Health and Health Commission： Internet medical services are expected to be included in medical insurance.
On September 27th, west china hospital, doctors from Huaxi Hospital, Ganzi People’s Hospital and shiqu county People’s Hospital consulted patients with echinococcosis through telemedicine platform. Beijing News reporter Xu Wenshe
A few days ago, the National Health and Wellness Committee issued three important documents in the field of Internet medical care, namely, Administrative Measures for Internet Diagnosis and Treatment (Trial), Administrative Measures for Internet Hospitals (Trial) and Management Standards for Telemedicine Services (Trial).
The document clarifies the scope of Internet medical care for the first time. According to users and service methods, Internet medical services involving diagnosis and treatment are divided into three categories: telemedicine, Internet diagnosis and treatment, and Internet hospitals, and classified management is implemented, and the policy "red line" is clearly drawn.
Lu Qingjun, director of the National Center for Telemedicine and Internet Medicine and the Telemedicine Center of China-Japan Hospital, participated in the formulation of the above-mentioned documents. According to it, the National Medical Insurance Bureau is formulating the price guiding principles for Internet medical care, and Internet medical services such as telemedicine are expected to be included in medical insurance.
case
Internet medical care on the plateau
At an altitude of 4,178 meters in shiqu county, Ganzi Tibetan Autonomous Prefecture, Sichuan Province, the liver of Tibetan Tashi (pseudonym) is being eaten by echinococcosis. Three years ago, the 31-year-old man refused the doctor’s advice on surgery, but his increasingly unbearable abdominal pain made him go to shiqu county People’s Hospital again.
On September 27th, Tashi’s medical records were displayed in front of Wang Wentao, an echinococcosis expert and deputy director of liver surgery in west china hospital, through the telemedicine system. This was a multi-party consultation. More than 10 doctors from shiqu county People’s Hospital, Ganzi People’s Hospital and Huaxi Hospital discussed Tashi’s illness remotely through the screen. His electronic medical record and abdominal MRI were displayed simultaneously on the screen.
"This is a very clear patient with advanced alveolar echinococcosis. The important structures in the liver and neighboring organs have been violated. It can be seen that the bile duct and portal vein of the first hepatic portal have all been eaten. It is recommended to arrange surgery as soon as possible." During the consultation, Wang Wentao gave treatment suggestions.
Echinococcosis, a chronic parasitic disease zoonotic, is plaguing 66 million farmers and herdsmen in western China. There are two kinds of echinococcosis: cystic echinococcosis and alveolar echinococcosis. Among them, alveolar echinococcosis has a long incubation period, and the patient has no treatment, and the 10-year mortality rate is 94%, which is also called "insect cancer".
Shiqu county, where Tashi is located, is the hardest hit area of hydatid disease. However, the local medical level is limited. If you go to Huaxi Hospital 1000 kilometers away, you have to go to Kangding for two days, and then transfer to Chengdu. Many late patients give up treatment. Nowadays, with the help of telemedicine, patients can get diagnosis and even treatment from experts in big hospitals without leaving the local area.
On September 28th, Devaji, a 28-year-old Tibetan girl, met Wang Wentao again at Ganzi People’s Hospital. Seven months ago, Wang Wentao gave Dwaji, who had advanced hepatic echinococcosis, an autologous liver transplant in People’s Hospital. This time, Wang Wentao came from Chengdu to review Dewaji and 11 other patients after surgery.
"The recovery is very good. If you continue to take albendazole, you can reduce it from 4 tablets a day to 2 tablets a day." Wang Wentao made a diagnosis and told Dewaji to pay attention to hygiene in his daily life, not to drink raw water and wash his hands before meals.
In Sichuan, such a telemedicine system has covered all 88 poverty-stricken counties and 1,800 medical institutions. Throughout the country, according to Jiao Yahui, deputy director of the Medical Administration and Hospital Authority of the National Health and Wellness Commission, 22 provinces have established provincial telemedicine platforms, covering 13,000 medical institutions and more than 1,800 counties. In 2017, the total number of telemedicine services exceeded 60 million.
superiority
It is expected to solve the problem of uneven medical resources.
For policy makers, telemedicine is not only a simple medical service project. With the advantages of telemedicine, the problems of insufficient total medical resources and uneven distribution can also be solved.
Lu Qingjun, director of the National Center for Telemedicine and Internet Medicine and the Telemedicine Center of China-Japan Hospital, explained that at present, 10% or 20% of the top doctors in the country undertake 80% of the diagnosis and treatment business, but they do not need to undertake many common diseases. With the help of telemedicine system, higher-level hospitals can improve the level of doctors in lower-level hospitals through remote teaching, remote discussion of difficult cases and remote live teaching of surgery, so that they can undertake more diagnosis and treatment of common diseases. Hospitals below the second level can undertake 60%~70% of the diagnosis and treatment business, and doctors in tertiary hospitals can spare more time to treat intractable diseases.
Taking Sichuan as an example, Wang Wentao said that the team composed of doctors from vascular surgery, anesthesiology and ICU of West China Hospital went to Ganzi Prefecture once or twice a month to conduct teaching rounds and surgical teaching, and sent corresponding experts to explain the confusing problems according to local needs, helping the local authorities to establish a multidisciplinary team.
