Study On The Dynamic Mechanism Of Hierarchical Diagnosis In China's Medical Association

In 2009,the central state council of China put forward the "opinions on deepening the reform of the medical and health care system",and asked for various ways to guide the primary diagnosis,two-way referral and promote hierarchical diagnosis.In response to the national call,all regions have conducted graded diagnosis and treatment practices based on the medical association model according to their own actual conditions.From a national perspective,the overall development of the medical-association model is not mature enough,and grading diagnosis and treatment are difficult to develop.In this paper,literature review methods are used to describe the current research status of medical associations and grading diagnosis and treatment at home and abroad.The current status of grading diagnosis and treatment in medical institutions in China and the difficulties faced are summarized through bibliometric analysis methods.Systematic dynamic analysis methods are used to establish the model of hierarchical diagnosis.Then we find the internal motivation and external power source with the analysis of stakeholder theory,to find out the source of problems affecting the advancement of grading diagnosis and treatment in China,to explore the dynamic mechanism of in-vivo grading diagnosis and treatment in China's medical associations,and to analyze its source of motivation and interaction ways.Finally,I try to propose some policy recommendations for the major issues facing the current stage,and provide reference for China's next stage of hierarchical diagnosis work.Through bibliometric analysis,it has been found that the development of grading diagnosis and treatment based on the medical association is mainly concentrated in economically developed areas such as Jiangsu,Beijing and Zhejiang.The problems faced in the process of advancement are mainly reflected in three aspects.From the perspective of government,we can find that:The effect of government power is not obvious,the referral standards and norms are not unified,and the assessment and the examination and supervision of medical associations is not so strict.From the point of view of medical association,we can find that:Medical institutions at all levels have insufficient motivation,the unclear positioning of medical institutions and conflicts of interest leads to the lack of cooperation,the development of information exchange platform is backward,especially the primary medical institutions which have poor service capacity.From the point of view of the service object,it is mainly manifested in the residents' lack of cognition of hierarchical diagnosis and treatment,and the lack of trust in the basic medical institutions which lead to a wait-and-see or negative attitude towards hierarchical diagnosis.System dynamics analysis method is used to establish the model of hierarchical diagnosis system and determine the diagnosis system structure,then analyzes the mechanism of action of members of the system,At the same time,the motivation and resistance of the hierarchical diagnosis are analyzed through the help of Stakeholder Theory.Finally,according to the analysis results,policy recommendations based on three aspects are put forward to promote the hierarchical diagnosis work.that is,the government should play a leading role in strengthening the service capabilities of grass-roots medical institutions through various means,strengthen the legislative and regulatory mechanisms,establish the legal status of medical associations,and strictly supervise the behavior of medical institutions,leading hospitals to "de-administration" and doctors."Free People" reform;the medical institutions in the medical institutions should define their own self-reproach and division of labor,establish system-wide benefit-sharing and risk-sharing mechanisms,improve the system of two-way referral standards and systems,and finally strengthen the information platform for medical institutions.Medical insurance should mainly regulate the use of funds,strengthen supervision of medical services,and maximize medical insurance leverage through innovative medical insurance payment methods.With the joint efforts of the government,medical insurance,and medical associations,a benign treatment pattern for graded diagnosis and treatment has emerged.