Graded diagnosis and treatment to implement a year of initial results

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As one of the basic goals of the comprehensive reform of public hospitals, graded diagnosis and treatment is regarded as a weapon to effectively improve people's medical experience and straighten out the medical order. Graded diagnosis and treatment has achieved initial results in the past year.

"First diagnosis at the grassroots level, two-way referral, urgent and slow treatment, and upper and lower linkage", these 16-character goals appeared in the State Council's "Guiding Opinions on Promoting the Construction of a Hierarchical Diagnosis and Treatment System" in 2015. Fu Hongpeng, a researcher at the China Health Development Research Center of the National Health and Family Planning Commission, pointed out that the overall design of China's medical reform is to form a hierarchical diagnosis and treatment system that adapts to national conditions. Family doctors are an important basic link to achieve this goal. Diagnosis and treatment, treatment of minor diseases on the spot, and timely upward rotation of serious or intractable diseases ".

At present, family doctors have sprung up all over the country: more than half of the farmers in Liaoning have their own family doctors; more than 250 million people have signed up for family doctors in Xi'an, Shaanxi Province. Shanghai has launched a pilot "1+1+1" contract service combination. Residents sign a contract with a family doctor and choose a district or municipal hospital for treatment. If they go outside the combination, they need to be referred by a family doctor. The satisfaction of the masses to the service attitude and service effect of family doctors reached 95.5 and 89.1 respectively, ranking first in the service industry in the city.

Wang Hufeng, director of the Medical Reform Research Center of Renmin University of China, believes that "the essence of graded diagnosis and treatment is the adjustment of the pattern of interests". Wang Hufeng said that it is a long way to go to comprehensively push forward the hierarchical diagnosis and treatment system and build a reasonable medical order.

"At present, the graded referral is obviously stratified from county to city, but the referral levels of medical institutions at all levels in the county are not clear, and the reimbursement ratio is not very different, resulting in the overload operation of county hospitals, the difficulty of finding a hospital bed, and the great pressure on county-level medical insurance and finance." Xu Xiangdong, director of the Health Planning Commission of Dafeng City, Jiangsu Province, believes that while using the economic leverage of medical insurance, it is also needs to formulate a referral guidance catalogue and standardize the referral process.

Some experts pointed out that the biggest reason for hindering the classification of medical treatment is that patients do not trust primary medical institutions. It is understood that at present, only 7.8 per cent of village clinic practitioners in the country have a college degree or above, 78.8 per cent of rural doctors do not have the qualification of practicing (assistant) doctors, and it is difficult to see high-level medical talents in urban community hospitals. Physician qualification and lack of practice ability, so that the grass-roots doctors can not effectively triage, the grass-roots first diagnosis function is difficult to implement.

In the long run, the cultivation of grass-roots hematopoietic capacity can not be ignored. Xu Junfeng, director of the Primary Health Department of the Beijing Municipal Health and Family Planning Commission, suggested that an "order training" model should be set up to attract more high-level and high-quality medical talents to sink to the grassroots in the community, and give preferential policies in terms of salary and promotion of professional titles.