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Why the “Community First Diagnosis and Two-way Referral” system is difficult to implement in China

International Social Science Journal (Chinese Edition)
No.1, 2014
 
Why the “Community First Diagnosis and Two-way Referral” system is difficult to implement in China
(Abstract)
 
Gao Herong
 
The “Community First Diagnosis and Two-way Referral” (CFD-TR) system originated in the UK is imitated by many countries in the world. At the beginning of the century, Chinese government issued the guidelines for the health service in urban communities and tries to plot and spread it. Through the investigation in the pilot city of Xiamen, we found the system in Xiamen is dominated by the government to redistribute medical resources, the community hospitals are incorporated in the tertiary hospitals, which are comprehensive, and several community hospitals are commissioned to be managed by a tertiary hospital. At the same time, the medical insurance system is reformed, and the regional medical markets are intervened in such non-market ways as the medical insurance subsidies to attract people to take their first diagnoses in community hospitals. However, the educational background and professional titles of community hospital staff is generally not high, departments and the basic drug list have been set unreasonably, doctors in comprehensive tertiary hospitals are reluctant to serve in community hospital, which result in the stubbornness of patients’ preference to the comprehensive hospital, the CFD-TR system is not implemented well. The current situation urges us to strengthen the efforts to train general medical practitioners, improve the “Basic Drug System” and the conditions of community hospital, and implement the s CFD-TR system truly to easy the poor access and high fee of medical treatments.