ABSTRACT
Objective: To conduct a two-dimensional analysis on the key issues that affect the promotion of hierarchical medical system in China, whereby the two dimensions being taken into consideration are the imminence and solvability of the issue, so as to provide reference for the future decision-making on the policy formulation. Methods : 77 papers were systematically collected and 20 issues that may be hindering the hierarchical medical system in China were summarized through the literature review. The imminence and solvability of each issue under cause were evaluated through Delphi method and analytic hierarchy process (AHP). Finally,the key issues hobbling hierarchical medical system were listed by using the variation coefficient method. Results : Research results confirmed that the three issues found to be the key issues include the acute shortage and insufficient service capacity of general practitioners,imperfect physician multi-point practice system which hinders the free flow of doctors, and the current financial input mechanism which is not conducive to the implementation of graded diagnosis and treatment in China. Conclusion : In order to promote hierarchical medical system, suggested are the general practice education reform, stopping the policy restrictions to the doctors' free flow,strongly advocating for the development of primary private healthcare institutions,and constructing the cooperative and restrictive relationship between primary healthcare institutions and higher level hospitals.