Research On Problems And Countermeasures Of Hierarchical Diagnosis And Treatment System In Chongqing Liangjiang New Area

Since the 21st century,with the deepening of urbanization,the deepening of population aging and the change of disease spectrum,the health needs of Chinese residents are increasing,and the existing problems in the medical and health service system are becoming more and more prominent,including the unreasonable distribution of medical resources,the inadequate medical insurance system,the difficulty of medical treatment for residents,and the high cost of medical and health services.The operation efficiency of the system is not high and the contradictions between doctors and patients occur frequently.In this situation,China implemented the new medical reform in 2009,and the implementation of the hierarchical diagnosis and treatment system is the core strategy of the current new medical reform,which is of great significance to optimize the allocation of medical and health service resources,promote the equalization of basic medical services,improve patients’medical experience and reduce the burden of medical expenses.In September 2015,the general office of the State Council issued the guiding opinions on promoting the construction of hierarchical diagnosis and treatment system^[1],which clearly defined the construction of a hierarchical diagnosis and treatment mode of primary diagnosis at the grass-roots level,two-way referral,rapid and slow treatment,and upper and lower linkage,so as to provide patients with accessible,high-quality,efficient,convenient and continuous medical and health services.According to the deployment of the central and municipal levels,Liangjiang New Area issued the implementation plan for promoting the construction of hierarchical diagnosis and treatment system in 2016,officially implementing the hierarchical diagnosis and treatment system.Since the implementation of three years,although some achievements have been achieved,the implementation effect of the first visit and two-way referral at the grass-roots level is not ideal due to the government,medical institutions,patients and other reasons.Specifically speaking,at the government level,the leverage role of medical insurance policy and the guiding role of financial subsidy policy are not reflected;at the medical institution level,the positioning of different levels of medical institutions is overlapped,the grass-roots medical service capacity is insufficient,and the construction of information platform is lagging;at the patient level,the concept of hierarchical diagnosis and treatment is not popularized enough,medical habits,information asymmetry,and medical and health resources allocation are not enough.Those factors will affect the decision-making of patients’medical treatment,which makes it difficult to implement hierarchical diagnosis and treatment.Aiming at the problem that the effect of hierarchical diagnosis and treatment in Liangjiang New Area is not ideal,this paper selects three successful cases of implementing hierarchical diagnosis and treatment system in China,including Xiamen building a hierarchical diagnosis and treatment network of"three divisions and two networks"with chronic diseases as a breakthrough;Luohu,Shenzhen building a close hospital group and implementing"total amount management";Ningbo implementing"double sinking and two upgrading"and building cloud hospital to promote the hierarchical diagnosis and treatment.From these 3 cases,we can get 4 enlightenments:first,the design of hierarchical diagnosis and treatment system should be centered on patients;two,the design of hierarchical diagnosis and treatment system should follow Pareto optimization as far as possible;three,we should rely on information technology and Internet plus means to promote grading diagnosis and treatment;four is to guide and restrict related policies.On the basis of the above three successful cases,this paper puts forward countermeasures and suggestions to improve the hierarchical diagnosis and treatment management of Liangjiang New Area:first,clear the scale of medical and health institutions at all levels,strengthen cooperation;second,promote the sinking of medical resources,improve the service capacity of the grass-roots level;third,improve the guidance and guarantee mechanism;fourth,guide patients to change the concept of medical treatment.