Study On The Optimization Of China’s Two-way Referral System

With the overall social development, contradiction betweengrowing need and limitation of medical service has made “poor accessand expensive fee in seeing a doctor” a focused question in the area ofpublic administration. On one hand, the allocation of medicalresources in different areas and agencies is unbalanced. On the otherhand, insufficiency and idleness are both existing due to disorderlinessand randomness caused by information asymmetry when patientsseek medical service. Therefore it is our direction and goal of basicmedical reform to establish a more scientific medical system to betterallocate and make use of medical resources in order to meet therational need of people in an all round way in line with the principle offairness, easy access and high efficiency. Two-way referral system isan approach to refer patients between community and tertiaryhospitals, comprehensive and specialized hospitals according to their illness. This system is based on classification of diagnosis andtreatment with definition of responsibility and function of differentlevels of medical agencies to guarantee the full, rational and efficientuse of medical resources. The scientific design of two-way referralsystem by establishing supporting policies, directing patients ingetting medical services and using medical resources with highefficiency is an important way to solve the problem of “poor accessand expensive fee in seeing a doctor”.In2006Ministry of Health in China expanded the two-wayreferral system to the whole nation. During these four years, we haveachieved significant accomplishments and laid solid foundation forfurther achieving the goal of medical reform. However, we alsoencountered difficulties in the progress. Since the pattern of seeing adoctor has not been build fundamentally and insurance is not actingeffectively as an economic level, patients are still going to tertiaryhospitals as their first choices, which resulted in the situation ofunresolved problem. This study is to argue the effect of two-wayreferral system on rational use of medical resources. After that, withthe example of Shanghai, questionnaires, expert consultation,literature review and comparative study are carried out to analyze thebottleneck of the implementation of two-way referral system. Finally,recommendations are raised as the following: Medical resources can be scientifically allocated under the mode of hospital groups with theguarantee of sound policies, the foundation of well-distributedcommunity medical facilities and hardware equipments, the supportof highly-skilled medical team, the orientation of medical insurancepolicy and shared platform of personal health records. We hope to putforward references for health management in different cities andareas with a scientific design of system to support the implementationof referral system and eventually to improve the rational use of basicmedical resources.