A Study On Cause And Countermeasure Of The Difficulty In Down Referral In Two-way Referral Policy In Zhanjiang City

The two-way referral policy is a major measure in the reform of public health system in recent years,and it is of great practical significance to promote the reform and development of public health in China.Since the implementation of the two-way referral policy,there has been a common phenomenon that it is easy to referral to higher level hospital and hard to referral to lower level medical institution,and there is even a siphon effect.The medical burden of large hospitals and the pressure of patients seeking medical treatment have not been effectively alleviated.Therefore,public administration research is urgent to find out the cause and countermeasure of the difficulty in down referral.This study,based on the Health Policy Triangle theory,takes the difficulty in down referral in the two-way referral policy in Zhanjiang city as the research point,and collects data by means of expert interviews,questionnaire surveys and participatory observations.It combs the situation and difficulty in down referral,analyses the reasons for difficulty in down referral and proposes countermeasures to solve the problem.The study found that there are four main manifestations of the difficulty in down referral: the health administrative department is more than willing but lack of power,the medical staff of higher level hospital is not motivated,hospital has a heavy burden,and the patient willingness of down referral is weak.The paper comprehensively analyzes the reasons from four dimensions and draw the following conclusions: policy content factors(Ill-considered referral procedure,lack of guidelines for assessment,lack of binding policy content,insufficient power of referral control),and policy actors factors(lack of attention from government agencies,conflicts of economic interest between medical institutions,low service level of the primary medical institutions,insufficient policy awareness of patients),policy context factors(irrational health care systems,slow economic development,tense doctor-patient relationship,constraints of traditional concepts),and policy process factors(lack of research,lack of coordination and communication).Finally,it is suggested to solve the problem from three directions: establishing and perfecting supporting mechanisms,increasing resources investment,and increasing publicity and guidance.