Six Networks Built to Try the Integration of Medical Services in the Yangtze River Delta——Jiefang Daily’s Report on Our Hospital’s Exploration of the Integration of Medical Services in the Yangtze River Delta

In Oct. 2016, the Strategic Alliance of Hospitals in the Yangtze River Delta for Coordinated Development was established. This alliance jointly initiated by Shanghai General Hospital, Jiangsu Province Hospital, Zhejiang Provincial People’s Hospital and Anhui Provincial Hospital now covers 112 hospitals in 26 cities. With their joint efforts, these hospitals have built “six networks” (critical care network, chronic disease prevention and control network, specialized medical alliance network, network of medical insurance settlement for medical treatment received in a different place, remote outpatient service network, air ambulance service network) and promoted the high-quality medical development in the Yangtze River Delta. “The medical profession has no shortage of ‘exclusive clubs’ for academic exchange. The Yangtze River Delta needs to vitalize various elements in medical services, to promote higher-quality integrated development.” Shanghai General Hospital’s president Wang Xingpeng said.

Specialized Medical Alliances Cover County-level Hospitals

Medical treatment needs big data. People living in the Yangtze River Delta have similar lifestyles, which causes a convergent spectrum of disease. As a result, one-sixth of China’s population have accumulated sufficient samples for clinical research here. 

In China, prediabetes morbidity is as high as 50.1%. The annual expenses of diabetes treatment add up to RMB 200 billion Yuan.

“One hospital cannot do everything from prevention to recovery. We must build an interconnected urban and rural medical service system.” Shanghai General Hospital’s chief of endocrinology Peng Yongde told the reporter. The Yangtze River Delta Endocrinology Forum has been established for 6 years. On this basis, the Yangtze River Delta Diabetes Alliance was established in April this year. “This time, we focus on county-level people’s hospitals in Shanghai, Jiangsu, Zhejiang, Anhui.”

Shanghai General Hospital’s vice president Xia Shujie said frankly: “to truly get serious illnesses treated in county-level hospitals, it’s not enough to build highlands. We must also fill up depressions and establish specialized medical alliances to cover all medical disciplines.” It has been revealed that in Oct. this year, 15 specialized medical alliances, including ophthalmology, orthopedics and urinary surgery, will respectively release a Yangtze River Delta Specialized Medical Alliances White Paper. Provincial hospitals will drive the common development of county-level hospitals on this basis. 

Location Is No Longer A Limitation On Medical Services

As long as you see a doctor, you can't avoid the problem of medical insurance settlement. In the Yangtze River Delta, it’s common for people to work in Shanghai but live in Jiangsu or Zhejiang. Isn’t it troublesome to go back home to apply for reimbursement every time one sees a doctor? According to Shanghai General Hospital’s chief accountant Xia Peiyong, China’s current medical insurance system is based on the county as a unit, which causes differences in the payment scope and settlement standards, as well as the lack of information sharing and other problems. Facing this “hot potato” that must be tackled, the alliances take actions. 

It’s learnt that Shanghai General Hospital’s Information Department, Finance Department and Medical Insurance Office together finished the matching of medical reimbursement lists between other places and Shanghai and the upgrading of the hospital’s terminal card readers. In July 2017, Shanghai General Hospital joined the National Medical Insurance Settlement Platform for Medical Treatment Received in a Different Place. By the end of May this year, it had benefited 3,145 patients. 

“Provincial hospitals should bring the spillover effect of medical services into play. In the near future, offline outpatient services in tertiary hospitals may shrink by half. Online outpatient services will become a key to development.” said Wang Xingpeng. Apart from remote consultations and ward rounds, the appliances have begun to actively explore the remote outpatient service model.

In the future, senior doctors in tertiary grade-A hospitals in Shanghai, Jiangsu, Zhejiang and Anhui will adopt unified scheduling. All the alliance’s member hospitals will have real-time access to the schedules of expert clinics. At present, there is no formal settlement standards, but all the departments have carried out this zero-cost “online clinic”. “County hospitals’ doctors and patients all feel reassured. We finally find the right consultant.”

A 3D Medical System Has Taken Shape

Last Nov., a helicopter from Wuhu of Anhui landed on the apron of Shanghai General Hospital’s South Division. A 73 years old woman’s breath and heart stopped after choking on food. Considering she had a history of cerebral infarction, her family decided to seek medical treatment in Shanghai. It usually takes at least 4-5 hours to finish the more than 300km journey by an emergency ambulance. However, after receiving the call, the air ambulance medical workers, who are on call 24 hours a day in Songjiang, received and treated the patient in less than 2 hours and gained time for saving the old lady.

This air ambulance network covers every corner of the Yangtze River Delta. A 3D medical service system has taken shape. Anhui Provincial Hospital’s party committee secretary Liu Tongzhu said: “at first, we agreed with each other with great passion. Later, we began to put the idea into practice. Now, everyone has turned from an onlooker into a participant.”

“In the past, the hospital was filled with complacency. Now, it’s all gone.” Zhejiang Provincial People’s Hospital’s president Huang Dongsheng said proudly that since the establishment of the alliance, the hospital had significantly improved its comprehensive strength and driven the common development of grass-roots hospitals. “Standing on the Yangtze River Delta in the era of sharing, we must join hands to share resources, complement each other with our advantages, and cooperate to win together.” Jiangsu Province Hospital’s president Tang Jinhai believes that in the new era when medical technology flattens day by day, cities in the hinterland of the Yangtze River Delta can also take advantage of the Internet to leap into the forefront.

In the second half of the year, training and surveys mainly for building specialized medical alliances have been carried out steadily. It’s reported that the design, distribution and collection of a baseline survey of county hospitals in Yangtze River Delta on their speciality construction are already on the schedule. On the basis of training classes for chief physicians in county hospitals, APPs and WeChat groups for doctors based on the speciality as a unit are being built. In the next stage, based on the existing hospital platforms, the alliance will further promote medical business cooperation and hierarchical diagnosis and treatment through services such as AI imaging and personal health archives, to gradually achieve seamless referral.

Short Review

To Go Far, A Driving Force Is Necessary

Wang Renwei

Solving the problem of settlement for medical treatment received in a different place, building specialized networks covering county hospitals, planning telemedicine with a reasonable distribution of benefits…the Strategic Alliance of Hospitals in the Yangtze River Delta for Coordinated Development jointly initiated by Shanghai General Hospital and three provincial hospitals have done practical work. The key is that they have found a driving force for cooperative development at a deeper level: a win-win mechanism. On a platform joined by many hospitals, if there’s only one winner, the platform won’t be sustained. Only win-win cooperation can make the platform bigger and stronger.

Hospitals in Jiangsu, Zhejiang and Anhui want to join hands with Shanghai’s medical highland to develop specialized strengths, so the Alliance for Coordinated Development has woven a specialized medical network. Even cases from grassroots hospitals in these provinces have enriched the big data most needed by the Yangtze River Delta’s clinical research. Today, the Yangtze River Delta has great population mobility. The settlement for medical treatment received in a different place has been a big problem. As a result, we get together to solve this problem. Moreover, remote diagnosis is now available on the Internet, how to balance outpatient expenses between different hospitals? These are real problems. To go deep and far, we must face the challenges.

We can draw inferences about other cases from one instance. Inspiration can be drawn from the exploration by the Strategic Alliance of Hospitals in the Yangtze River Delta for Coordinated Development: only by establishing a win-win mechanism can we secure a sustainable driving force of development.