Classification Of Health Resources Allocation And The Cognition Of Two-way Referral In Shanxi Province

Objectives:This study mainly focused on the hierarchical medical system,from the status of the classification of medical resources,the use of medical services and the patients’ cognition to two-way referral status in Shanxi province,to analysis the factors which have effect to hierarchical medical system and to provide relevant policy guidance for the health sector and government to improve this system.Methods:(1)Literature researchNot only collect and sort out the policy and documents about hierarchical medical system extensively,but also refer to the relevant documents on the medical reformation of public hospital,the Yearbook of 2013-2015 Shanxi Province Health Statistics and the related research reports.We also consult relevant literature research in the Chinese knowledge network,WanFang medicine,PubMed and other Chinese and English database.(2)Questionnaire surveyA total of 800 patients were selected from each of the 4 top three hospitals in Shanxi Province.To investigate the basic demographic characteristics and the cognition for current situation of two-way referral system with questionnaire survey.(3)InterviewInterviews were conducted with 1 government workers,3 hospital administrators,and4 patients about hierarchical medical system(views,difficulties,and recommendations)to provide support for the idea.(4)Mathematical StatisticsAll data are using Excel2007 database.The allocation of medical resources and medical services are using descriptive analysis with Excel2007,the data and cognitive status of two-way referral in patients are using statistical description,chi square test,multivariate analysis and Logistic regression analysis with SPSS20.0,P<0.05 have significant difference.Results:(1)The number of health institutions in 2013-2015 in Shanxi: the number of grassroots medical institutions is far greater than the top hospital,and it is increasing year by year,its’ growth rate is also greater than the basic medical institutions.The number of beds of medical institutions in 2013-2015 in Shanxi: the number of hospital beds is far higher than the base and keeping increasing year by year,the number of beds in basic medical institutions is decreasing year by year.The number of health workers in2013-2015 is increasing year by year,but the number of medical staff in basic health care institutions is decreasing year by year;(2)Shanxi medical service ability: The patients in hospital increased year by year,the growth rate of 10.98%,but the patients to the grassroots medical institutions are decreasing,the growth rate of-5.79%,in 2013-2015.The clinic and emergency patients are increasing year by year,the growth rate of 10.50%,but the same patients of basic medical institution are decreasing,the growth rate of-4.46%,in 2013-2015.The number of hospital admission is far more than the basic medical institutions,the growth rate is 8.41%.But the number of people at the grassroots medical institutions decrease year by year,the growth rate is-13.67% in 2013-2015.(3)The concept situation of hierarchical medical system: The knowledge related to hierarchical diagnosis of most of the patients is not clear,and filled with self-consciousness.The 33.9% of the patients from the primary referral to the hospital deemed that the diagnosis and treatment ability of basic medical is not enough,22.8% of the patients consider that patients and family members have the greatest impact on referral,and 59.7%patients think that the "self-referral" is best.(4)First intention: 53.7% patients suffering from minor illness make choice of top hospital firstly.This part of people is mainly make choice of free-referral that think the tophospital can avoid duplication of inspection and do not understand the two-way referral system.(5)Two-way referral intention: 76.4% of patients had referral experience,this part of the people is "rural,internal medicine,secondary school / high school,workers,NCMS" patients.(6)Two-way referral aspects: 36.1% of patients considered that the procedures of two-way referral are too much trivial.Conclusion:The main conclusions of this study are as follows six aspects:(1)The medical resources are uneven in Shanxi Province.Although the number of top hospitals is small,but the number of beds and medical staff are more than basic medical institutions.(2)Medical service ability in Shanxi have big difference.Top hospitals have overload operation,but fewer and fewer health care in basic medical institutions.(3)The concept of hierarchical medical system is not clear.Patients generally do not understand the hierarchical medical system and two-way referral.(4)The first diagnosis intention is inclined to top hospital.The minor illness is also preferred to top hospitals,and grassroots medical institutions are not believed.Just because the medical ability of basic institutions is impugned.(5)To improve the ability of primary medical service and advocate rational referral.Most of the patients with referral experience mainly come from remote rural areas,and their knowledge level is low.(6)Simplify referral procedures to make it convenient for people.The complex referral procedures is an important factor affecting the patient’s medical treatment.