| Objective At this stage,there are still many patients who are lacking of knowledge of health and disease,they always tend to choose the large hospital no matter what their disease is.It can cause the waste of medical resources,and delay the treatment of critically ill patients.It will lead to a heavy financial burden to both the society and themselves.The establishment and perfection of hierarchical medical system is conducive to optimizing the allocation of medical and health resources,constructing a coordinated medical and health service system,forming a reasonable medical pattern,controlling the high medical expenses and creating a harmonious doctor-patient relationship.Therefore,the hierarchical medical system is deemed to the major strategic initiatives to solve "difficult and expensive to see a doctor".This study mainly explores the feasibility and necessity of the promotion of hierarchical medical system in the urban community;through the research on behavior change of the residents in the background of hierarchical medical system in two surveys,I analyzes the changes of residents’ medical behavior after the policy;find the conflict point of the urban residents’medical-care-seeking behavior and the hierarchical medical system policy,so that the two point harmonize eventually from a perspective of policy implementation.Methods 1.First of all,I Analysis the relevant policy documents and realistic Situation.On the basis of the policy survey,I analyzed the policies and documents that collected,to extracted the relevant information on the hierarchical medical system.I used of network databases,various professional journals,the internet and other resources,to have a systematic review of the literature.I collect and sort out the literature about hierarchical medical system both in China and abroad.2.Status survey and analysis.I did a second survey and the implementation of hierarchical medical system.I collected the information about implementation of the hierarchical medical system in Gongshu District,compared the results of the second survey with the baseline survey,and analyzed the existing problems of urban residents’medical-care-seeking behavior.I combined with the existing literature and the reality of the situation,selected the greater impact on the individual factors.3.I did comparative analysis according to the status quo investigation and second survey one year later,and proposed to promote the implementation of hierarchical medical system.Result 1.The surveyed residents have higher approval rates of hierarchical medical system,and the increase was greater.It indicating that the policy advocacy about hierarchical medical system has a certain effect,but the intensity still needs to be increased.When the residents fully realize the importance and superiority of the hierarchical medical system,the implementation of the policy can be promoted better.The main way to receive advocacy of hierarchical medical system for residents is TV and radio.2.Civil servants agreed the hierarchical medical system more than other groups(63.64%),followed by student groups(61.11%),freelancers is the least(15.79%).3.For people who claims more satisfied with their own health insurance preferred the hierarchical medical system more(62.24%).4.The signing rate of family doctors in the surveyed population increased from 28.8%to 45%within one year,and the "family doctors" was progressing well.5.Residents who preferred to community hospitals when they were ill were raised from 52.8%to 61.7%,and residents who were willing to listen to referral views rose from 68%to 79.2%.The reason that residents preferred community hospital is that the community hospitals located closer to them mainly.6.Civil servants preferred to community hospitals when they were ill more than Enterprise employees group(OR=0.178);residents who had go to community hospital preferred to community hospitals when they were ill more(OR=0.119,0.175);residents who signed a family doctor preferred to community hospitals when they were ill more(OR=0.072,0.323)7.Residents in the two surveys have better reactivity of treatment in the community hospital,each entry "very good"+"good" constitute more than 60%of the the doctor credibility and environmental facilities.The reactivity of counseling and waiting time is lower relatively,but it is already a relatively high level compared to other hospitals.Conclusion First,policy advocacy about hierarchical medical system needs to be strengthened,combined with new media communication,to strengthen the policy of popularization is conducive to better policy implementation.Second,update the medical payment method,to pull the reimbursement ratio between different levels of medical institutions appropriately.Increase the rate of payment according to the disease more scientific medical payment at the same time.Third,the signing rate of Family doctor needed to be improved,and improve the role of family doctors in the same time。We should not only pay attention to the data,but also improve the family doctor’s clinical thinking ability,slow disease management ability and doctor-patient communication ability to attract residents.Fourth,we should strengthen the medical quality and service quality of community health institutions.General practitioners should be cultivated both in quantity and quality.We can recruit assistants to help family doctors to improve the quality of medical care.Fifth,we should strengthen the construction of regional medical consortium,to promote the integration of medical resources.Community medical institutions to give full play to geographical advantages,while speeding up the quality of medical resources,equipment sink,attract more residents choose the community medical institutions in the first place.So that the hierarchical medical system could be carried out better.Sixth,We should speed up the construction of information technology to promote the effective flow of medical information.And establish a standardized and effective medical referral process. |
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