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primary care workers' perception of the system is vital to the implementation of the system，so studying their perception of the
system and associated factors is of great significance. Objective To analyze primary care professionals' perceptions of hierarchical
medical system and associated factors based on the results of 2018 Sixth China National Health Survey，providing a reference for
further improvement of the system. Methods From April to October 2019，one representative urban district and one suburban
county were chosen from each of six selected provinces in which hierarchical medical system has been implemented. Then by
stratified random sampling，about six community health centers/township health centers were extracted from each district（county）
（46 community health centers and 30 township health centers in total），in which primary care professionals who were on
duty on the day of survey were invited to attend a questionnaire survey for understanding their demographics，perceptions of the
importance and effectiveness of，as well as barriers to the implementation of hierarchical medical system. Results Altogether，
1 308 cases who effectively completed the survey were included for final analysis. According to the analysis，the benefits of
implementing hierarchical medical system were：improving the health service system〔approved by 1 231 cases（94.11%）〕，
improving the healthcare services for patients and residents〔agreed by 1 219 cases（93.20%）〕；improving the quality of
medical services〔1 209（92.43%）〕；improving the efficiency of medical services〔1 189（90.90%）〕；improving doctor-
patient relationship〔1 087（83.10%）〕；reducing the medical risk〔786（60.09%）〕；reducing medical expenses〔611（46.71%）〕.
As for the outcome of implementing hierarchical medical system，its implementation would not hinder the development of health
institutions〔982（75.08%）〕. When it comes to the barriers to the implementation of hierarchical medical system，there were
no relevant incentives〔759（58.03%）〕，patients and their families' were unwilling to accept hierarchical medical system due
to getting used to free healthcare-seeking pattern〔753（57.57%）〕，there were no unified bi-directional referral criteria and
system〔712（54.43%）〕，the implementation of hierarchical medical system may lead to conflict of interests between medical
institutions〔451（34.48%）〕，there was no an effective referral route〔403（30.81%）〕，their medical institutions had
insufficient capacities to effectively implement hierarchical medical system〔387（29.59%）〕. Univariate analysis revealed
that primary care professionals' perceptions of hierarchical medical system differed significantly by province，sex，educational
background，professional title，type of their medical institution，and type of post（P<0.05）. Multiple linear regression analysis
indicated that province，sex，educational background，professional title，and officially budgeted post were associated with
primary care professionals' perceptions of hierarchical medical system（P<0.05）. Conclusion These primary care professionals
had good perceptions of the importance and effectiveness of the implementation of hierarchical medical system，but also showed
their concerns about the barriers to its implementation. Professional title and province were associated with their perceptions of the
system. To promote the implementation of hierarchical medical system，it is suggested that the government departments increase
investment，improve policy details，provide corresponding incentives，and carry out targeted publicity and education.
【Key words】 Hierarchical medical system；Health personnel；Perception；Community health centers；Township
health institutions；Root cause analysis

2009 年发布的《中共中央 国务院关于深化医药卫
本文要点：
生体制改革的意见》（中发〔2009〕6 号）明确提出，
基层卫生技术人员是分级诊疗制度的关键实践
我国要在城市医疗服务体系中采取增强服务能力、降低
者，其对分级诊疗制度的重要性、效果及阻碍等方面
收费标准、提高报销比例等综合措施，引导一般诊疗下
的具体感知可能会对患者就诊选择和实际服务利用造
沉到基层，要逐步实现社区首诊、分级医疗和双向转诊。
成影响。本研究通过问卷调查，调查了 1 308 例基层
2015 年发布的《国务院办公厅关于推进分级诊疗制度
卫生技术人员对分级诊疗制度在重要性、效果和阻碍
建设的指导意见》（国办发〔2015〕70 号）指出，到
方面的感知状况，并分析其影响因素。
2017 年分级诊疗政策体系逐步完善，2020 年分级诊疗
本研究发现：基层卫生技术人员对分级诊疗制度
服务能力全面提升，基本建立符合国情的分级诊疗制度。
的重要性和效果的感知较好，但也担忧制度在实施过
分级诊疗制度的建立和完善，有助于优化卫生资源配置，
程中存在阻碍。基层卫生技术人员的所属省份、性别、
构建协同整合的卫生服务体系，建立合理的就医格局， 学历、职称是其对分级诊疗制度感知的影响因素。
［1］
被认为是破解“看病贵、看病难”问题的重大战略举措 。
根据研究结果提出以下建议：政府部门从加大投
基层卫生技术人员是分级诊疗制度的关键实践者，基层
入、完善政策细节、提供相应激励及进行针对性宣传
医疗卫生服务是分级诊疗制度实施中的重要环节。当前
/ 宣教等方面，促进分级诊疗制度贯彻与落实。
的研究主要针对基层卫生技术人员对分级诊疗制度的知