Plan to develop Family Medicine in Viet Nam

Plan to develop Family Medicine in Viet Nam period 2016 - 2020

Definition of Family medicine l According to American Association of Family Physician: family physicians are dedicated to treating the whole person, family medicine's cornerstone is an ongoing, personal patientphysician relationship focusing on integrated care. Family medicine integrates care for patients of all genders and every age, and advocates for the patient in a complex health care system. l To WHO definition, family doctor is a precious career – the backbone of primary health care system – the comprehensive health services with lowest cost and the patient is the centre of service.

Advantages of Family medicine l To people: Easy access to family doctors l Be taken care with continuous primary health services even when they do not catch a disease, family doctor is a private doctor l Be consulted on health issues, preventive medicine and medical services on normal diseases ->> comprehensive cares l Lowest cost

Advantages of Family medicine l l To people: Family doctor remains close relation to each family member. Be screened, diagnosed, early treated or transfered to right hospital-- effective treatment Chronic diseases are curved at community 70% people’s demand on medical care served at community

Advantages of Family medicine l l l To family doctors: To take care patients with or without health insurance To implement medical services at patient’s house To work sustainably with certain quantity of patients and sustainable incomes

Advantages of Family medicine To family doctors l Be able to attend training courses to update professional knowledge on family practice l Be supported with health care system on career development

Advantages of Family medicine l To health system and society: To improve primary health care service quality l Effective disease screening, patient transferred to suitable hospital contributing to the reduction of hospital overload at higher level. l To reduce burden and time cost for specialized doctors l To improve coordination between patients and health staff

Advantages of Family medicine To health system and society : l To contribute to people’s health improvement l Family doctor can be considered as “the guard” in health care service system l To save hospital fee, insurance expenditure and bring about economic efficiency for patients and society

The project on Family doctor clinics development The Ministry of Health initiated: The project: “Develop the model of family medicine clinics in Viet Nam period 2013 2020 (Decision No 935/2013/QĐ-BYT dated 22 March 2013). l l Period 2013 -2015: Implemented in 8 pilot cities and provinces Hồ Chí Minh, Hà Nội, Hải Phòng, Thái Nguyên, Thừa Thiên Huế, Khánh Hòa, Cần Thơ, Tiền Giang. . l Period 2016 - 2020: To expand the model nationwide

OUTCOMES OF 2013 -2015 1. Legal background l Circular No 16/2014/TT-BYT with instruction on pilot activities on family doctor and family doctor clinics l Circular No 37/2014/TT-BYT dated 17 Nov 2014 with instruction on primary health care registration and medical services transfer, denoted that family doctor clinics can work independently and be among primary care stations.

OUTCOMES OF 2013 -2015 l l 2. Human resource training To provide training programs oriented to family medicine (3 months training course included) in order to issue work permit 900 doctor specialized category I trained and 1200 specialized doctors with family medicine oriented.

OUTCOMES OF 2013 -2015 l l 3. To establish model of family doctor clinics at 8 provinces, cities To December 2015, 240 family doctor clinics set up 8 central provinces/cities, (exceeding the target: 80 clinics) To June 2016, 332 family doctor clinics set up

OUTCOMES OF 2013 -2015 HCM City: 217 family doctor clinics/Hospital/medical station and 10 private family doctor clinics -Hà Nội City : 90 family doctor clinics - Hải Phòng City : 05 medical stations/family doctor clinics - Thừa Thiên Huế : 05 integrated medical stations and 01 private family doctor clinics. - Tiền Giang: 04 medical stations/family doctor clinics and 01 private family doctor clinics. -Khánh Hòa: family doctor clinics located in General Hospital of Ninh Hoa and Medical Centre of Ninh Hoa commune - Thái Nguyên: 04/180 local medical station, 01 private family doctor clinics -

OUTCOMES OF 2013 -2015 After 3 years being implemented in 8 pilot cities/provinces; the model of family doctor clinics have gradually proven its effectiveness and its feasibility to be expanded Though it is newly opened, family doctor clinics are functioning as family medicine principles With the following activities: medical services provided, screening, personal/family/community health management aiming at continuous and comprehensive management. At family doctor clinics, people get thorough services, consultation and instruction.

