Study Of The Existing Problems Of Hierarchical Diagnosis And Treatment In Zunyi Based On Structure-Process Analysis

Objectives: To investigate the existing problems in the implementation of hierarchical diagnosis and treatment in Zunyi using structure-process analysis method in order to provide reference for the improvement of the hierarchical diagnosis and treatment.Methods: Literature research,panel discussions,and Delphi method were used to determine the elements of structure-process analysis in hierarchical diagnosis and treatment.The data of service capacity of township hosptials and county hospitals,and the interests claims of the subjects the social interaction and the dynamic changes of the subjects in the hierarchical diagnosis and treatment in Zunyi were collected by means of depth interview,field investigation and questionnaire.Then the database with Epi Data3.1software was established,and statistical analysis of the different characteristics of data and research purposes by using SPSS17.0.Results:1.Elements of structure-process analysis of hierarchical diagnosis and treatment in Zunyi which included structural constraints,behavior subjects,social interaction and duration of dynamic changes played the role in promoting and constraining hierarchical diagnosis and treatment.2.The structural constraints included that the lack of service capacity of township hospitals,information technology and general practitioners,the basic drug equipment which failed to meet the needs of patients,the problems of referral capacity.Though the medical service efficiency,the medical business income,the establishment size and the beds available in Zunyi county hospital were better than the average national level of county hospitals,the medical equipment was not sufficient,the information construction was low,and the staffing ratio couldn’t meet the basic standards of service capacity of county hospitals.Also,the bidirectional evaluation mechanism,the referral system and facilities construction were incomplete.3.In concerning the main body of the behavior,the trust level of patients and their families on the primary medical institutions were relatively low mainly in that the primary medical institutions’ service ability and medical quality couldn’t meet the demand of the first option.It was difficult to meet the interest claims of the patients in hierarchical diagnosis because of limited training opportunities for the doctors of township hospitals and county hospital,low payment affected their enthusiasm and personal professional skills improve insufficient.4.In concerning the social interactions,it was still demanding to upgrade and enhance the doctor-doctor interaction,doctor-medical institution,medical institution-medical institution.5.In concerning the dynamic changes,referral patients starting line and medicare reimbursement proportion was more favorable,but the medical payment reimbursement method was more humane and concise,the staff income of primary medical institutions increased slightly after the implementation of hierarchical diagnosis and treatment,those benefits to carry out the hierarchical diagnosis.However,different level medical institutions service price gap was not enough difference and there was neither significant change of professional title promotion for doctors,nor the obvious change of referral desire happened to patients due to the long-term medical habits.Conclusion:1.Service efficiency is higher in Zunyi county hospitals,reimbursement is convenient,the staff income of primary medical institutions increased slightly after implementing the hierarchical diagnosis.Those benefits to carry out the hierarchical diagnosis.2.Further improvement should focus on the service capacity of primary health care institutions,but also the establishment of efficient assessment measures,the information construction,a sound referral system,and the increase of publicity to encourage residents to change their habit of medical treatment.3.The improvement of the quality of primary health care and the personal development of doctors is conducive to the implementation of hierarchical diagnosis and treatment in Zunyi.4.The improvement of the title evaluation system of doctors in primary health care institutions,and the increased learning opportunities,help to stabilize the health care workers,improve medical technology level and people’s trust level on primary health care institutions,so to promote the hierarchical diagnosis and treatment in Zunyi.