A Study On The Implementation Status Of Hierarchical Diagnosis In Shaanxi Province

In 2009,A new round of medical reform around the solution "the difficult medical services and expensive medical cost" problem opened the curtain.Hierarchical diagnosis system,as the highlight in the new medical reform has caught a widespread concern.Hierarchical diagnosis and treatment work vigorously develop all over the country,but was implemented for a pilot in 2015 in Shaanxi Province.During the two-year trial run,how it is going?How effective?What problems?These questions are worth focusing and researching.This paper analyzes the basis,the mode and the effect of the implementation of hierarchical diagnosis in Shaanxi Province,by means of sampling investigations,literature analysis,data arrangement and questionnaire investigation.The result shows that there are some problems such as the shortage of professionals,low qualification and low title generally exist in grassroots medical institutions in Shaanxi Province.These problems leads to the weakness of basis of hierarchical diagnosis;Xi'an,Baoji,Yan'an,these places use a variety of means to carry out hierarchical diagnosis mode,but all means seem to be longitudinal collectivization and loose type of mode.Grass-roots first diagnosis rate and bi-directional referral rate have improved,but did not reach the desired level.From the perspective of the diagnosis and treatment institutions,it shows that the level of expertise in grassroots medical institutions is too low,a lot of public health work and poor conditions all impede the development of grassroots medical institutions.And the current performance mechanism also makes provincial and municipal hospitals obtain economic benefits by continuesly increase the number of patients.It is because of the above-mentioned reasons that make the inverted triangle structure of medical institutions difficult to change in the short term;From the patient's point of view,the traditional concept of diagnosis and treatment plus poor health knowledge make them have trouble deciding appropriately on medical institutions;From the government's point of view,general practitioners system construction is not sound enough,grassroots physician training system has not been down to earth,health insurance policy is not perfect,secondary hospital of City development is not advanced,together with other aspects of the factors are hindering the implementation of the hierarchical diagnosis system.According to the factors above,this paper tries to rovide some suggestions based on advancing the level of expertise in grassroots medical institutions,adjusting the scale of medical institutions,improving the health literacy level of residents,optimizing the collectivization management style and consummating the health insurance systen,and tries to promote the implementation of the hierarchical diagnosis system in Shaanxi Province.