Breathing fresh air into medical reforms(3)

Way forward

The medical and health division of the Shanghai Municipal Committee of the Chinese People's Political Consultative Conference submitted a proposal at the session. The proposal not only mentioned expanding the availability of drugs, but also widening the scope of medical examinations and tests at primary medical institutions.

It also said it is necessary to increase charges for medical services, which are currently much lower than their real value. "In the current situation, tertiary hospitals, which are mostly responsible for their own profits and losses, have to pursue large amounts of services to survive. This also results in doctors' having an excessively heavy workload," said the proposal.

"This results in lighter loads on secondary and primary hospitals and doctors there aren't able to improve their skill sets because they cannot access a variety of patient cases."

Gu also suggested diverting a proportion of medical appointments usually done at higher-level hospitals to doctors at primary medical institutions.

"This way, patients who first seek medical advice at a primary institution who don't have their problem solved will have priority access to a senior doctor at a tertiary hospital," Gu said. "This is the original intention of building the three-level system compared with the current situation, where people go directly to a big hospital for almost everything," Gu said.

She also said physicians in certain departments at primary medical institutions should be authorized to prescribe certain medications for longer periods, making their services more attractive to local residents.

Other measures to make using primary medical institutions more attractive include higher reimbursements for medical bills and extension of service hours, said Jin Ying, a Shanghai legislator and director of the Dapuqiao Community Health Service Center in Huangpu district.

"When someone runs a fever their temperature usually rises in the afternoon and during the night, while primary medical institutions usually stop providing services at 4:30 pm," she said. "This leaves patients with no other choice but to go to big hospitals."

Jin said that her center received an average of 300 patients per day during the seasonal peak of respiratory diseases in December, while Renji Hospital, a tertiary hospital located in the same district, reported 2,200 patients a day attending its emergency and fever clinics.