National Health Commission to consolidate diagnosis and treatment systems

The National Health Commission has stressed the need to consolidate the hierarchical diagnosis and treatment system in a circular released on Wednesday.

The system entails first diagnosis at the grassroots level hospitals, the introduction of a two-way referral system, separate treatment of acute and chronic diseases, and coordination between primary and tertiary hospitals.

According to the circular, by the end of 2025, a smooth two-way referral system should be established within "compact medical alliances", such as urban medical groups and county medical communities.

By 2027, a smooth referral system for transferring patients between medical institutions within the province-level region will be established. By 2030, the hierarchical diagnosis and treatment system will play an effective role in providing patients with systematic, equitable and accessible medical services, the circular said.

Under the hierarchical diagnosis and treatment system, the attending physician responsible for the initial consultation should decide whether there's a need for referral based on an assessment of the patient's condition and the medical institution's treatment capabilities.

Once a referral is deemed necessary, the physician should contact the department responsible for referrals to assist in transferring patients to other departments within the medical institution or to other hospitals.

"It is the job of the department in the medical institution responsible for referrals to facilitate the process, instead of leaving patients to handle it themselves," said Jiao Yahui, director of the medical administration department of the National Health Commission, at a news conference on Wednesday.

Patients who need specialized diagnosis and treatment or require comprehensive medical capabilities, such as pediatric patients, patients diagnosed with cancer and complex or rare diseases, should be referred to tertiary hospitals, the most advanced hospitals in China's three-tier hospital system, or specialized hospitals.

For patients who need rehabilitation or care after the acute phase, the referral center of the tertiary hospital can coordinate with primary medical institutions in the same medical alliance to facilitate transferal.

"Zhejiang province has been advocating patients to have imaging, electrocardiograph (ECG), and other clinical tests in township-level hospitals and then get a diagnosis in tertiary ones. So far, the province's primary medical institutions have a total of 649,000 upward referrals, of which 75.96 percent of patients are transferred to county-level hospitals," said Wang Renyuan, director of Zhejiang Provincial Health Commission.

Tapping into the potential of information technology in providing continuous medical service, Zhejiang has launched a "digital human" built on China's first medical artificial intelligence large model.

The digital human serves a digital family doctor who provides one-stop services from appointment registration, report inquiry, medication guidance, home care and to follow-up consultations.

Zhejiang has also developed an online referral service platform that connects 2,647 medical institutions at provincial, city, county and township levels. "It enables efficient referral services across cities and between medical alliances," Wang added.