A Study Of The Mechanism Of First Treat System In The Primary Level Under The Condition Of Urban And Rural Co-Ordinationa In Chongqing Municipality

Objective:This study is aims to know the implementation of first treat system in the primary level institution under the condition of urban and rural co-ordination, to research its present situation, influence factors, obtained experience and existed problems,to explore and establish a set of "gatekeeper" first treat system in the primary level health institutions and operation mode adapt for the urban and rural co-ordination areas.Research Methods:1. Data : literature material and the field survey data.2. Survey methods: the methods of stratified random sampling ,cluster sampling and simple random sampling are combined. 33 primary level health institutions and 7 superior hospitals are choosed, 430 patients were surveyed by questionnaires and 376 copies questionnaires are valid in different health institutions. Superior doctors: 360 questionnaires were issued and 345 valid back. Primary level doctors: 350 questionnaires were issued and 315 copies valid back.3. Research methods: the methods of literature study,normative analysis, on-site interview, empirical analysis and statistical analysis were adopted. The statistical analysis methods of single factor analysis (χ2) and logistic multiariate analysis were include.Research results:1. The theoretical research of first diagnosis system in the primary level institution under the condition of urban and rural co-ordination: the ethic basis to implement the first diagnosis system in the primary level institution.The strengths, weaknesses, opportunities and threats to develop the first diagnosis system.2. The status and effect of the first treat in Chongqing municipality's primary level institutions: the grass root patients are in favor of first diagnosis in the primary level institution. By logistic regression analyzed,the instituitions where patients first treat at ordinary times are relatively to their income, occupation, medicare and service satisfaction degree in the primary level hospitals.3. There are many influence factors and reasons to implement the first treat system in the primary level institutions in Chongqing municipality,including the government, the supplier and the buyer aspects.There are two-way effect for the rural and urban co-ordination practice to the grass-roots first treat system. Conclusions and policy recommendations:Currently There has certain requirement to develop the first treatsystem in the primary level institutions in Chongqing municipality, but there still exist some difficulties, the following endeavor work is needed: The government aspect,the efforts to promote the reform of rural and urban co-ordination in-depth should be continued,and make other policies to support it, leading enact and perfect grassroots first treat system and two-way referral policy,and make the supervision work well, the coordination of urban and rural social career development (social security and medicare),to strengthen the publicity; Primary level health institutions :continue to improve the health service ability under urban and rural co-ordination conditions, to establish and perfect the grassroots first treat system and two-way referral mechanisms, to put into check,go down to the primary unit,to connect the residents intimately,to establishment and perfect the grassroots information system; Demand aspect: to increase the understanding of the basic health institutions,to establish the mutual trust relationship.