Plan period 2016 – 2020 GOAL To multiply and develop the model of family doctor clinics nationwide in order to provide basic/comprehensive/continuous health services for persons, family and community contributing to primary health care promotion and hospital overload reduction

TARGETS To accomplish the model of family doctor clinics with priority is to develop the model integrated to medical stations 1. 2. To multiply and develop the model of family medicine To follow roadmap of 2020, 80% central provinces and cities implement the model of family doctors

TASKS AND SOLUTIONS 1. To accomplish the model Medical stations follow family medicine principles v Family doctor clinics Ø Private family doctor clinics (included the clinics provide services out of office hours) Ø Family doctor clinics belong to General hospital (State hospital)

TASKS OF MEDICAL STATION FOLLOWING FAMILY MEDICINE PRINCIPLES a) To follow tasks denoted in Circular No 33/2015/TT-BYT b) To implement health management for people, family and community c) To transfer patient to suitable hospital and follow regulation of family medicine d) To implement consultation, screening activities, early detection

TASKS OF MEDICAL STATION FOLLOWING FAMILY MEDICINE PRINCIPLES đ) To implement palliative care, end of life care e) To implement technical services at patients’ house g) To participate into science research and training on family medicine

TASKS OF FAMILY DOCTOR CLINICS a) To implement preventive care and primary care b) Medical service First aid, medical care to normal diseases To provide health care services at the clinics or patients’ house, screening – early detecting To manage medical profile of patient and family complying with MOH regulation To implement palliative care To manage occupational diseases, mother – child – elderly care

TASKS OF FAMILY DOCTOR CLINICS - Patient transferred - Implement technical care at patients’ house - Rehab and health promotion Medical consultation: Direct or indirect medical consultation, prevention, community care - - Science research and training on family medicine

LEGAL DOCUMENT DEVELOPMENT 1. Financial mechanism of the medical services provided by family doctor clinics 2. Instruction on health insurance payment for medical services provided by family doctor clinics 3. Amendment of Circular No 16/2014/TT-BYT dated 22 May 2014 on pilot activities of family doctor and family doctor clinics

LEGAL DOCUMENT DEVELOPMENT 4. Circular on patient transfer 5. Circular on technical items, equipment, drugs of family doctor clinics 6. Sample of health profile

IT APPLICATION 1. To apply IT in health insurance payment, to develop software on clinics’ function and organization 2. To develop health profile

Human resource training for family medicine 1. Types of training: 1. 1. To organize training course on family medicine for students at Medical University 1. 2. To organize training course oriented family medicine within 3 or 9 months 1. 3. To organize post graduation training course on family medicine (specialized, master, doctor degree)

Human resource training for family medicine 1. 4. To train and promote staff working on family medicine 2. Based on situation and training demand on family medicine, Ministry of Health would develop project on human resources for family medicine

To multiply and develop the model of family doctor clinics To set up model of family doctor clinics at provinces, cities nationwide and follow the roadmap to assure at least 80% of all central cities/provinces implement this model

Roadmap to multiply and develop the model of family doctor clinics v 2016: To maintain, multiply the model at 8 central cities/provinces which have already implemented these clinics v 2017: To expand the model to some other provinces/cities v 2018: To expand to other provinces to assure at least 40% clinics established

Roadmap to multiply and develop the model of family doctor clinics v 2019: To multiply the model to assure 60% of central cities/provinces implement family doctor clinics v Năm 2020: To expand the model to assure 80% central cities/provinces covered with clinics

Plan for 2016 1. To maintain, consolidate and establish family doctor clinics at 8 pilot cities/provinces 2. To put 40 medical stations (implementing family medicine principles) of Ha Noi, HCM, Hai Phong anf Thua Thien Hue in to effective operation

Plan for 2016 3. Apart from the mentioned provinces/cities, if the other central provinces/cities have demands to implement the model of family doctor clinics, they could develop Plan and submit it to Chairperson of People Committee for approval and report to the Ministry of Health for implementation.

