| Research purpose and meaning: to understand the choice of 3 armour hospital patients hospitalized intention and behavior of hierarchical diagnosis and its relevant policies known degrees and attitude to the grading system,the basic situation of the exploration under the hierarchical diagnostic system was hospitalized intention and behavior of the main influence factors,aims to better solve the problem of shunt difficult level 3 general hospital patients,so as to provide Suggestions for grading diagnosis system reform direction;This paper analyzes the relationship between medical resource allocation and patients’ willingness and behavior to seek medical treatment,as well as the effective implementation of hierarchical diagnosis and treatment system,so as to provide factual basis for the scientific allocation of medical resources.Methods: in this study,literature research and expert consultation were used to design the questionnaire by ourselves.The reliability and validity of the questionnaire were tested by pre-survey.The patients in 5 grade a hospitals in 4 cities were investigated face to face.A total of 500 questionnaires were distributed to outpatients,and 422 effective questionnaires were recovered,with an effective recovery rate of 84.4%.500 questionnaires were distributed to inpatients,and 498 effective questionnaires were recovered,with an effective recovery rate of 99.6%.Epidata3.1 was used to input data and establish a database,and Spss17.0 was used for data analysis.Descriptive analysis was conducted on the data by using such indicators as frequency,composition ratio and median.The chi-square test,univariate Logistic regression analysis,nonparametric rank sum test and other statistical methods were used to analyze the data.P<0.05 was considered statistically significant.There was no statistical significance in the differences between outpatients and inpatients,so no difference was made in their willingness and behavior to seek medical treatment and their attitudes toward hierarchical diagnosis and treatment.Results :(1)the awareness of patients’ graded diagnosis and treatment system and related policies was low,and the awareness of differentiated medical insurance reimbursement policy was 55.9%.The awareness of graded diagnosis and treatment system was 55.2%.(2)patients have a weak awareness of primary diagnosis after illness: for patients with non-acute diseases,the preferred primary diagnosis is 41.4%;Under the condition of knowing the differentiated medical insurance reimbursement policy,59.1% of the patients with common diseases and chronic diseases were the first choice for grassroots treatment.If there were support experts at the grassroots level,47.5% of the patients who had no experience at the grassroots level were willing to choose the grassroots level.(3)the patients were less willing to be transferred when their condition was in the rehabilitation stage,and only 30.8% of the patients were willing to be transferred to lower(grassroots)medical institutions for further treatment.(4)age,education,occupation,medical insurance and grassroots medical treatment experience are the main influencing factors of primary diagnosis;Education level,per capita family annual income,awareness of medical insurance and differentiated medical insurance reimbursement policy are the main factors influencing patients’ willingness to transfer.(5)patients have a high degree of support for the hierarchical medical system and a low degree of support for the differentiated medical insurance reimbursement policy.(6)most patients hold a neutral attitude towards the first diagnosis,while their attitude against referral is higher than that of the first diagnosis.(7)patients have a high degree of support for the treatment of common diseases and chronic diseases that cannot be met by the allocation of medical resources in grassroots medical institutions.(8)patients tend to be supportive and neutral towards the attitude that it is difficult and expensive to see a doctor in a big hospital,but beneficial to the diagnosis and treatment of diseases,and towards the attitude that it is necessary to repeat the examination conducted by a lower level medical institution after referral to a big hospital;To no matter serious illness minor illness all the attitude that registers expert diagnosis expresses neutrality and object more.Conclusions :(1)patients have low awareness of the hierarchical diagnosis and treatment system and related policies,and the policy publicity mode needs to be improved.(2)patients’ medical habits have not yet changed,and rapid and slow divide-and-conquer is difficult to achieve.(3)patients’ awareness of primary diagnosis at the grassroots level is weak,and differentiated medical insurance reimbursement system has no obvious guiding effect on patients’ medical treatment.(4)the service capacity of grassroots medical institutions is insufficient and the continuity of downward referral is blocked.(5)patients’ willingness to receive primary diagnosis and their willingness to be referred downward are affected by various factors.(6)patients have a high degree of support for the hierarchical diagnosis and treatment system,but a low degree of understanding of its core concepts.(7)patients have low support for differentiated medical insurance reimbursement policies.(8)patients lack trust in grassroots medical institutions.(9)different groups have different attitudes towards hierarchical diagnosis and treatment.Countermeasures and Suggestions :(1)strengthen the publicity of hierarchical diagnosis and treatment system,and guide patients to establish the concept of scientific medical treatment.(2)optimize the allocation of medical resources and improve the ability of grassroots medical services.(3)define the functional positioning of medical institutions at all levels and improve the hierarchical diagnosis and treatment cooperation mechanism.(4)improve differentiated medical insurance reimbursement policies and effectively guide patients to seek medical treatment in a scientific and orderly manner.(5)reform the personnel management system and accelerate the training of general practitioners.(6)promote "Internet + hierarchical diagnosis and treatment" and accelerate the construction of medical information network system. |
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