How can the incentive mechanism be "online" when doctors are "online"?
2022-07-04
"When receiving patients online, we should first understand the patient's main complaint, ask the medical history in detail, view the medical record data, and then give the patient treatment suggestions, issue drug prescriptions and write the medical record." Zhang Ke, deputy chief physician of the Department of Otolaryngology of the Third Hospital of Peking University and a doctor of the Internet hospital, introduced her online treatment process to the reporter of workers' daily. Internet hospitals have built a new bridge for doctor-patient communication. Relying on offline hospitals, many Internet hospitals have also settled in a powerful team of doctors, providing convenience for the masses to seek medical treatment. However, the reporter learned from interviews in Beijing, Shenyang, Shenzhen and other places that many doctors are not very enthusiastic about Internet hospitals, and some Internet hospital doctors even have zero visits, zero evaluations, and zero replies. The 2021 report on the development of Internet hospitals in China shows that less than 10% of Internet hospitals can truly achieve effective and sustainable operation, and most of them are in the state of construction rather than use or simply stop. Zhaoyongsheng, vice president of Peking University Shenzhen Hospital, said that the biggest difficulty in the real implementation of Internet hospitals lies in how to mobilize the enthusiasm of doctors. Doctors use their spare time to reply to patients In 2018, after strict training and access assessment, Zhang Ke officially became a doctor in the Internet Hospital of the third Beijing Medical College. In her view, Internet hospitals can not only keep patients in touch with doctors, facilitate timely and smooth communication, but also improve the doctor-patient relationship to a certain extent. According to reports, many Internet hospitals have strict doctor access mechanisms. Doctors not only need to have doctor certificates, entity hospital qualification certificates, and independent clinical experience, but also need to obtain Internet hospital qualification. Xu Xuedong, director of the medical department of the Third Hospital of Beijing Medical University and director of the office of the Internet hospital, said in an interview with workers' daily that online reception can meet the needs of patients for follow-up visits in a timely manner, thereby providing more offline outpatient resources to first-time patients. At the same time, through the integration of online and offline connection, patients' health management and medical services can form a closed loop, making treatment continuous. Internet hospitals provide many conveniences for patients to seek medical treatment, but many doctors are not very enthusiastic about it. Some doctors only regard the work of Internet hospitals as a "sideline". Zhang Ke bluntly said that in her daily work, she must first ensure the time of offline medical services, and the treatment of patients in Internet hospitals is mainly completed by taking breaks or fragmented time. At present, she receives more than 30 patients in the Internet hospital on average every week. In April this year, the reporter saw in the consulting room of the infectious diseases department of Peking University Shenzhen hospital that the attending physician Li Yaqin was using his mobile phone to reply to online patient inquiries through the Internet hospital platform. She told reporters that doctors will receive SMS notifications when patients are consulted online, and usually reply during breaks. Online diagnosis and treatment service pricing is not reasonable In addition to the difficulty in ensuring working hours, the reporter of workers' daily also found in the interview that the pricing of diagnosis and treatment fees in Internet hospitals is unreasonable, which is also the reason for doctors' low enthusiasm. Zhou Wen, chief physician of internal medicine in a third-class hospital in Shenyang, told reporters that in fact, visiting Internet hospitals is not easier than offline, and doctors at different levels charge according to the price of general outpatient diagnosis items when visiting, and the diagnosis and treatment fees of chief physicians and doctors are 9.6 yuan. "The pricing of diagnosis and treatment services is not reasonable, and there is a 'one size fits all' phenomenon, which can not fully reflect the labor value of medical personnel, which also frustrates the enthusiasm of high-level medical personnel to some extent." Zhou Wen said. Zhou Wen also bluntly said that compared with offline, she spent 20% more time on diagnosis and treatment for each patient online. Sometimes, in order to determine the patient's condition, she may need to spend more time communicating with patients online, and most pre diagnosis consultations are free. The 2021 China Internet hospital development report points out that taking online follow-up as an example, Beijing charges 50 yuan, while the offline ordinary number of well-known experts in the hospital is 100 yuan, and the special number is 300 yuan. The relevant person in charge of the Internet Hospital of Shenzhen maternal and child health hospital also felt the same, "the current online diagnosis and treatment fee is difficult to mobilize the enthusiasm of doctors. After doctors complete the offline high load workload, it takes a lot of time and energy to use the rest time to carry out online consultation services, and can only charge the minimum diagnosis and treatment fee standard, that is, 25 yuan, which is difficult to mobilize their enthusiasm." Provide "sunshine income" for doctors' online visits "To increase the activity of doctors, we need to provide 'sunshine income' for doctors' online visits." Zhou Wen said that under the COVID-19, offline diagnosis and treatment are limited, which plays a catalytic role in doctors' online and continuous provision of online services. "However, in order for doctors to truly embrace and participate in Internet hospitals, they also need to meet the diversified needs of doctors." The 2021 China Internet hospital development report emphasizes that the establishment of an effective benefit distribution mechanism and cost compensation mechanism for hospitals and an effective performance incentive and evaluation mechanism for doctors is the first prerequisite for the sustainable development of Internet hospitals. The report also points out that Internet hospitals have integrated online and offline processes. Compared with traditional diagnosis and treatment services, the business model and user treatment path have also changed greatly. If the performance incentives for doctors cannot follow the business adjustment, it is bound to restrict the development of Internet hospitals. According to the guidance of the National Medical Security Bureau on actively promoting the payment of "Internet +" medical services, designated medical institutions provide "Internet +" medical follow-up services that meet the regulations, and charge and pay according to the price of general outpatient diagnosis items in public hospitals. Zhao Yongsheng said that in order to improve doctors' enthusiasm, Peking University Shenzhen hospital holds regular Internet hospital meetings every week, and takes all the consulting fees as doctors' performance rewards. Zhang Ke suggested that the relevant departments should formulate the corresponding norms and price standards for the diagnosis and treatment of Internet hospitals in a timely manner, improve the performance incentive and evaluation mechanism of personnel in different roles, so that the labor value of doctors, nurses, pharmacists and technicians can be reflected respectively. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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