The hierarchical medical system is one of the main necessary measures carried out to promote China′s medical reform.We studied the factors responsible for successful implementation of patient referral system in Hong Kong based on field training in the department of general practice of Hong Kong public hospitals and community medical centers,deeply interviewing the Hong Kong community healthcare managers and family doctors about this aspect,and analyzing the characteristics of healthcare system and general situation of primary healthcare services in Hong Kong on the grounds of reviewing the related literature.In view of the challenges existing in the hierarchical medical system carried out in the mainland of China,on the basis of Hong Kong′s nice experiences in implementing the patient referral system,we put forward eight suggestions for overcoming these challenges:formulating and enacting and perfecting the supporting policies related to hierarchical medical system;quickening the medical insurance system reform;promoting the cooperation between medical institutions at all levels;constructing a medical information system covering all the treatment data of patients that can be used in nationwide;enhancing the service capabilities of grassroots medical institutions;general practitioners(GPs) should deeply understand the essence of responsibility of family doctor services and fully perform the duty;improving the patient encounter skills in GPs;bettering the residents′ abilities of self-management of health.%分级诊疗制度是我国医疗改革推进过程中必要的改革举措.笔者通过在香港公立医院和社区医疗中心普通科实训,与香港社区医疗管理人员和家庭医生深入访谈交流,结合相关文献总结香港医疗卫生体制的特点和基层卫生服务的概况,分析香港有效落实转诊制度的原因,并结合内地实施分级诊疗中存在的问题进行对比分析.建议在政府指导下健全分级诊疗相关配套政策、加快医疗保险制度改革、推动各级医疗机构上下联动、建立统一医疗信息系统、提高基层医疗机构服务能力、深化家庭医生责任制服务内涵、提升全科医生接诊服务能力、提高居民健康自我管理能力,从而保障分级诊疗制度有效落实.
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