The Present Situation,Problems And Countermeasures Of Hierarchical Diagnosis And Treatment From Perspective Of Multiple Subjects

In recent years,with increasing demand for health,more and more people hope to acquire health security through high quality medical treatment.As a gathering place of high quality medical technology and precision equipment,the tertiary hospitals attract lots of patients,resulting in difficulty and high cost of medical treatment.This is in stark contrast with insufficient utilization of medical resources in grassroots medical institutions from a number of areas.Therefore,the hierarchical diagnosis of “first visit to primary institutions,two-way referral,partition of acute and chronic diseases and upper and lower linkage” was put into force in the whole country of People’s Republic of China.Through the implementation of hierarchical diagnosis,people with common disease,frequently-occurring disease and/or chronic diseases are expected to be gradually leaded to primary or grassroots medical institutions.The hierarchical diagnosis system has been proved effective and obtained good results in some places.But for most cities,this system could not be built overnight.Through methods of literature research,comparative study,questionnaire survey,qualitative interview,and so on,taking Xi’an as an example,we analyzed the present situation of the hierarchical diagnosis and treatment system,collected and analyzed the government documents and statistical data of health resource,and conduced questionnaire survey and qualitative interview for medical and health service provider,demander and supervisor.We found out the problems on policy,resource,satisfaction of service demander,evaluation of service supplier,and government attitude of Xi’an.For example,the political response on hierarchical diagnosis was imbalanced in different areas;the health resources are rich but the effect of hierarchical diagnosis is not obvious;the awareness of hierarchical diagnosis is low;the resources of primary medical institutions are limited and underutilized,and the referral requirements can’t be met;downward referral is difficult,and so on.Using the good experiences of some areas or countries where hierarchical diagnosis system run well for reference,we provide suggestions from four aspects including government,medical institutions,medical workers and information platform construction,to promote development of hierarchical diagnosis in Xi’an.