Research On The Construction Of Hierarchical Diagnosis And Treatment System In China

Hierarchical diagnosis and treatment system is an important foundation for establishing a sound medical and health system,and is a viable option for refining medical services.In recent years,in order to protect people’s right to health and meet people’s medical and health needs,the government attaches great importance to the construction of a hierarchical diagnosis and treatment system,and has introduced a series of supporting measures to promote the implementation of the hierarchical diagnosis and treatment system.All localities have also actively carried out pilot exploration,but from a national perspective the results are limited.The large hospitals are overcrowded,and the situation of very few patients in the primary health care institutions has not been fundamentally changed.The problem of"difficult to see a doctor and expensive to see a doctor" has not been properly solved.There is still a big gap in the formation of the basic pattern of hierarchical diagnosis and treatment system.How to clarify the positioning of medical institutions at all levels,establish a patient-centered division of labor and cooperation mechanism between medical and health institutions,and formulate a scientific and reasonable supporting policy with the overall goal of building a hierarchical diagnosis and treatment system,is the key to promoting the construction of a hierarchical diagnosis and treatment system.In view of this,this paper firstly analyzes the research progress of hierarchical diagnosis and treatment at home and abroad based on relevant literatures;Secondly,it summarizes the health care statistics such as the number of medical and health institutions,the number of hospital beds,the number of medical staff and the number of medical treatments between 2012 and 2017 in the China Health and Safety Statistical Yearbook and China Statistical Yearbook,and consider the implementation effect of hierarchical diagnosis and treatment from a macro perspective.Then,combined with the 2016 CFPS adult questionnaire data,this paper uses the binary Losgictic model to analyze the factors affecting patients’choice of medical treatment from three aspects:predisposing characteristics,enabling resources and need,and analyzes hierarchical diagnosis and treatment from a microscopic perspective.The results of the analysis show that although some progress has been made in the construction of primary health care institutions in China in recent years,from the data allocation and utilization of medical and health resources and the data of two-way referrals,the effect of hierarchical diagnosis and treatment system is not significant;age,family per capita monthly income,medical treatment time,medical insurance,total annual medical expenses,self-rated health status and chronic conditions have a significant impact on patient choice.Based on the results of data analysis,combined with China’s specific national conditions,it is found that there are mainly the following problems in promoting the hierarchical diagnosis and treatment system in China:(1)Patient level:information asymmetry affects patients’ choice of medical care,medical and health resources structure affects patients’ choice of medical treatment;(2)Medical and health institutions level:insufficient capacity of primary health care institutions,unclear function of medical and health institutions,conflicts of interest between medical and health institutions,lack of information sharing platforms for medical services,lack of uniform standards for referrals;(3)Government level:the government’s insufficient investment in primary health care institution,the leverage of the medical insurance system has little effect,and the promotion of the hierarchical diagnosis and treatment system is not in place.Last but not least,the following policy recommendations are proposed:(1)Flexible guidance for residents to change their medical treatment behavior:use chronic disease management as a breakthrough to promote the primary diagnosis at the grassroots level,popularize basic medical knowledge through multiple channels,and increase the intensity of hierarchical diagnosis and treatment;(2)Improve the capacity of primary health care institutions Level:strengthen personnel training,reform the management mechanism of primary health care institutions,and increase financial input;(3)Rationalize the relationship between medical and health institutions at all levels:clarify the functional orientation of medical and health institutions at all levels,and strengthen communication between medical and health institutions at all levels,change competition into division of labor and cooperation;(4)Improve barriers and promote policy implementation:formulate perfect referral standards,implement physicians’ multi-point practice system,strengthen collaboration,promote triple medical linkage,and build a medical service information sharing platform.