| How to increase the utilization efficiency of health resources is a very important project in the development of health affairs all the time. Some reforms implemented in the health field, including adjusting the price of medical services; establishing the share of mechanism of medical insurance; advocating developing rural health and urban CHS, are targeted at making the limited health resources realize their utmost utility, and better protect and promote people's health. Besides, rational patients' flow is also an efficient pathway to efficiently utilize the resources and control the health expenditures. The main aim of this study is to provide some feasible evidences about patients' flow from hospitals to CHS facilities, and analyze its social and economic benefits. The concrete study aims include: describing and analyzing the distribution of patients' visit to health facilities and the major factors that influence their choice; investigating the feasibility of outpatients' flow in the hospitals; evaluating social and economic benefits coming from patients' flow; proposing policy recommendations that leading to patients' rational visit to health facilities.Study methods: based on study aims, qualitative and quantitative materials were collected. Qualitative materials included interviewing key informants to learn about their ideas and opinions about the feasibility and benefits of outpatients' flow; quantitative materials mainly included investigation of different tiers of medical facilities as well as outpatients and doctors. The purpose is to learn about the services provided by different tiers of medical facilities, services provision ability of the CHS facilities, influential factors of patients' choice to visit a health facility, and benefits coming from outpatients' flow in the hospitals. All the materials were studied in descriptive and analytical approaches. Descriptive study mainly included distribution of outpatients, influential factors of patients' choice to visit a health facility, relevant policy documentations leading to patients' rational flow, interest groups' ideas and notions on outpatients' flow, feasibility of patients' flow from hospitals to CHS. Analytical study mainly included influential factors of patients' choice to visit a health facility and benefits coming from patients' flow. Single factor and multiple factors' analytical methods were combined, while square test was adopted for the former one and Logistic regress model was adopted for the latter one.Major conclusions of this study were as follows:1. There existed unbalanced development of three cities. There were great gaps in terms of network configuration, services functions, personnel's qualification and marketing of the facilities. Meanwhile, CHS facilities can't get residents' complete belief.2. Patients in the CHS facilities and hospitals have obvious difference in terms of their characteristics. The major factors that influenced patients' choice to visit a health facility included distance, technology level, equipment, price of the medical services, services attitude and possibility of reimbursements.3. Patients' habit to visit doctors is an important factor of influencing patients' flow from hospital outpatients to CHS facilities. Single factor analysis indicated that, under the voluntary circumstance, the major factors that influenced patients' choice included the tiers of the medical facilities, patients' age, occupations, medical security, and whether or not the patients preferred to visit the CHS facilities usually. The proportion of patients preferring to visit CHS facilities was higher, who knew more about CHS facilities, thought that CHS facilities had their advantages, had the experience to visit the CHS facilities once and agreed on choosing the CHS facilities as the first contact point. Multiple analysis indicated that the major factors that influenced patients' choice included the tiers of the hospitals, occupations, the usual facilities that patients chose to visit, patients' knowledge of the CHS facilities, patients' consent to choosing CHS facilities as the first contact point and the health expenditures one year before the investigation. The three cities had mild difference in these aspects.4. Patients' flow from hospitals to CHS was feasible, which was mainly embodied in great potential of patients' flow, mutual complement between hospitals and CHS facilities, mutual promotion of the two kinds of facilities, gradual improvement of CHS system, successful experiences from UHPP's exploration for choosing CHS facilities as the first contact point when conducting MFA, support of medical insurance policies and different areas' experiences and some practice and experiences of the foreign countries.5. Patients' flow from hospitals to CHS facilities would bring in great economic and social benefits. Economic benefits were embodied in greatly decreasing patients' indirect and direct health expenditures and decreasing the risk of medical insurance funds. Social benefits were embodied in shortening journey and waiting time, relatively lengthening consulting time, making the services be more human being, heightening services quality and patients' satisfaction and stimulating efficiently utilization of health resources and benign operation of health care system.6. All the areas were exploring and practicing dual transference. However, it was not very smooth, especially, patients seldom returned to the CHS facilities. At present, there were some challenges facing patients' flow from hospitals to CHS facilities, including, implementation of the Guiding Suggestion of the State Council on Urban CHS Developmentand its matching documentations, establishment of rational reimbursement mechanism for the suppliers, and patients' traditional concepts of visiting doctors and their belief in CHS.Policy recommendations:1. Improving CHS networks; prioritizing developing CHCs that have larger scale, more qualified personnel and comprehensive functions; setting CHS stations according to residents' needs and maneuvering to increase patients' access to CHS.2. Increasing investment in CHS facilities, and establishing scientific and rational operational mechanism in terms of revenues and expenditures. Government should increase the investment in build-up of infrastructure, diagnostic equipment, staff training, public health and medical services, personnel's remunerations and benefits, and establish stable investment mechanism and utilizing, managing and supervising mechanism of funds with high efficiency. 3. Enhancing build-up of staff. Through standard training, position training, introduction of assets with high qualification to continuingly elevate health workers' professional ability and improve the services quality.4. Intensifying monitoring and management of CHS. Conducting strict admission in terms of facilities, personnel and technology; improving technical criteria and working systems of CHS, enhancing monitoring and supervision, formulating detailed rules about transference and relevant bylaws, such as criteria, standards, procedures and diseases of transference.5. Defining the functions positioning, establishing rational and cooperative two-tier urban health care system. CHS should be positioned at small diseases, appropriate technologies, essential drugs and immediate transference when facing some diseases in excess of its capacity to deal with. Hospitals should gradually decrease offering outpatients services of some common diseases, focusing on treating some complicated and serious diseases, carrying out clinical researches, cultivating medical staff and offering guidance and training to CHS facilities.6. Enhancing marketing of CHS. Adopting a multitude of ways and pathways to let residents know about the functions, advantages, and relevant policies of CHS, and change people's traditional concepts to see doctors. CHS facilities should also improve their services models; deeply provide health education, maternal and childcare, prevention of communicable diseases and treat some diseases that are common and have high incidence. Keeping on heightening services quality and level. Therefore, making community health affairs truly gain population's full belief, acceptance, active participation, concerns and supports.7. Improving medical security, leading patients' rational flow. Qualified CHS facilities should be timely included within the scope of BMI's designated facilities network; medical services items conforming to regulations should be included in the payment scope of basic medical insurance. Actively adopting prepayment system, increasing proportion of reimbursement, encouraging and leading the insured to "visit CHS facilities with small diseases, visit big hospitals with serious diseases, and return to CHS facilities to get rehabilitation services".
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