【Silin Monograph】Improving the effectiveness of the medical and health system from the perspective of consumer health needs

[Editor's Note] With this article "Improving the efficiency of the medical and health system from the perspective of consumer health needs" as the first article, Shilin Information opens the "Scilin Monograph" column, the special issue of the characteristics of some common concerns in the field of biomedicine Thoughts and discussion articles.

Key points

-Because of the limitation of knowledge and ability, healthy consumers as individuals are "restricted health behaviors" and cannot make health decisions independently

-The medical and health industry implements the "consumer health needs expression agent system", and consumers' health needs are largely expressed by the government, pharmaceutical companies, medical units and insurance institutions

-Therefore, the medical and health field has duality: subject duality (consumer and agent are both subjects), medical product duality (drugs have both the characteristics of medicines and the commonality of commodities), and the duality of decision-making (patients are treated by medicine and are healthy decision making)

-The deficiency of consumers’ right to express their health has led to an unbalanced duality in the medical and health field: "Consumer’s health demand expression agency system" has long emphasized the subject status of the agent and the consumer as the object; it emphasizes the characteristics of drugs and weakens them Commodity attributes; emphasizing patient medical treatment, weakening consumer decision-making

-Establish the right to express consumers' health needs, and strengthen consumers' health consumer status through the assistance of mobile Internet and big data, which provides us with a balanced duality in the medical and health field, so that consumer needs can better guide the allocation of resources and improve medical health A new perspective on system efficiency

This article discusses the following two issues:

-The predicament of "Four Questions" in drug supervision is the superficial manifestation of the deep imbalance of the consumer health demand expression agency system.

-Build consumer health expression rights based on mobile Internet and big data, and improve the efficiency of medical and health resource allocation.

Professor Zhu Hengpeng of the Chinese Academy of Social Sciences put forward the "Four Questions of Heart" when discussing medical innovation.

-Home appliances, cars and IT products have been upgraded from imitation to innovation, why not in the pharmaceutical industry?

-Home appliances, cars, and IT products are getting better and better, and their prices are getting lower and lower.

-There is no price control for home appliances, cars, and IT products, and the prices are getting lower and lower.

-Home appliances, cars, and IT products have realized the shift from import-oriented to export-oriented.

The answer is: The predicament of the "heart-wrenching four questions" of drug supervision is the superficial manifestation of the deep imbalance of the consumer health demand expression agency system.

Specifically, the fundamental reason for the "heart-wrenching four questions", that is, the essential difference between the "medical industry" and the "household appliances, cars, and IT product industries", lies in the significantly different roles played by consumers in the "medical and health industry".

In the "household appliances, cars, and IT product industries", consumers are customers and gods.

In the "medical and health industry", consumers are mainly positioned as "patients" because they do not have sufficient expertise in diseases and treatments, and they have always played the role of being spoken for, saved, guided, and made decisions.

Therefore, the medical and health field has duality: subject duality (consumer and agent are both subjects), medical product duality (drugs have both the characteristics of medicine and the commonality of commodities), and the duality of decision-making (patients are treated by medicine and make health decisions ).

Consumers (patients) have triple defects in expressing health needs, which hinder the balance of duality in the medical and health field:

(1) Consumers do not have complete health information expression rights

-Everyone can describe their own health, but this does not constitute an effective expression of health information.

-Although the relevant agents believe that: "No one understands the health needs of consumers better than me", the process of expressing the health needs of consumers through the agent will experience double filtering:

-When the agent listens to and collects the health needs of consumers, the information received is filtered through the first layer because of the limited perspective and communication framework; when the agent expresses the health needs of the consumers, the second layer of filtering will be generated because of the benefit screening.

-Therefore, the health needs of consumers expressed by agents will always be different from the real needs of consumers in dynamic changes.

As individual cases, people are often accustomed to it and simply accept it as “there is no treatment at present, or bad luck, poor treatment effect, or too expensive to see a doctor, and no money to see a doctor”; but when analyzing from the perspective of society as a whole, they will find that Unreasonable phenomena in the industry like the "Four Questions of the Heart".

(2) Lack of rights of consumers' health data subjects

With reference to the information rights framework established by the EU's General Data Protection Regulation (GDPR), data subjects should have a series of rights such as the right to know, access, correction, portability, deletion processing, opposition, and automated personal decision-making rights.
, Medical and health consumers have obvious deficiencies in data subject positioning, data access rights, and data portability rights (and the health information expression rights mentioned above).

The positioning of consumers as subjects of medical and health data is unclear.
Under the current international and domestic electronic medical records and electronic health records systems, consumers (residents, patients) are regarded as the objects of electronic medical records or electronic health records, and they are not able to actively publish health information, conveniently access health records and target different objects.
The subject that determines the scope of authorization.