Criteria for the selection of agency with outstanding model a) For the medical stations which follow family medicine principles -Populated locality, far from district hospital -Doctors with work permit on family doctor or trained with family medicine Participated into medical service activities with health insurance - With IT application in operation -With basic medical equipment meet the demand of professional services - With desire to develop an outstanding model -

Criteria for the selection of agency with outstanding model b) To private family doctor clinics - They have to meet all the criteria as medical stations which follow family medicine principles. - At least 200 patients re-take health check up 3 times up per patient

TASKS OF STEERING COMMITTEE Medical services Administration: To give direction, coordinate and support HCM Health Dept in implementing 20 medical stations operating with family medicine principles. - - Planning and Finace Dept: To give direction, coordinate and support Ha Noi Health Dept - Health insurance Dept: To give direction, coordinate and support Thua Thien Hue Health Dept - Personnel Dept: To give direction, coordinate and support Hải Phòng. Health DEpt

TASKS OF STEERING COMMITTEE Ministerial Cabinet Office: To give direction, coordinate and support Health Dept of Tien Giang - - Technology and Informatics Administration: To give direction, coordinate and support Health Dept of Thái Nguyên. - ICD: To give direction, coordinate and support Health Dept of Khánh Hòa. - Science Technology and Training Administration : To give direction, coordinate and support Health Dept of Cần Thơ.

Regulation for patient transferred - Family doctor clinics is the first foundation in screening, checking and transferring patients to other suitable hospitals in case patients need more specialized check up. The clinics is also responsible for taking care patient transferred from other medical units.

Regulation for patient transferred - Based on patient situation, the family doctor clinics could transfer them to provincial or central hospital which can be considered as the right level -Family doctor clinics within district Hospital can transfer patients from clinics to clinical division of the hospital

Regulation to issue work permit on family medicine a) For those request to be issued the work permit before 1 st Jan 2020, it is a must to have at least graduation degree of general practioner and certificate of family medicine (minimum 3 months) issued by Ministry of Health or relevant Health Dept

Regulation to issue work permit on family doctor b) For those request to be issued the work permit before 1 st Jan 2020 and after, it is a must to have at least graduation degree of general practitioner and one of the certificates of specialized I, specialized II, master/doctor degree on family medicine, or certificate of training oriented family medicine

Payment method a) b) l At first, payment for medical services at medical station following family medicine principles have to comply with current regulation For medical examination at patients house, the payment for doctors have to follow: For the elderly and prioritized group: Comply with Circular No 35/2011/TT- BYT of the Ministry of Health dated 15 Nov 2011 with instruction on the elderly care and Circular No 21/2011/TT-BTC dated 18 Feb 2011 of Ministry of Finance that denoted budget disbursement of primary medical care for the elderly at their locality, birthday and rewards for the elderly

Payment method + Others: Follow local government’s regulation, or agreement between patients and medical stations c) To develop Circular on Finance mechanism of the medical services provided by family doctors (DRG or fee for service)

a) Conditions for certified practice For those request to be issues work permit on family doctors before 1 st Jan 2020, it’s a must to have official document certified their practice within 18 months as denoted in Medical Law and Circular No 41/2011/TTBYT dated 14 Nov 2011 of Minister of Health

Conditions for certified practice b) For those request to be issues work permit on family doctors from 1 st Jan 2020, it’s a must to have official document certified their practice of family medicine within 18 continuous months and up at a General Hospital.

Budget for project implementation Sources: National budget, aid, ODA, others l l Ministry of Health: HPET provides financial support for training and medical equipment for some medical stations l Local authority: Arrange their budget for plan implementation

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