On The Administration Bottleneck And Solution To The Difficulty Of "Downward Deferral" Met By Public Hospitals Patients

To solve the "difficulty of getting medical services and high expenses on medical services",China has been constantly exploring medical service modes that are suitable for China's national conditions.In 2015,it was proposed in the Instructions of the General Office of the State Council to Promote the Construction of Hierarchical Diagnosis and Treatment System to develop a hierarchical diagnosis and treatment mode of "initial diagnosis at the basic level,two-way referral,separate treatment of acute and chronic diseases,upper and lower linkage" in 2020.Two-way referral refers to the process of hospital transferring for diagnosis and treatment between superior and subordinate hospitals,or between specialized hospitals,or between comprehensive hospitals and specialized hospitals,in accordance with the patient's condition."Downward referral" is an important part of the two-way referral system,as well as a significant link of giving full play to the function of two-way referral system,namely to make full use of health resources and reduce medial cost,etc.The settlement of the existing difficulty in "downward referral" will be of great significance for the establishment of a new patten for residents to receive medical services,solution to the problem regarding the access to medical services,reasonable allocation of medical resources,and improvement of overall medical services.This research has collected literatures and documents related to "hierarchical diagnosis and treatment" and "two-way referral" from books and the Internet based on the literature research method,to learn about the implementation in China and foreign practical experience,absorb and quote previous research achievements.Besides,it also interviews related cadres from related department of health and managers from different levels of medical institutions,to know their views and opinions on the implementation of two-way referral.Meanwhile,investigations into related conditions of two-way referral are launched among medical staff and patients with the questionnaire survey method.Through the above three research methods,combining the theory of public administration,and based on the practical condition of Zhaoqing City and survey on D Hospital,systematic research analysis has been carried out from the perspective of hospital administration.It is found that typical administrative hierarchy makes it difficult to formulate and implement referral standards ofexplicit division of labor from the perspective of external organization governance.Besides,the present medical insurance fails to play its guiding and control role.Moreover,the design of compensation system and incentive system for medical staff results in a weak desire to implement the "referral system",which is the primary problem of hospital internal governance.In addition,the competition system in market economy,and information asymmetrical between patients and doctors,and other objective reasons are also factors restricting "downward referral".To promote the solution to the difficulty of "downward referral",this research makes suggestions of promoting the "downward referral" hospital administration according to the inspiration of domestic and foreign research achievements,as well as related theories,like modernization of governance and administration of public hospitals: it formulates operable two-way referral standards and process,establishes the incentive and restrictive system for "downward referral" medical insurance,improves the government supervision and market competitive mechanism,innovates the administration mechanism of public hospital,builds a scientific and reasonable compensation hospital and inventive system for hospitals,and implements full-course management for patients by relying on the "Internet+".