The Development, Current Situation, and Pain Points of Medical Referral in China

During China's "13th Five-Year Plan," significant advancements were made in establishing a hierarchical diagnosis and treatment system, including the integration of health organizations, optimization of medical insurance models, and the implementation of family doctor contracts. Despite progress, challenges persist in the medical referral system, which is crucial for optimizing resource allocation in the face of rising healthcare demands driven by urbanization and population ageing. The system faces the issue of "easy upward referrals, difficult downward referrals," where patients can move from grassroots institutions to large hospitals with ease but struggle to return. This problem stems from an underdeveloped primary healthcare system, low trust in grassroots institutions, and complex stakeholder interests. While the development of medical consortia has made improvements, challenges remain, such as incomplete referral processes, insufficient information sharing, and limited capacity at grassroots institutions. This paper reviews the system's development, assesses current issues, and offers policy recommendations to strengthen the healthcare service system, clarify the roles of institutions, improve referral information systems, and build trust in grassroots healthcare. These steps aim to improve referral efficiency, equity, and the overall functioning of the healthcare system in China.