Duoji, president of Ganzi People’s Hospital, told the reporter that Huaxi Hospital has trained two surgical teams for echinococcosis. In the past, the People’s Hospital could only do 20 echinococcosis operations throughout the year, but now it can do more than 500 operations every year, basically realizing the local cure of echinococcosis. In 2016, Ganzi People’s Hospital successfully established the top three hospitals.
"Medical resources face multiple dilemmas. The first one is the shortage of total medical resources. When the total amount remains unchanged, the efficiency of diagnosis and treatment will be improved, and the patient’s experience will also be improved. The distribution of our medical resources is a pyramid-shaped triangle, but the flow of patients is an inverted pyramid, and now it needs to be reversed. " Lu Qingjun said.
question
The technology is not standardized, and the enthusiasm of doctors is difficult to guarantee.
But the status quo is not optimistic. Lu Qingjun pointed out that the medical quality of telemedicine is uneven, some hospitals are not standardized in technology, and even QQ video and WeChat chat are used for telemedicine, and the quality of medical image transmission simply cannot meet the requirements; Although some hospitals have built telemedicine platforms, they have been idle for a long time, "just for show"; Some hospitals regard telemedicine as a channel to siphon patients from lower-level hospitals.
The enthusiasm of doctors to participate is also difficult to guarantee. An anesthesiologist in a 3A hospital who didn’t want to be named told the reporter that although the hospital will give certain performance rewards to doctors participating in telemedicine, the enthusiasm of doctors is not high. "The whole perioperative period (around the whole process of surgery, including preoperative, intraoperative and postoperative) requires teamwork. Doctors go to primary hospitals and leave after surgery. The conditions and level of primary hospitals are not enough. What should I do if patients have problems during the recovery period after surgery?" Doctors have their own concerns.
A few days ago, the National Health and Wellness Committee issued three heavy documents, namely, Administrative Measures for Internet Diagnosis and Treatment (Trial), Administrative Measures for Internet Hospitals (Trial) and Management Standard for Telemedicine Services (Trial). For the first time, the scope of internet medical care was clarified, and businesses that did not involve the core of medical care, such as online appointment registration and online health consultation, were excluded.
Internet medical services involving diagnosis and treatment are classified into telemedicine, Internet diagnosis and treatment, and Internet hospitals according to the users and service methods, and classified management is implemented.
"Some people think that the Internet can do everything, which is wrong." Lu Qingjun participated in the formulation of the new regulations. He believes that the core point of the document is to ensure medical quality and medical safety.
The three documents have drawn a "red line" for Internet medical behavior. For example, the operation of Internet hospitals needs to apply for a license from the regulatory authorities, and it must be run by offline physical medical institutions; Internet diagnosis and treatment can provide patients with some common diseases and chronic diseases for follow-up, and patients may not be treated for the first time; The new regulations also require that doctors who conduct Internet diagnosis and treatment must be certified by their real names, so as to avoid quack doctors impersonating well-known experts; The platform construction, management process design and doctor’s responsibility division of telemedicine information system are also clarified.
look ahead
We are studying the formulation of price guidelines.
But this is really just the beginning. Lai Jian, deputy director of the Sichuan Provincial Health and Family Planning Commission, bluntly said that Internet health care is still in the exploratory stage. With continuous exploration, the service content will continue to be enriched and deepened. It is necessary to continuously improve the work management system, incentive assessment mechanism, project charging standards, medical insurance reimbursement and payment and other supporting policies in collaboration with the development and reform, human society and other departments.
The most urgent thing is to fill the gap in the Internet medical price policy. Lu Qingjun told reporters that in the past, Internet medical services such as telemedicine did not have a definite business model, and the price department could not calculate the cost and pricing. If hospitals set their own prices and charge fees, they will be defined as "arbitrary charges" by the price supervision department. Therefore, many hospitals provide telemedicine services free of charge, but the telemedicine equipment is millions, and the cost of a remote consultation is 2,400 yuan to 2,700 yuan.
Without pricing, medical insurance reimbursement is out of the question. The reporter noted that in April this year, the General Office of the State Council issued the Opinions on Promoting the Development of "Internet+Medical Health", proposing that qualified Internet medical services should be gradually included in the scope of medical insurance payment.
"But the premise is that there must be fees first." Jiao Yahui said that because not all Internet diagnosis and treatment behaviors belong to the basic medical category, they do not have to be included in the scope of medical insurance reimbursement. If it belongs to the category of basic medical services, medical insurance should be reimbursed; Do not belong to, by the patient’s burden.
Lu Qingjun revealed that the National Medical Insurance Bureau is stepping up the formulation of guiding principles for Internet medical prices, and has now entered the stage of expert discussion. After the country issued the preliminary guiding opinions, the local price departments can formulate local price standards according to the guiding principles.
"The principle is uncertain, and there will be many bottlenecks in local standards. When the principle comes out, a game of chess in the country can be done. " Lu Qingjun said. (Reporter Xu Wen)