Chen Lei, President of Funan County People's Hospital, on Implementing Tiered Diagnosis and Treatment in Primary Care Settings

“A tiered diagnosis and treatment model featuring ‘initial consultation at primary care facilities, two-way referrals, differentiated management of acute and chronic conditions, and coordinated care between upper- and lower-level institutions’ has been preliminarily established. This enables residents within the jurisdiction to ‘stay healthy, fall ill less often, and receive rational and effective treatment when sick,’ thereby making healthcare ‘accessible and affordable’ for the general public and advancing toward the goal of ‘keeping 90% of patients within their county.’”

Compared with 2014, the number of out-of-county inpatient reimbursement cases for the First County Medical Community in Funan County decreased by 13.5% year-on-year in 2015; meanwhile, the number of inpatient visits at the County Hospital increased by 70% year-on-year. Among these, member units of the medical community made the greatest contribution. In 2015, Chaiji Town Health Center, a member unit, referred a total of 356 patients to the County Hospital, including 233 inpatients; Jiaopi Town Health Center referred a total of 378 patients, including 273 inpatients; and Zhaizhai Town Health Center referred a total of 304 patients, including 218 inpatients.

Referring patients with conditions that cannot be managed at the primary care level to county hospitals for treatment is a key component of the tiered diagnosis and treatment model. Taking abdominal hysterectomy as an example, this procedure cannot be performed in many township health centers. When primary care institutions are unable to address such cases, patients can be directly transferred to the county hospital via the 120 emergency ambulances established among member units of the medical consortium by Funan County People's Hospital. This approach not only ensures timely treatment for patients but also reduces the time spent seeking medical care and the travel costs associated with back-and-forth transfers, thereby greatly facilitating access to healthcare for the public.

It is not merely about individual referrals. To enhance the service capacity of primary healthcare institutions, Funan County People’s Hospital has placed particular emphasis on tilting policies and concentrating resources toward the grassroots level, thereby substantially strengthening both the hardware and software infrastructure of these facilities. By implementing centralized volume-based procurement of pharmaceuticals within the medical consortium, achieving unified management and shared use of large-scale medical equipment, and optimizing the allocation of high-quality medical resources, the hospital has significantly improved the medical service capabilities of township health centers. In 2015, Funan County People’s Hospital referred more than 200 patients to subordinate township health centers. Specifically, 73 patients were referred to Chaiji Town Health Center (with 30 hospitalized), 67 patients were referred to Jiaopi Town Health Center (with 47 hospitalized), and 67 patients were referred to Zhuzhai Town Health Center (with 40 hospitalized).

With the implementation of tiered diagnosis and treatment, we have truly achieved a win-win situation where “hospitals secure patient flow, physicians see increased income, and the public enjoys tangible benefits.”

The internet has become a crucial driver in advancing modern healthcare in China, with a particularly significant impact on primary care institutions. In April this year, Funan County People’s Hospital successfully transitioned to an upgraded health information system that covers all hospital operations, meeting operational needs and enhancing the efficiency of medical staff. By August, the client-side platform of Professor E’s Clinic in Funan County was smoothly deployed across clinical departments at the county hospital, township health centers, and village clinics. The telemedicine service platform has established a “four-in-one” online interaction framework linking county-, township-, and village-level medical institutions with the Chinese PLA General Hospital in Beijing, laying a solid foundation and providing strong support for the regional expansion of healthcare services in Funan.

Therefore, as a terminal for information sharing, the Internet holds epoch-making significance, particularly in the medical field. The Internet exerts substantial influence on healthcare and physicians, especially in building physicians’ personal brands. Digital platforms can rapidly expand a physician’s reach and influence among patients. Furthermore, the Internet has transformed healthcare by streamlining appointment scheduling and payment processes. By leveraging internet technologies, patients can save considerable time and avoid cumbersome procedures during diagnosis and treatment, thereby enhancing physicians’ clinical efficiency.

In addition to tiered diagnosis and treatment, information technology will serve as a powerful driver for internet-based healthcare, primarily manifested in the following five aspects:

1. Medical Information Sharing and Service Platform. Support third-party institutions in building medical information sharing and service platforms for medical imaging, health records, laboratory test reports, electronic medical records, etc., and gradually establish a standard system for cross-hospital medical data sharing and exchange.

2. Convenient Services. Actively leverage mobile internet technologies to provide convenient services such as online appointment scheduling, wait-time reminders, price calculation and payment, access to diagnostic and treatment reports, and medication delivery.

3. Telemedicine. Guide medical institutions to provide telemedicine services, such as primary-level examinations and superior-level diagnoses, for small and medium-sized cities and rural areas.

4. Public Health Services. Encourage internet enterprises to collaborate with medical institutions in establishing medical network information platforms, strengthen the integration of regional healthcare service resources, and fully leverage technologies such as the internet and big data to enhance capabilities for the prevention and control of major diseases and public health emergencies.

5. New Health Services. Actively explore the application of online medical and health services, such as internet-based extended physician orders and electronic prescriptions. Encourage qualified medical testing institutions and healthcare service providers to collaborate with internet companies to develop health service models, including genetic testing and disease prevention.