A Study On The Implementation Of Hierarchical Diagnosis And Treatment System In Jiangsu Province

Background: As the gap between the growing health needs of residents and the scarce health care resources become more difficult to bridge,the advancement of China's health care reform is facing severe challenges.As an important form of allocation optimization of health resources,hierarchical diagnosis and treatment system has been fully recognized and explored nationwide.Since the beginning of 2015,Jiangsu Province has carried out pilot projects for comprehensive reform at the provincial level,and comprehensively promoted the construction of hierarchical diagnosis and treatment system.Objectives: Through investigating and analyzing the status quo of the implementation of hierarchical diagnosis and treatment system in Jiangsu Province,the purpose of this study is to analyze the problems existing in the construction of hierarchical diagnosis and treatment system,propose specific improvement strategies as well as provide a reference to further promote scientific and rational medical treatment and improve collaborative hierarchical diagnosis and treatment.Methods: Using the methods of literature review,the theory of Synergetic was constructed to build the theory and analysis framework.Through the combination of stratified sampling,typical sampling and occasional sampling,the on-the-spot investigation was conducted.Using the survey data and collected statistical report data as support,the status quo of hierarchical diagnosis and treatment construction in Jiangsu Province was evaluated from three aspects: multi-sectoral policy collaboration,hierarchical health service system coordination,and medical service coordination,according to the theoretical analysis framework.Descriptive analysis,chi-square test and binary logistic regression analysis were performed on quantitative data,and qualitative data were analyzed by subject frame method.Results:(1)A relatively complete policy framework has been established preliminary to provide multiple policy guarantees for the construction of hierarchical diagnosis and treatment system.The construction has been steadily advanced,but multi-sectoral policy collaboration has not yet been fully established.There is still a gap between policy formulation and policy implementation,influencing the exertion of Synergistic.(2)The flow of high-quality health resources has not yet been achieved,and the allocation of health resources needs to be further optimized.The construction of medical associations provided a guarantee for the coordination of medical institutions in terms of organizational structure.The increase in the number of referrals and referral rates indicated that the referral system has been continuously promoted.In addition,the effect of collaboration has begun to appear,and the hierarchical health service system has been continuously improved.(3)48.6% of the patients chose the primary health care institution for the first visit,which was lower than the proportion of patients who chose the general hospital for the first visit.Among the patients with referral experience,62.0% were dissatisfied with the construction of the two-way referral system,higher than the proportion of patients with satisfactory.The initial diagnosis and referral services received by patients during the construction of hierarchical diagnosis and treatment system are still unable to meet the needs of patients.There is still a large gap between the supply and demand of medical services,influencing the effect of Synergistic.Suggestions:(1)Improve the top-level design and establish a policy coordination mechanism;(2)Improve the support system construction and promote the promotion of hierarchical diagnosis and treatment;(3)Optimize the allocation of health resources and strengthen the coordination of medical institutions;(4)Strengthen the primary diagnosis ability of the grassroots construction and refine the two-way referral implementation rules.