Study On The Current Situation And Development Strategy Of Hierarchical Diagnosis And Treatment Health Service System In Chongqing Municipality

(1)PurposeThis research is for the purpose of deeply investigating the current situation of,restraining factors and typical cases for hierarchical diagnosis and treatment in Chongqing,the right of guaranteeing treatment of disease which is a basic civic right and a basic human right as well,public administrative issues to be solved the problem of fair and efficiency in the integration of public health services,and comprehensive analysis of social governance work related to community construction in during implementation of hierarchical diagnosis and treatment policies.Research will be carried out also combining domestic and overseas hierarchical diagnosis and treatment patterns to explore a conceptual model for the operating process of Chongqing’s health service system in terms of hierarchical diagnosis and treatment,to find out the restraining factors existed in its hierarchical diagnosis and treatment and establish relevant policies,so as to provide reference to deepening Chongqing’s medical reform.The methods and means for optimizing configuration of medical resources will be explored,in order to relieve the pressure in medical services in major hospitals and initiate an ordered hospital environment in society.This will help alleviate the difficulty of getting medical service and weak of comprehensive strength of basic medical and health institutions in Chongqing by offering relevant policy reference.It is expected that this research will serve as a basic research for further realization of optimal configuration of health resources,rational division of labor in medical and health service institutions,high efficient use of health services.(2)MethodsThe research methods adopted in this research are as follows:1)Document-data MethodThe Chinese searching work is carried out based on the full-text database for CNKI academic journals,the CNKI degree thesis database,Wanfang Data and vip Chinese journal database.The key words for the search content include the Chinese forms of “hierarchical diagnosis and treatment”,“dual referral” “equalization of basic public health services”,etc.As for the English searching work is from the PubMed and the Bing Academic,the key words for the search content include “hierarchical”,“health”,“services”,etc.The author summarizes the newest domestic and overseas relevant research literature to grasp the research frontiers.2)Field Research MethodBased on the document search,the author interviews or carries out questionnaire survey oriented to people in charge of the Medical Affairs Section of the Population and Family Planning Commission of Chongqing Health Bureau,people in charge of medical institutions,principles of basic health organizations,medical workers from medical institutions at all levels,as well as patients.The investigated issues include hierarchy configuration of medical resources,utilization of medical and health services,the awareness of hierarchical diagnosis and treatment of medical workers of medical institutions at various levels and patients,etc.On the basis of the investigating results,factors influencing the development of Chongqing’s hierarchical diagnosis and treatment system are discussed.3)Statistical Analysis MethodStatistical methods adopted in the research include statistical descriptive analysis,chi-square test,binary and multi-variate logistics regression analysis.Based on these methods,data obtained from field investigation is combed,summarized and analyzed.The software supporting the data entry and analysis in this research includes EXCEL2007 and SPSS21.0.(3)Conclusions1)Study on the relationship between the theory to equalization of basic public health services and the Hierarchical health service system.Combining with the relevant literature,the author analyzes the theory and content of equalization of basic public health services and the significance of the hierarchical health service system in realizing the equalization of public service.All of these pave the way for the further study.The study results are as follows: the functional division of the hierarchical diagnosis and treatments health service system can clearly quantify the degree of equalization of basic public health services;From the aspects of the allocation of the public medical and health resource and utilization efficiency of basic medical and health institutions,the implement situation of two-way referral system and expense of medical treatment,the author gives a compressive and systematic analysis on the equalization of basic public health services and draw the conclusion that the implement of the hierarchical diagnosis and treatment health service system can gain a more reasonable disposition of public medical service sources and effectively shunting patients,improving the service productivity of basic medical treatment and controlling health care costs.And Finally all of these can promote the realization of equalization of basic public health services2)The analysis of the current development situation of Hierarchical health service system in ChongqingThis chapter divided into three parts:a.Classification of health resource configuration,utilization of medical and health services,the change conditions of two-way referral.According to the information from the official website of the Population and Family Planning Commission of Chongqing Health Bureau and the statistical yearbooks,the author summarized nearly five years’ statistical data and draws three conclusions: first,In Chongqing,the allocation of medical and health resource is increasing gathered to large hospitals included health human resources and the proportion of the number of patient beds;Secondly,on the aspect of utilization of medical and health services,the increasing demand of hospital outpatient and emergency department leads the demand reduction in the same sectors at the basic medical service institution.In addition,as the hospitals still handle most hospital service and have the tendency to expand scale,the same sectors of the basic medical service institution is shrinking.Thirdly,as for the two-way referral situation,literature study indicates that there exists “patient transfer to hospital easily but to the basic medical service institution hard” phenomenon in most parts of Chongqing.b.Analyzing the Chongqing medical staffs’ cognitive and action about the hierarchical health service system.This portion which is based mainly on questionnaire studies medical staff from nine senior hospitals and basic medical institutions of nine areas.The sample selection based on the various