Study On The Hierarchical Medical System’s Problems And Strategies In China

The document on hierarchical medical system was published by the State Council. This document referred to the goals, which was to optimize health resources allocation, promote the priority medical resources into the primary healthcare institution, let patients more likely to go to the primary healthcare institution and improve the efficiency of health resources in 2017.This study aimed at the state council’s goals. The Gini coefficient and Theil index were used to analyze medical resource allocation of hierarchical medical system in China, which can be provided to optimize health resources allocation and promote the priority medical resources into the primary healthcare institution. And these resources included practicing (assistant) physicians and beds in medical institutions. Then this study analyzed the utilization of health resources of hierarchical medical system in China. At last, BCC models in DEA were used to calculate efficiency of health resources. These can be provided to let patients more likely to go to the primary healthcare institution and improve the efficiency of health resources.Based on this analysis, this study can get the following conclusions. (1) The proportion of practicing (assistant) physicians in the hospital had risen to 54.8% and the proportion of beds in the hospital had risen to75.2% in 2014. The hospital possessed too many both manpower and material medical resources, especially the medical resources. (2) In the Theil index, the contribution of rural-urban gaps of practicing (assistant) physicians and beds were 62.5% and 78.6% respectively. The rural-urban inequality had the primary responsibility for regional inequality. (3)The Gini coefficient of practicing (assistant) physicians and beds in medical institutions were less than 0.2. And the Gini coefficient of beds was lower than the Gini coefficient of practicing (assistant) physicians. There was small gap between provinces in health resource allocation. (4) The patients more likely to go to the hospital, especially in the eastern region. The proportion of outpatient in the primary healthcare institution was slightly higher than the hospital. But proportion of hospital was rising when the proportion of primary healthcare institution was going down. The proportion of inpatients in hospital was much higher than the primary healthcare institution. And proportion of inpatients in hospital was rising. The density of the primary healthcare institution is much higher than the hospital. However, the patients were more likely to go to the hospital when the primary healthcare institution was more convenience.(5) The efficiency of hospital, included pure technical efficiency, technical efficiency and scale efficiency, was higher than the primary healthcare institution. 25.8% of hospital and 16.1%of primary healthcare institution had relatively effective efficiency in 2014. The beds and doctors had been fully utilized to achieve the optimal output relatively here. The 41.9% of hospital and 12.9% of primary healthcare institution were increasing returns to scale while 29.0% of hospital and 67.7%of primary healthcare institution were decreasing returns to scale. In short, the scale efficiency of primary healthcare institutions was generally low in China.Based on the problems of thehierarchical medical system in China and the practical experience at home and abroad, this study provided some suggestions to optimize hierarchical medical system.(1) optimizing health resources allocation, promoting the priority medical resources into the primary healthcare institution. (2) building Diagnosis-Related Groups and "Internet+" healthcare system. (3) improving efficiency of health resources utilization and the effectiveness of medical services.