Present Situation And Countermeasures Research On Two-way Referral In Medical Association

Objective Under the new situation of actively exploring and popularizing medical association in china,this study analyzed the present situation of the two-way referral in Xi'an Fengdong New City medical association,combed its operational status and problems,putted forward the corresponding countermeasures,provided reference for other areas of china to promote medical reform.Methods This study mainly used the research methods such as literature research,field investigation,questionnaire survey and depth interview to understand the operation and problems of two-way referral in medical association.Result During the period from 2014 to 2016,the total upwards referral and total down referral were 10892 and 3431 respectively,accounting for 0.65% and 0.20% of the total outpatients.The medical insurance of the referral patients was mainly urban workers medical insurance,followed by residents of basic medical insurance,new rural cooperative medical care.The most important reason for the upwards referral was the conditions of the primary hospital can not carry out treatment or lack of drugs,and the most important reason for the down referral was the acute phase of chronic disease after treatment to stabilize the need for follow-up treatment.The most diseases of the upwards referral were cardiovascular disease,followed by respiratory disease,endocrine disease.The most diseases of the down referral were respiratory diseases,followed by neurological diseases,renal disease.Through the survey of doctors found that: Of the 274 doctors,254(92.7%)doctors understood medical association,and the community hospital doctors knew more about medical association than thelevel-two hospital doctors orlevel-three hospital doctors,and thelevel-two hospital doctors knew more about that than the level-three hospital doctors.Doctors mainly through hospital training to obtain medical association information.137(53.9%)of the 254 doctors who knew medical association supported the policy of medical association,and the community hospital doctors were more supportive of medicalassociation policy than the level-two orlevel-threehospital doctors,and the level-threehospital doctors were more supportive of that than the level-twohospital doctors.179(70.5%)of the 254 doctors who knew medical association expressed doubts about whether the medicalassociationcould improve the status of two-way referral operation,and only 47(18.5%)were optimistic,and the community hospital doctors thanthe level-two orlevel-threehospital doctors more recognized medicalassociationcould improve the status of two-way referral operation.Only 55(21.7%)of the 254 doctors who knew medical association said that the referral channel was smooth or very smooth,and there was no difference in the cognition of two-way referral channels among doctors at all levels.Only 60(23.6%)of the 254 doctors who knew medical association were satisfied or very satisfied with the operation of the two-way referral in the medical association,and there was no difference in the satisfaction of the two-way referral among doctors at all levels.Through the survey of residents found that: Of the 287 residents,162(56.4%)said they knew medical association.Residents' access to medical association information was mainly through doctors to tell or participate in hospital lectures(42.0%)and television newspapers and other media(37.7%).Only 38(24.5%)of the 162 residents who knew medical association indicated that they were satisfied or very satisfied with the work of medical association.In the survey of the dissatisfied reason,the residents were mainly considered to have no relevant help and medical association lack of publicity.Of the 287 residents,193(67.2%)were informed of two-way referral.77(39.9%)of the 193 residents who were informed of two-way referral expressed satisfaction with two-way referral work.In the survey of the dissatisfied reason,the residents considered that hospitalsfor their own interests were reluctant to referral,did not know the referral process and standards,referral procedures trouble,did not enjoy the benefits of the offer and could not choose their own referral hospital.Conclusion At present,Xi'an Fengdong New City medical association is steadily developing,and the two-way referral in the medical association has made some achievements.But through the research still found that there were problems such as upwards referral difficulties,small referral ratio,poor residents' awareness,lacking of service capacity of primary health care institutions,lacking of general practitioners.So we need to further strengthen the mission to raise awareness of residents;need to increase cooperation among medical union members to improve the service capacity of primary health care institutions;need to strengthen policy guidance and support,give full play to the role of health insurance leverage;need to smooth referral channel,improve the supervision and management mechanism;need to build and improve the information platform,strengthen internal communication;need toimprove the use of essential drugs and equipment.