Medical and health research and practice in developed countries have proved that the primary-level health care service system with general practitioners (also known as "family doctors") as the mainstay has significant advantages in terms of the allocation of national medicalresources, the control of overall medical costs and the improvement of medical service quality. Therefore, how to build a team of general practitioners and what kind of medical policies to adopt have become the focus of attention of governments and public health scholars.
Compared with developed countries in Europe and the United States, there is still a big gap in China's overall investment in medical and health services, but our growth rate is significant. The proportion of the total medical cost in GDP continues to rise, from 4.99% in 2011 to 7.1% in 2020. However, against a background of theslowing economic growth and increasing social aging, it is not advisable to simply increase the investment of medical resources;and the key lies in how to improve the efficiency of the use of resources. Based on ourown conditions and advantages, we should conduct scientific and creative top-level design, reasonably allocateand utilizemedical and health resources, and build upa general practitioner service system with Chinese characteristicsso as tomeet short-term primary-levelmedical needs andalso achievelong-term sustainable development of medical undertakings. We suggest we take the following specific measures.
First, we should pay attention to the development of disciplines, continue to improve the general practitioner training system and increase the dedicatedfinancial investment. We should enrich the faculty of general medicine in colleges anduniversities, optimize standardized teaching syllabuses for undergraduates and resident doctors, and have students learn to make clinical judgment of various diseases at multiple departments of general hospitals so as to develop their clinical practice and communication skills. Preferential policies such as providing training for specific students and fee reduction can beused to attract college graduates to become general practitioners.
Second, in order to enhance the job satisfaction of primary-levelmedical personnel and reduce the turnover rate, we must substantially raise the salary of in-service general practitioners. In this regard, Shenzhen introduced a salary policy as early as 2019, using economic means to attract general practitioners and giving each general practitioner a one-time living subsidy of 250,000 to 350,000 yuan. On the basis of increasing basic salary, we can set up a multi-dimensional salary structure for general practitioners; the assessment can bemadeaccording to the quantity and quality of contracted services to mobilize their enthusiasm. In addition, we should reinforcetraining for primary-leveldoctors, improve training qualityand change the promotion path of professional titles that simply relies on scientific research achievements so as to effectively provide an upward path and psychological guarantee for the career development of general practitioners.
Third, we should reconstruct the functional division of medical institutions at all levels and vertically integrate medical resources through medical treatment combinationto achievedivision of labor and cooperation. On the one hand, we should formulate and strictly implement hierarchical medical management measures, such as increasing the number of patients who can enjoy expert diagnosis and treatment, examination and hospitalization assigned to primary medical institutions for referral to higher-levelhospitals, and controlling the proportion of first diagnosis that exceeds the level. On the other hand, we should relyon medical treatment combinationto build a unified big data platform tomakereferralmore convenientand institutionalize referralandsave medical resources for outpatient serviceand testing. We can usethe remote video diagnosis and treatment system to transfer patients with intractable diseases from community hospitals to specialists in tertiary hospitals at any time, so as to give full play to the role of medical experts and provide more on-the-job learning opportunities for primary general practitioners.