Study On The Path Of Hierarchical Diagnosis And Treatment In Pukou District

Objective: With the deepening of the reform of the medical and health system,hierarchical diagnosis and treatment has gradually become an important system for China to optimize the allocation of health resources,guide residents to seek medical treatment reasonably,and solve the problem of “difficult to see a doctor and expensive to see a doctor”.Under the national call,all localities are actively exploring the realization path of hierarchical diagnosis and treatment.As a pilot area for medical treatment in Jiangsu Province,Pukou District of Nanjing began to explore the construction of a hierarchical diagnosis and treatment system based on family doctors' contracting services in September 2015.However,many problems have arisen in the course of the pilot.These problems are also in various parts of China.Therefore,based on sufficient theoretical research and comprehensive empirical research,this study aims to explore a feasible path for hierarchical diagnosis and treatment in Pukou District,and does not provide reference for other similar regions in China.Methods:(1)Using the literature research method,combing the relevant concepts and theories of hierarchical diagnosis and treatment,summarizing practical experience at home and abroad,based on WHO's six-module theory and the“structural-process-results” framework,trying to construct a theoretical analysis framework for the implementation of hierarchical diagnosis and treatment.(2)Using on-the-spot investigation,based on the theoretical framework of construction,analyze and discuss the current situation of hierarchical diagnosis and treatment inPukou District from three aspects: structure,process and result,summarize the main obstacles that restrict the realization of grading diagnosis and treatment in Pukou District,and find the key Policy entry point.(3)Based on the conclusions of the current situation analysis,according to the key policy entry points,from the aspects of improving service capacity,optimizing service order,and improving service experience,the implementation path of grading diagnosis and treatment in Pukou District is formulated.Results: The current classification and treatment system in Pukou District is based on the family doctor contract service,providing residents with primary care and two-way referral services,that is,the family doctor contract service as the path to achieve hierarchical diagnosis and treatment.As a result,the construction of hierarchical diagnosis and treatment based on family doctors' contracting services has begun to take effect.The signing of residents and medical staff has differentiated the evaluation of family doctor services.The service capacity of primary health care institutions is weak,and it is difficult to achieve referral.In the process,residents' understanding of family doctors' contracting services is not high,residents' use of family doctors' contracting services is not high,and medical staff's enthusiasm for signing services is not high.Structurally,a unified leadership organization has not been established at the district level,and there is no attractive contracting service project.The supporting system is not perfect or failed to implement,and the layout of primary medical institutions is unreasonable.Conclusion:Based on the above analysis,Pukou District should aim at improving the ability of primary health care services and family doctor services,improving the enthusiasm of family doctors for both domestic and foreign partners,and standardizing the service delivery behavior of suppliers.Government-led,multi-sectoral collaboration;policy guidance,voluntary coercion;quality priority,and the right to health is the basic principle.To improve the family doctor contract service as the basic path to achieve hierarchical diagnosis and treatment,to reform the medical insurance payment and compensation policy as the key path to achieve hierarchical diagnosis and treatment,to coordinate with the upper and lower hospitals as an important path to achieve hierarchical diagnosis and treatment,to establish a unified leadership group,etc.Auxiliary path,and finally achieve hierarchical diagnosis and treatment in Pukou District.