Xiamen's multi-tiered medical care system better serves patients

Innovations in building a multi-tiered medical care system have resulted in less medical expenditures and easier access to health and medical care services for patients in Xiamen, Fujian province, according to the city's health chief.

Xiamen has taken a series of measures to improve distribution of medical care resources so patients could also enjoy quality grassroots services instead of overwhelming a few big hospitals in the city for minor or chronic diseases, Yang Shuyu, director of Xiamen Health and Family Planning Commission, said.

"Major hospitals in big cities have been excessively crowded in the past years, while community-level medical facilities are withering and weakened," Yang said. "This caused difficulty for patients to get medical care and increased medical expenses for them."

In some big hospitals in the city, patients with chronic diseases such as hypertension or diabetes used to account for more than 70 percent of all patients waiting in long lines to see doctors, and these patients could be diverted to community-level medical facilities with the reform, he said.

A major measure of the reform the city has been taking in the past few years has been building a unique medical and health care service system since 2014 which integrates top specialists from major hospitals, general practitioners and health management specialists at the grassroots.

Through the system top specialists from major hospitals are encouraged to work at community health and medical centers for certain hours every week to see patients there and provide guidance to general practitioners, and general practitioners are encouraged to sign a service contract with community residents. Heath management specialists provide services such as health education for their communities on prevention and control of chronic diseases such as diabetes so the patients can better manage their own health.

Different medical staff at the three-tiered system perform different roles, so patients with chronic or common diseases are encouraged to see doctors in their own communities first. They can also be transferred to big hospitals through green channels when referred by their general practitioners when necessary, according to Yang.

With these measures, more patients are choosing community-level medical facilities first and the clinical treatments at major hospitals are declining, according to Xiamen Health and Family Planning Commission.

The number of clinical services offered by top-grade hospitals in Xiamen decreased by 7.28 percent during the first six months of this year, compared with the same period last year, and the average time that a patient waits to see a doctor at such hospitals decreased to within 10 minutes, from 40 minutes before the reform, the commission said.

Meanwhile, average medical cost for patients with chronic diseases in Xiamen also decreased. The average cost for a treatment for a patient at community hospitals in Xiamen was 101 yuan ($15) during the first half of the year, while the cost at a top hospital in the city was 190 yuan, according to the commission.

"The experiences of medical reform in Xiamen can be promoted to some other areas in China," Yao Jianhong, an official for medical reform at the National Health and Family Planning Commission, said.

Like Xiamen, many other areas in China have also piloted in medical reforms to enable residents to have easier access to and more affordable medical care services, and the reforms should be adjusted and improved during practice, he said.