Research On The Government Responsibility In The Process Of Two-way Referral

Two-way referral system is the orientation of health reform and development, and is one of the important measures to solve the problem" medical treatment (seeing doctor) is difficult and expensive for the common people. Implementation of the two-way referral system will be helpful to exercise different functions and roles of medical institutions at all levels, realization of reasonable diversion of patients will save health resources and will improve the effective utilization of health resources; the system helps to reduce the blindness of medical treatment and to lower medical costs and patient's burden.Nearly 10 years, with emphasis of governments at all levels and policy support, under organization of health authorities, through the efforts of health workers at grassroots health institutions, urban community health service organizations and networks have basically established, success is achieved in aspects of community illness prevention, care and health education to a certain extent. However, due to weakness of medical technology and capability at community health service institutions, and the absence of the government role, the medical pattern "minor illness in the community, serious illness in the hospital, rehabilitation back to the community" is not yet formed, as a result, the existing medical and health resources can not be utilized reasonably, economically and efficiently, which, to some extent, affects the effectiveness of health system reform, and the situation of high medical costs has not yet been improved.Patients at community health service institutions that should undertake basic medical services are less, while the large-sized and medium-sized hospitals that are orientated in difficult and complicated cases are busy with simple disease treatment services. Under the shortage in overall health resources, waste of health resources within a certain region occurred. The purpose of two-way referral is to achieve "minor illness in the community, serious illness in hospitals, and rehabilitation back to the community ", is to make reasonable use of health resources and to reduce medical costs of common people. Therefore, how to reasonably distribute health care resources adaptable to community health services to meet the needs of the masses, how to guide patients to make the orderly flow in medical services, and how to carry out two-way referral between large or medium-sized hospitals and community health service institutions have become an important issue without delay.Part 1 of this article describes an overview of two-way referral. First, the article introduces the concept of two-way referral, study of the article is to determine the upper and lower level two-way referral between grassroots community health service institutions and large general hospitals. Then it introduces the background, objectives and significance of the proposed two-way referral: First, to optimize health resources allocation, enabling the reasonable diversion of patients; Second, to reduce effectively health care costs, saving the medical insurance funds; Third, implementation of two-way referral will adapt to the changing situation of population aging and disease spectrum; Fourth, to make a clear allocation of functions to medical institutions, and promoting collaboration among medical institutions; Fifth, to promote the development of community health services, reflecting the characteristics of community health services; Sixth, to reduce medical disputes, improving sickbed turnover rate. Finally, it introduces the development of two-way referral in foreign countries. Successful operation of two-way referral system in developed countries is because the Government has developed a very comprehensive system chain.Part 2 describes the government's role in implementation of the two-way referral, including four aspects, the government should be the general director to implement two-way referral, should create policy support environment for two-way referral, should be the supervisor and management in the implementation process of the two-way referral, and should undertake compensation liability for community health service institutions in its implementation of the two-way referral. Analysis of the basic role of government will make the government understand their functions in the two-way referral, to better play a leading role and to ensure the smooth development of two-way referral.Part 2 introduces the investigation on two-way referral implementation conducted at community health service institutions in Jilin City, points out the problems occurred in the implementation process of two-way referral, and analyze the reasons for the problems, including: Out of their own economic interests, various medical institutions subjectively are reluctant to make referral of patients to other institutions for treatment, hindering the two-way referral; quality of staff at community health service institutions is not high, lack of general practitioners, weak community health services technology, which are difficult to win the trust of the masses; No two-way referral system and standards, referral is difficult to carry out; referral to community health services treatment, no preferential medical insurance reimbursement, and even some of the costs can not be reimbursed, the current health insurance system has become the "stumbling block" of two-way referral.The Part 4, the final part, introduces the major countermeasures of governments, as the leading role in the implementation process of the two-way referral. According to the current problems, the following countermeasures are put forwarded: to construct a reasonable regional health planning, to form appropriate health service system; to renovate ideas, to make reasonable adjustments on the economic interests between the upper level and lower level medical institutions; to strengthen policy support and standardized management of two-way referral; to improve the related systems of health insurance and medical fees; to improve the service quality of community health service institutions, and to establish first diagnosis system of the community general practitioner; to speed up the reform of public hospitals and improve the national essential drug system.Facing the problems in the implementation process of two-way referral, governments need to make regulation at the macro level in order to achieve the overall win-win situation; governments need to formulate the appropriate policies to smooth two-way referral channel; governments need to include two-way referral in medical procedures, to consider comprehensively interests of all parties, to coordinate a number of related departments to jointly explore and establish relevant regulations of two-way referral; governments need to improve the hierarchy construction of two-way referral system, to standardize operation of medical staff; governments need to participate in the whole process of hierarchy construction, and to play the roles in supervision, coordination and assistance of the implementation process.