factors like regional economic,social development of Chongqing and regional characteristics.The result shows that both qualified rate of medical institutions have low cognitive degree which the situation from the basic medical institution are better than the higher level.Moreover,73.3% medical staff do not receive the training of the standards of two-way referral and operating instructions from related medical institutions and official institutions.In addition,on the one hand,through analyzing the influencing factors of the implementation effect of two-way referral system,the result shows that the influencing factors of the medical staff from the basic medical institutions are “Whether there is a clear two-way referral system in the medical situation” and “whether they will learn the patient information through check the two-way referral list”.On the other hand,the influence factors of medical staffs from hospital are “whether it is convenience to gain the tracking information of the patients who transferred into other medical institutions” and ”whether receive the relevant referral information”.Finally,the author points out the main factors of restricting the development of hierarchical health service system and two-way referral are the medical staff are not familiar with the requests of two-way referral system and the patients do not understand the two-way referral system.Based on all of these analysis,the author gives the suggestion: make the policy by various kinds of design and strengthen the various medical institutions staff’s cognitive abilities on the two-way referral system,especially enhancing their power of execution.c.Analyzing the Chongqing patients’ cognitive and action about the hierarchical health service system.This part is still based mainly on questionnaire.And the author also choose the same investigation sites as the previous parts.The result shows that 71% patients support Chongqing government to carry on the related work of hierarchical health service system and 72.1% patients support the first contact care of community.At the same time,they give some improvement suggestions like enhancing the payment level of basic medical insurance and the diagnosis and treatment technology of basic medical staff.As for the influence factors of the patients’ satisfaction to Chongqing medical and health service system,on the basic medical and health institution,it mainly decided by the patient’s level of education,whether they have the chronic diseases and whether they can gain the health advisories in the living places.On the aspect of hospital,it mainly focus on the patient’s level of education,the health care form they own and whether they learn the hierarchical health service system.Therefore,the author gives three suggestions : first,designing the referral services through the various policies like medical insurance policies.Secondly,place emphasis on improving the overall specialized technical level of medical staff to change patients’ psychological recognition degree.Thirdly,enhance the policy influence through extensive promotion.(4)DiscussionsBased on the literature information in home and abroad,result of the field survey,returned to the goal and principle of realizing the equalization of basic public health services,the author points out the obstacles and suggestions of the development of Chongqing hierarchical diagnosis and treatment health service system which from the aspects of the systems’ macro-level,medical institutions intermediate-level and individual micro-level.1)Based on the perspective of equalization,the obstacle factors analysis of hierarchical diagnosis and treatment health service system in Chongqing Municipality.The equalization of basic public health services is the essential requirement of mechanism design on the allocation of resources.Therefore,this study shows the obstacle factors of the macro system level.The portion will be elaborated from three aspects: first,the low utilization of basic medical and health service;Secondly,lack the effective two-way referral system and standard;Thirdly,the un-sufficient reform of social medical insurance.The three aspects are leaded by the disproportionate of the allocation of medical treatment source in Chongqing.The obstacle factors of medical institutions.On the one hand,the difficulty of the development on the basic medical and health institutions which included the lack of talent people in the institutions and the signing difficulty for the family doctors.On the other hand,from the problems of the vague of the definition on the medical treatment and unreasonable expand of the medical institutions,the author finds all of these blunted the construction and development of Chongqing hierarchical diagnosis and treatment health service system.As for the obstacle factors of individual level,these included the influence that patients and medical staffs lack the knowledge of hierarchical diagnosis and treatment health service system.2)Based on the perspective of equalization,the development strategy of hierarchical diagnosis and treatment health service system in Chongqing Municipality.As the perspective of equalization of basic public health services provides a more fair and humanity,reasonable perspective and theoretical foundation for the reform of the Hierarchical health service system,this study points out that the development measures of Macro-system level includes the government departments’ macro-control,the guidance of equalization allocation in public health resources,the construction of medical treatment process concept model of hierarchical health care service system,the promotion in effective operation of two-way referral and the adjustment in the proportion of medical insurance payments according to the demand;The development strategies of the medical institutions level includes three aspects,which are the talent construction of basic medical and health institutions,speeding up the reform of public hospital and the reasonable division of hospital orientation;As for the development measures on the individual level,on the one hand,the medical institution should improve patients’ cognitive and change their concept of medical treatment so that enhancing their demands for primary health care institutions.On the other hand,specifying the responsibilities of medical staffs.First of all,medical staffs should be familiar with system requirements,two-way diagnosis guidelines and the processes in their own classification system.Second,they should also strengthen the sense of responsibility and the sense of mission.At the same time,they should raise the sense of responsibility,strengthen the mission and take responsibilities to educate patients.