Consumers have insufficient data access rights to their own medical and health data.
At present, different top three hospitals provide consumers (patients) with different ways to obtain medical information (print and paste on the medical record book, log in through the hospital's official account, etc.
).
Electronic medical records between different hospitals are not shared with each other, and consumers lack convenience for integration.
Ways to access their own medical and health data at any time.

Consumers are far from enjoying the right to data portability.
Data privacy agreements are unilaterally formulated by service organizations, and the terms are clearly unfair.

The lack of rights of these health data subjects has weakened the ability of consumers to express their health needs.

(3) Health information communication did not form a closed loop, and did not provide sufficient information for consumers to make independent decisions

To effectively exercise the "restricted health decision-making ability", consumers need the help of a closed-loop healthy communication, that is, to obtain sufficient information needed for healthy consumption decision-making in a convenient way, including:

-Medical and health decision records

-Health experience expression information

-Healthy consumption information

When the medical and health decision-making records are scattered in different medical diagnosis institutions, they are not shared with each other, and there is no effective integration.
When the "efficacy" is not based on the consumer's health experience, but only based on the doctor's diagnosis, the medical and health costs paid by consumers are not comprehensive According to statistics, when giving consumers intuitive feedback, health information communication has not formed a closed loop for consumers, and the information required for independent decision-making on healthy consumption is insufficient.

These shortcomings of consumers’ right to express their health have led to an unbalanced duality in the medical and health field: "Consumer’s health demand expression agency system" has long emphasized the subject status of the agent and the consumer as the object; it emphasizes the characteristics of drugs and weakens them.
Commodity attributes; emphasizing patient medical treatment and weakening consumer decision-making.

Reflected in the overall operation result of the medical and health system, the role of consumers as the main body of health needs is blurred, and health needs cannot effectively express and guide the allocation of economic resources like other industries.

Build consumer health expression rights based on mobile Internet and big data, and improve the efficiency of medical and health resource allocation.

We want to ask two questions:

(1) When a society’s primary energy is not to shape how government agencies make decisions, how to be generous and charitable by insurance organizations, how to be charitable by medical institutions, how to invent and innovate by pharmaceutical companies, but to focus on how to help consumers better Expressing their own health experience, how to assist consumers to use their limited money to make independent decisions to obtain greater health benefits, is such a society different, and is it worth looking forward to?

(2) Assuming that balancing the duality of the medical and health field is worth looking forward to, but it is not easy because too many interest groups have to be touched.
Is this change possible and where does the motivation come from?

To answer these questions, we must first clarify what is "consumer health expression rights" and discuss what changes it can bring to the efficiency of the healthcare system.

What is the "right to express consumer health needs"?

"Consumers’ right to express their health needs" means that consumers, as health subjects, can directly express their health experience with the help of mobile Internet and big data, and receive effective feedback to continuously improve their own health decision-making efficiency and conduct health in line with their own needs.
Consumption and other healthy behaviors, the right to be fully supported by laws, systems, policies and social infrastructure.

The complete right to express consumer health needs should include the following elements:

-Consumers are regarded as the main body of health data, and the health experiences released by consumers consciously and voluntarily are regarded as effectively expressed health information.

-The collection, storage, use and sharing of health data are authorized by consumers themselves based on a relatively independent and fair format contract drawn up by a third party.

-Consumers have personal national health records that can be accessed and used at any time through mobile phones.
This file integrates personal health codes, personal electronic medical records (cross-hospital), personal health experience expression accounts, and personal health consumption accounts (including medical Insurance consumption) as the basic content, you can optionally add extended content such as personal sports health data collected by wearable electronic devices.

-Relevant parties (governments, pharmaceutical companies, doctors, insurance companies, etc.
) can obtain integrated and anonymous big data health information.

-By integrating three types of basic health information (health experience information, medical health decision-making information, and health consumption information), a closed loop of consumer health information feedback is constructed to help consumers with sufficient information for health decision-making and better express their true health needs , To guide the supply side to optimize resource allocation.

What kind of improvement can the "right to express consumer health needs" bring to the efficiency of the medical and health system?

First of all, consumers have always had the desire to express health experience, but this desire lies in (1) consumers do not have complete rights to express health information, (2) the rights of consumers’ health data subjects are lacking, and (3) the entire social infrastructure Not supported.
Consumers' health communication is inhibited without forming a closed loop.

When these conditions change, suppressed consumer health expression can be activated.
For example, the existing and emerging technical and social organizational capabilities in the era of the new crown epidemic have created new conditions for consumers to effectively express their health needs:

-Mobile Internet

-E-commerce

-Wearable electronics

-Internet of Things

-Electronic Medical Record

-Electronic Health Record

-In the epidemic prevention and control environment, a new social organization and communication mechanism represented by the health code

These conditions provide a new infrastructure for building a closed loop of health information communication on the mobile terminal and building consumers' right to express their health.

Secondly, the fact that "consumers are recognized as having the right to express health information" is meaningful in itself.

To paraphrase a poetic sentence from many psychologists today: "To be seen is a cure.
" When consumers voluntarily publish health experiences to obtain systemic recognition and effective feedback, this fact itself will have an impact on consumers' health behaviors and effects.

