浙江省卫生人员对分级诊疗和双向转诊的认知调查

Cognition study of medical workers in Zhejiang province on tiered medical services and two-way referral medical system

目的了解浙江省分级诊疗、双向转诊实施过程中的影响因素，为构建以社区首诊制为基础的分级诊疗秩序提供可行性建议。方法按照经济发展水平分层抽样，选取浙江省5个地市9个县（市、区）的137名卫生行政人员及医疗机构人员进行定性访谈，了解社区首诊、分级诊疗服务格局建立情况及影响因素。结果医疗保险政策调节力度不够，医疗水平、绩效工资制度、基本药物制度等，影响了社区医疗服务的发展。结论政府主导，搭建大医院与基层医疗机构的信息平台，通过完善医保政策、药物政策等，逐步引导分级诊疗、双向转诊制度的建立。

Objective To learn influencing factors on tiered medical services and two-way referral in Zhejiang for feasibility recommendations of building the tiered medical services based on community first-visit practice. Methods Stratified sampling was made according to economic development levels, for qualitative interview of the 137 health administrators and medical workers from five cities and 9 counties in Zhejiang. The purpose of this effort is to learn the establishment of the first-visit in community and tiered medical services and their influencing factors. Results Poor regulation by medical insurance policies, medical competency, merit pay system and essential medicine system were influencing factors on community medical services. Conclusion The government should take the lead in building an information platform between large hospitals and primary healthcare institutions,guiding the establishment of tiered medical services and two-way referral system by means of better medical insurance policy and drug policies.