medical services are only provided by hospitals and doctor clinics, from medical treatment, laboratory testing, diagnosis, treatment to postoperative rehabilitation and chronic disease management. The above two types of institutions cover almost all functions. This "large and comprehensive" institution has high operating costs, unclear main functions, and a large amount of costs are invested in daily operations, rather than treatment for patients; The emerging medical service model shows the characteristics of more professional division of labor, dispersing multiple functions to various independent institutions, and providing cheaper and better services to patients with the help of continuously improving information technology and diagnosis and treatment technology.
Simply distributing diagnosis and treatment to different institutions can significantly improve service efficiency.
With the help of information technology, patients can upload their own test results through the Internet, obtain accurate diagnosis from professional doctors, and treatment can be completed through micro clinics, specialized hospitals, etc. On the basis of accurate diagnosis, the treatment of many diseases is only a controllable and reproducible process, which can be completed by doctor assistants or even nurses.
A considerable number of institutions dedicated to this have emerged in the United States, such as rediclinic and MinuteClinic, which were acquired by American drugstore chain CVS in 2007, specialized surgical hospitals such as Shouldice hospital, as well as many eye surgery clinics, heart disease hospitals, cancer rehabilitation centers, etc. Compared with traditional hospitals that charge for all services by item, these treatment focused institutions have begun to charge fixed fees to patients based on a single procedure. The process is unified, the risk is controllable, and the medical expenses brought by it are clear and clear. In September, 2006, the provencare program of Geisinger health system began to charge fixed rate fees to insurance companies for selected heart bypass surgery, and also provide a 90 day warranty period.
Clayton Christensen's research shows that compared with medical institutions that provide diagnosis and treatment at the same time, these clinics that only provide specific treatment services can provide the same level of medical services at half the price. For the same treatment of external abdominal hernia, shordays hospital only treats a few types of external abdominal hernia patients, but all patients use the same clinical path, which takes only four days in total. They need to prepare meals the day before yesterday, perform surgery the next day, and rest on the third and fourth days. The assembly cost is $2300, the patient satisfaction rate is close to the vast majority, and the litigation cost of medical accidents is almost zero; In contrast, in a general hospital in North America, the cost of the same operation is $3350, and the operation is completed in the outpatient department. If the patient is hospitalized, the cost will be as high as nearly $7000.
Upper respiratory tract infection, sinusitis, pharyngitis and other common frequently occurring diseases can also be treated in mini clinics mainly operated by nurses. Mary Kate Scott, an expert in the field of micro clinics in the United States, statistics that with the correct technical support, a total of 60 to 100 kinds of diseases can be treated by micro clinics. Although the types are limited, these diseases account for 17% of the diseases of family doctors in the United States, and the cost of micro clinics to deal with these diseases is 32% to 47% lower than the cost of family doctors. Its convenience and no need to queue up also greatly reduces the time for patients to seek medical treatment and greatly improves patients' satisfaction.
Since nurses are enough to play a major role in the new medical service model, which greatly reduces the workload of doctors, doctors' human resources can be more invested in professional clinical diagnosis.
The Cleveland Clinic in the United States changed the original center into an organization characterized by cross department expert cooperation through reorganization, such as hiring oncologists, radiologists, neurosurgeons, psychiatrists and psychologists in the Institute of neurology to integrate with neurologists to diagnose the etiology and different types of patients as accurately as possible. The continuous accuracy of diagnosis promotes a better division of labor between diagnosis and treatment.
In addition, doctors can also greatly expand the scope of medical diagnosis with the help of information technology.
In traditional communities, the service range of a general practitioner is about 1000 to 1500 people. In the new medical service mode, patients no longer need to rely on the face-to-face medical treatment mode. Doctors can provide services and make diagnosis to patients from all over the world with the help of the Internet. Under this new service mode, the general practitioner team can expand its service scope to 5-10 times that of the original traditional mode.
The echo project of the State University of New Mexico uses electronic communication technology to provide specialized medical services, such as the treatment of hepatitis C and AIDS, to rural communities in New Mexico. However, echo project is completed through the cooperation between specialists and local medical service providers. In this process, the technical ability of local medical staff has been improved, indirectly promoting the improvement of local medical service level. This is obviously of great significance to developing countries or less developed regions.
2、 Establish a coordination network to promote patients' self-healing
The rapid development of the Internet in all corners of life has also brought new possibilities to the treatment and management of chronic diseases.
The treatment effect of many chronic diseases is closely related to the patients' own lifestyle and daily behavior. How to improve the compliance of patients with chronic diseases with treatment plans is a headache for many doctors. It is obvious that the effect of relying only on doctors to prescribe is limited, and the long-term and huge cost of chronic diseases has increasingly become the main disease burden of various countries.
In the United States, the patient network built on the Internet platform allows patients to actively participate in their own treatment, which greatly improves the effect of treatment and significantly reduces the cost of treatment.
Take Dlife website as an example. It is committed to helping diabetes patients and their families establish network mutual assistance, and allows registered users to help and encourage each other by broadcasting TV programs and website navigation. The same institutions include waterfront media and WebMD, which are committed to establishing a mutual aid network for patients with chronic diseases, and using a large amount of patient data, so that patients can find other "people like themselves". Patients can directly compare with other patients to understand their treatment progress, and eventually these patients can communicate and learn from each other.
For chronic diseases with dependence, such treatment is particularly effective. Take abstinence as an example. All the communication in the patient network is user-made content. They share their experience in overcoming alcohol addiction and encourage each other in the process of abstinence. Although many doctors also treat patients with acute alcoholism, alcoholic liver disease or alcoholism, their role in treating chronic diseases as the cause is limited.
With the support of the network, such institutions can help patients find similar "patients" by using registered private medical records and anonymous medical bills, and some can even provide metrics for patients to compare with similar patients. Combined with the model prediction tool, the probability of disease occurrence can be calculated, and the corresponding prevention and treatment suggestions can be obtained. With the continuous accumulation and increase of data, the accuracy of matching and diagnosis also continues to rise, forming a virtuous circle.
This also brings great convenience to the growth of doctors.
In the traditional medical service mode, doctors' diagnosis and treatment level largely depends on their clinical experience accumulation, and now the big data based on the Internet platform allows doctors to easily browse a large number of cases and improve the accuracy of diagnosis.
In the United States, the restless legs syndrome (RLS) Foundation helps patients "obtain cutting-edge treatment options and arm themselves with information to teach doctors their information about RLS". This has become a new channel for doctors to learn and progress.