Problems And Countermeasures Of Grading Diagnosis And Treatment Service In China

The report of the 18 th National Congress of the Communist Party of China put forward the requirement of “reasonably allocating medical resources and constructing a grading diagnosis and treatment service system”.This requirement points out the direction of the reform of the current medical and health service system and the reform of the current basic medical insurance system in China.At the National Health Conference in August 2016,President Xi Jinping made a speech and pointed out that “grading diagnosis and treatment reform is the top priority of medical reform”.As the frontier and pioneer of China's reform and opening-up,Dongguan City took the lead in exploring the community medical first consultation system in October 2008 and actively promoted the reform of the graded diagnosis and treatment system.After years of practice and exploration,Dongguan City has established a relatively complete grading diagnosis and treatment service system.The medical treatment mode of “small diseases to the community,serious illnesses to hospitals,and rehabilitation back to the community” has gradually been accepted by the masses.The system has achieved relatively great results in the allocation and use of medical resources and improving the overall efficiency of medical services.However,in the course of operation,some contradictions and problems have gradually emerged.It is necessary to continuously reform and improve the system.The study is consisted of five parts.The first part "Introduction" mainly expounds the reasons and research significance of this study,lists the research status,content and method,the theoretical basis and the innovation point at home and abroad.Based on the theory of public service equalization and the integration theory of health service system,this paper analyzes the positioning,role and effect of each subject within the grading diagnosis and treatment service system,and discusses how to establish and improve the efficient mechanism of the grading diagnosis and treatment service system.The second part is the analysis of the status quo of the implementation of the grading diagnosis and treatment system in China by taking Dongguan City as an example.It defines the concept of grading diagnosis and treatment system,and discusses the background and policy basis of the implementation of grading diagnosis and treatment system in China.It describes the social background and policy background of the implementation of graded diagnosis and treatment in Dongguan.It is urgent to promote the grading diagnosis and treatment system,medical insurance policies,and provide policy basis and legal protection for exploring grading diagnosis and treatment.It describes the basic situation of the implementation of the current grading diagnosis and treatment system in China.Firstly,it describes the general medical treatment path of grading diagnosis and treatment.And then describes the three modes of the current practice of grading diagnosis and treatment system in China.The exploration and implementation of the grading diagnosis and treatment system in Dongguan is the highlight,including the establishment of a community health service system;the establishment of a long-term mechanism to actively promote the community's first-visit;complete the protection policy and promote the sustainable development of grading diagnosis and treatment system.Based on this analysis,a new reform goal of the grading diagnosis and treatment system in Dongguan was put forward.Finally,it describes the achievements of the grading diagnosis and treatment system in Dongguan,including the increasing reception of the community's first-visit,which make a great effect on effectively reducing the diagnosis pressure on hospitals;The cost of medical treatment is obviously reducing,which lower the economic burden of patients;family doctors are fully promoted to effectively reduce medical risks;health management services are effectively implemented,and public benefits are continuously improved.The third part discusses the case of Dongguan City to analyze the problems and causes of the grading diagnosis and treatment system in China.The authors pointed out that the following problems exist in the experimental program of grading diagnosis and treatment system by studying the theory,system and reality.Firstly,the allocation of medical resources is uneven,the medical and health system tends to focus more on hospitals instead of community clinics,which means the distribution of medical resources tends to be higher-grade hospitals,and the primary medical team is weak.Secondly,the two-way referral implementation is not well performing.Thirdly,the current medical insurance payment method obstructs the patients visit the community clinics at first.There are three reasons for causing the above questions:1.the government lack of regulatory role,so that the medical system lags behind,the medical resources of primary medical institutions are not valued,and the primary medical team is poorly treated.2.the grading diagnosis and treatment service system is not perfect.And also,the people's cognition of medical treatment is outdated.3.The payment method of medical insurance of the government is too simple.The fourth part shows the study of the foreign classification and treatment system to summarizing advanced experience and enlightenment.The grading diagnosis and treatment service system in United Kingdom,France,Japan and the United States have something in common: Good social medical insurance system and national welfare policy;high-quality medical personnel training system and professional family doctors;ordinary people's clearly-understanding of national grading diagnosis and treatment policies,and active cooperation and support for grading diagnosis and treatment system.The fifth part is to propose countermeasures and suggestions for improving the grading diagnosis and treatment system in China.Firstly,the government promote the reform of the medical and health system by market-oriented.The government plays the correct guidance role of and the market plays a regulatory role.Overall Promoting the reform of medical treatment,medical insurance and medicine.In addition,two-way referral,division and cooperation of the medical agencies must be strengthen and improve.Secondly,it's necessary to optimize the allocation of medical resources and develop primary medical institutions.Also,the following method is considered to be useful: improving the incentive and restraint mechanism,encouraging the participation of social capital,realizing the legalization of regional medical planning,rationally arranging medical resources;strengthening collaboration among medical institutions,improving and enhancing primary medical capabilities.Thirdly,strengthening the construction of medical staff and improving medical service capabilities.It means Increasing the training of medical personnel,enriching the grassroots medical team;breaking the institutional wage bottleneck and enhancing the attractiveness of primary medical care.Fourthly,changing the concept of medical treatment and guiding the grading and reasonable medical treatment.The government should give play to the optimization role of medical insurance,promote the development of community outpatient clinics,vigorously promote family doctors and optimize medical service models.Fifthly,Promoting the implementation of a broader and more flexible medical payment method.The government should develop actively a number of designated community outpatient clinics for insured persons,and achieve that the patients pay the individual's medical expenses by medical personal accounts.