Major medical system reforms are continuing to offer better services to patients in a city in east China's Fujian Province 12 years after the improvement program was launched, with the measures setting a national example while providing affordable healthcare to local residents.
Sanming City started to reform its public hospitals back in 2012 to address issues surrounding expensive drugs and medical consumables and limitations of certain healthcare services, which led to expensive medical care services and a heavy burden for local medical insurance funds.
The latest changes have had a transformational effect for patients from outlying areas who often had to travel to larger hospitals for complex procedures such as dialysis treatment for diseases such as uremia or kidney conditions.
Before the completion of specialized rooms in township-level medical facilities, there was only one hemodialysis center at the city's Shaxian General Hospital, which saw patients from 12 townships in the region having to head there for dialysis multiple times per week, with those living farthest from the hospital having to endure lengthy bus rides.
During peak hours, all 39 machines in the dialysis center were constantly operational from 07:00 to 21:00 each day, but this still was not sufficient enough to fully meet patients' needs.
Those who have made the journey to the hospital explained how troublesome it was.
"It can be troublesome to go to Shaxian General Hospital. It takes us 20 minutes to get to the [bus station] on the main road, and another 40 minutes to get to Shaxian. Additionally, I have to pay 25 yuan (around 3.5 U.S. dollars) for the bus ticket and 30 yuan (over 4 U.S. dollars) for lunch, which is also very expensive," said Zeng Zhangquan, a patient.
Recognizing these issues and taking steps to better serve patients, the local government began allocating more medical resources to grassroots hospitals, including providing funding of over 3 million yuan (over 410,000 U.S. dollars) for medical equipment, and established the first localized hemodialysis center in the Xiamao Township of Sanming's Shaxian District.
The city also established a multi-tiered healthcare insurance system, aiming to improve both the basic health insurance system and promote commercial health insurance, which has greatly lowered the economic burden on patients.
"I started peritoneal dialysis in 2014, which cost 700 to 800 yuan (up to 110 U.S. dollars) per week. Since 2018, both hemodialysis and peritoneal dialysis have been completely free. Last year, I switched to hemodialysis, which now costs me only 1 yuan (around 15 cents) each time, so there's basically no financial pressure," said Jiang Fayin, a patient.
According to Sanming's medical insurance reimbursement policy, at primary hospitals in the city, a dialysis patient may only need to pay a small amount if they are properly insured, and medics have sought to ensure that patients do not delay their treatment out of financial concerns.
"Let's consider it this way: [the medical insurance expenditure] for each dialysis session is more than 300 yuan (about 40 U.S. dollars), totaling less than 4,000 yuan (about 550 U.S. dollars) per month. If patients skip dialysis due to financial constraints, they may experience serious heart failure. In such circumstances, patients not only suffer physically but could also face medical bills potentially amounting to hundreds of thousands yuan further down the line," said Lin Jizao, a doctor at the Xiamao Central Sanitary Hospital.
In the second half of 2019, Sanming authorities initiated a pilot reform program involving a 'three-level' medical service scheme to provide necessary care at the local village, township, and county-wide level, which was developed through medical consortiums.
Through this initiative, the local government provides subsidies to encourage doctors at county-level hospitals to frequently treat patients at smaller village and township clinics, while medical professionals from these more rural areas also have opportunities to study at higher-level institutions.
Capitalizing on the resources and personnel strengths of larger hospitals, all township clinics in Shaxian District are now equipped with essential staff and facilities. Shaxian boasts 150 general practitioners, and construction has begun on a second local township hemodialysis center.
Since 2016, Sanming has also been implementing its chronic disease health management system. Grassroots medical institutions are responsible for managing over 30 chronic diseases, including hypertension and diabetes. This includes full reimbursement of some medications under medical insurance and regular monitoring of treatment effectiveness.
"[I often visit the health clinic] to check my blood pressure and blood sugar. Sometimes if I haven't been for a while, the doctor would remind me over the phone," said Zhang Yulan, a resident of the Songlin Village.
"In our village, patients with hypertension and diabetes have their blood pressure and blood sugar measured once a month. They can also receive free medicine distributed by the government, enabling them to receive regular treatment and medication," said Peng Jiankang, a doctor at the Songlin Village Clinic. This vastly improved medical situation has removed a lot of the stress for villagers, who say they are satisfied with the services now available to them.
"The policy is good, as medicine [for hypertension and diabetes] are free," said villager Jiang Xiuqing.
Medical reform program helps provide affordable, local-level healthcare services in east China city
Medical reform program helps provide affordable, local-level healthcare services in east China city
