The Dilemma Of China's Hierarchical Medical Service System And Its Breakthrough

Since the new medical reform,in order to solve the problem that it's expensive and difficult to see a doctor,one of the key issues of reform is to improve the primary medical service system,and gradually establish a hierarchical treatment and two-way referral system.In 2015,the General Office of the State Council issued guidance on the construction of a hierarchical medical service system,which aims to promote the fairness and accessibility of medical and health services through the gradual establishment of a hierarchical system.However,there are many dilemmas in the process of promoting hierarchical system medical service in China,which not only hinders the process,but also cannot provide a good medical environment for the majority of patients.In the study of the hierarchical medical service system,the dilemma mainly found in the following aspects: from the medical system,the medical institutions in the hierarchical management of independent operation,public hospitals,especially higher hospitals enjoy a very large resource advantages,Grass-roots medical institutions can not compete with,leading to the inefficient competition mechanism between medical institutions.At the same time,the limitation of personnel management system makes it difficult for high-quality medical and health resources to sink to the grassroots level.From the regime,the lack of strict grass-roots first and two-way referral system,the proportion of health insurance policy does not have different levels of medical institutions opened a clear gap,imperfect health insurance policy also led to the abuse of medical insurance fund,intensified patient burden and other issues.From the institutional level,the primary health service system is weak,so that the lack of basic medical service system,the lack of medical personnel and medical resources to further weaken the level of primary health care institutions,and the large hospitals overload work did not give full play to their effectiveness value,leading to a double waste of medical resources.And from the patient's point of view,the patient is a life-threatening event,for the grassroots medical institutions of the stereotypes to a large extent affected their confidence in medical treatment,so patients tend to pay more time and money to get better medical services.The increasing demand for quality medical services also leads to irrational decisions that people ignore their own real needs.Can be said that the causes of these difficulties,the fundamental lies in the allocation of medical and health resources unreasonable,lack of division of labor between medical institutions.From the overall situation of China's medical resources,there is still a shortage of total medical resources.The country has increased its investment in the medical system year by year,but it is still insufficient compared with other countries.In this case,the distribution of medical and health resources is very unreasonable.80% of China's medical resources are concentrated in the city,while the large hospitals also occupy 80% of the city's medical and health resources,showing its imbalance.Grassroots medical institutions themselves lack of development,large hospitals through the expansion to seize market share,it cannot effectively implement the normal operation of the classification system.Therefore,the optimal allocation of medical and health resources,improve the efficiency of resource use has become an inevitable trend to promote the development of classification and medical and health care.In observing the mature medical service system,it is found that the model of medical union has become an effective way to integrate medical resources and has made remarkable achievements.China from the 1980 s began to explore the medical association,and formed a Daqing Medical Association,Beijing Medical Association as the representative of the medical union model.The construction of medical consortium has its realistic foundation for the development of hierarchical medical service system.In the absence of the total amount of health resources,the government is not enough investment under the premise of the integration of different levels of medical resources,so that three hospitals high-quality medical and health resources to enhance the primary health care institutions to improve the level of health care services.At the same time in the medical association can use the existing resources to promote the promotion of hierarchical diagnosis and treatment,smooth referral channels,the establishment of medical union within the green channel,making the patient even in the primary health care institutions can also enjoy the tertiary hospital quality medical services.In the observation of China's current medical development of the body and found that the current development model of loose medical complex-based development of a number of drawbacks,resulting in poor performance of medical association.Therefore,in order to solve the current situation,we propose to build a close medical association model,through the property rights to connect,break the barriers of interest,in the medical union members of the hospital to form a real community of interests and the responsibility of the community.On the basis of this,we will gradually strengthen the construction of the primary health care system in the medical union,form a reasonable flow of medical resources in the medical union,and lay a solid foundation for promoting the hierarchical medical system.At the same time,the establishment of close medical syndicate brand effect improve the patient's degree of trust,promote the implementation of health care related policies,but also in the process of establishing the medical union plays a vital role.The establishment of the medical consortium is not overnight,only to continue to explore the reality of our country for the medical association,in order to effectively promote the hierarchical medical service system.