The Study Of Dilemma Of Implementing Hierarchical Diagnosis And Treatment System:Based On Patient Selection Model

Under the guidance of the new medical reform in 2009,which stresses on strengthening grassroots and building mechanism,the state has been committed to promoting the construction of hierarchical diagnosis and treatment system.By the means of promoting the construction of grassroots medical institutions,the government expect to guide patients to choose the primary treatment and ease the pressure from large hospitals.However,the behavior of patients did not change significantly due to the grading policy.Large public hospitals have absolutely monopoly status in the medical market,which reflects in the climbing percentage of total visits in nearly 5 years and increasingly expanding talent advantage.The government tried to enhance the attractiveness of primary institutions through widening the reimbursement of different levels of hospitals.The policy is not ideal.Large hospitals are overcrowded while grassroots have few visitors."Expensive medical bills and difficult access to quality medical services" still exists.The purpose of this study is to explain why patient still tend to go to large hospitals under the policy background when the government invests a lot of financial funds to grassroots and applicates various preferential policies.What we should do to solve the dilemma of hierarchical diagnosis and treatment system.Different from the mandatory arrangements for some western countries,Chinese patients have the right to choose the medical institution.The key to build the hierarchical system is to change medical habits of residents with the preferences of choosing the large hospital,so that they are willing to acquire medical services from grassroots when they are ill.This paper takes the patient behavior as the breakthrough point,through the construction of patient selection model and clarification of the supplier&demand factors.We focus on the influence of providers’ "quality" and "price" factors on patient medical choice.The hypothesis of quality and price effect of patients’selection is proposed by model deduction,and the author takes three-panel data of China Family Panel Survey in 2010,2012 and 2014 to verify the hypothesis.This paper uses FE and RE to study the quality effect of patients’ selection,adopts natural experiment in Gansu province to clarify the price effect of patients’ selection by difference-in-difference model,adds the lag item to discuss the behavior inertia of the medical treatment choice and evaluates of policy by propensity score matching method.The conclusions are as follows:(1)Medical service quality of grassroots is the key factor affecting the choice of medical institutions;(2)Health preference can mediate the quality effect of patient selection;(3)Income effect on patient selection exists,while price effect of medical service is limited;(4)Patients’ medical selection has a "ratchet effect";(5)The hierarchical diagnosis and treatment system can effectively control expense without reducing the patient’s treatment effect.The patient’s choice of medical treatment has gone through from " medical inclination" to " medical behavior",and finally form the habit of seeking medical treatment.According to the conclusions of empirical research,this paper puts forward three policy recommendations:(1)To strengthen the policy advocacy,"patients are willing to choose";(2)To improve the quality of the grassroots,"patients can trust";(3)To focus on interactive communication,"patients will stay".