But we need to be down-to-earth and explore the scenarios in which the "right to express consumer health needs" may bring about changes.

One of the possible scenarios is to help improve the operational efficiency of medical systems such as electronic medical records

In the process of implementing electronic medical records in the United States and China, one of the biggest resistance factors is that electronic medical records will increase the occupation of doctors' working time.

Under the constraint of "the effective working time of doctors is the bottleneck of the medical system", the goal of improving the efficiency of the medical system is partly in conflict with the goal of effectively implementing electronic medical records.
To improve the efficiency of the medical system, it is necessary to increase the number of patients effectively handled by each doctor in each working day.
Internet information shows that the number of outpatient doctors in China can reach 80-150 patients per day, and each patient is within a few minutes.
The more patients that are effectively processed on each working day, the more electronic medical records he/she needs to fill in.

-A 2017 study published in the Annual Report of Family Medicine in the United States showed that in a working day of 11.
4 hours, the average time that doctors spend on electronic medical records is 5.
9 hours, while the time spent on patients is 5.
1 hours.

-The 2018 National Doctors Survey of Stanford University School of Medicine showed that 49% of participants said that electronic medical records reduce clinical efficiency.

Consumers’ self-expression of health experience cannot completely replace doctors’ filling in electronic medical records, but under the guidance of appropriate formats, part of the workload of doctors’ electronic medical records should be reduced.
Because the effective working time of doctors is the bottleneck of the medical system, if the effective output of doctors can be increased by a small amount, the effective output of the entire medical system can be significantly improved.
Using consumer self-expression of health experience to partially replace doctors’ electronic medical records and other documentary tasks is one of the ideas that can be explored.
(Of course, in the future, the use of information technology tools such as speech recognition and natural language processing can improve the efficiency of recording electronic medical records.
This is another way of solving efficiency problems using technical means)

The second possible scenario is to help explore the implementation method of the new concept of "pay for curative effect"

Drugs, first of all, are products and commodities.
"Medicine" modifies "products".
The pharmaceutical industry or the pharmaceutical industry places too much emphasis on the characteristics of medicines, ignoring the commonality of commodities.
But it is not easy to solve this problem, and it will touch too many interest groups.

In order to improve the medical and health system, experts have put forward many brand-new concepts.
Among them, "pay for efficacy" is hailed as a revolutionary idea that can become the core concept of the new generation of medical systems, but how to realize it remains to be explored.

"Paying for efficacy" should first be "paying for consumer health experience".
The complete consumer right to express health needs, including the right to express health experience, should be the prerequisite and basis for the realization of "paying for efficacy".

To put it simply, we hope to use the concept of "the right to express consumer health needs" to help China explore new ideas for medical and health model innovation and find new ways to improve the efficiency of medical and health resource allocation.

In the era of the new crown epidemic, the American lighthouse no longer guides the world, and the pressure and motivation for China's medical and health model innovation are unprecedentedly high:

-The failure of the United States in responding to the new crown epidemic during the Trump administration shows that the U.
S.
public health system has not been able to effectively respond to the challenge of global infectious diseases this time (of course, we must look at the problem to be objective and comprehensive, and the U.
S.
public health system is responding In terms of a large-scale emergency epidemic, there are indeed inherent problems, but its pharmaceutical industry is showing its talents this time.
The mRNA vaccine has been quickly developed and the supply chain has been locked);

-Although the U.
S.
medical system is developed, self-financed medical care is very expensive and cannot fully cover residents' needs for health services.
Taking the U.
S.
model as the highest standard, and other countries imitating and following the idea, can't guide the global medical and health system to achieve the ideal state.
The "Four Questions" is not just the plight of China's pharmaceutical industry.

-The development of the American medical system is reflected in technology and daily services.
But in terms of public health and coordinated management, it is very poor.
There are various types of federal and regional, public and private, hospitals, pharmacies, laboratories, and medical insurance companies, and there is almost no coordinated management between them.
This is an institutional malaise exposed by the new crown epidemic.

-The U.
S.
attack on Chinese technology companies such as ZTE, Huawei, TikTak, etc.
fully reflects the U.
S.
strategy of suppressing China's technological upgrading.
"Science" is still the gold standard for drug regulation, but it is undeniable that so is the principle of interest in competition among countries.
Competition based purely on science and free markets is not a reality of the international economy.

In this general environment, China's medical and health field has also reached the stage of "exploring in no man's land" as Huawei said.
No one will show you the way in front of you, and you must go your own way.

Establishing the “right to express consumer health needs”, through the assistance of mobile Internet and big data, strengthening consumers’ status as the main health consumer, helping consumers directly express their true health needs, and providing us with a balance between the duality of the medical and health sector and satisfying consumer needs A new perspective to better guide resource allocation and improve the efficiency of the medical and health system.

Author: Lin know - Gui