Consolidation of clinical referral system urged

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

The system involves initial diagnoses at 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 to facilitate the transfers of patients between medical institutions within province-level regions should be in place. By 2030, the hierarchical diagnosis and treatment system should be playing an effective role in providing patients with systematic, equitable and accessible medical services, the circular said.

Under the diagnosis and treatment system, the attending physician responsible for the initial consultation should decide whether there's a need for a referral based on their 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 the patient to another department within the medical institution or another hospital.

"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 diagnoses and treatments or require comprehensive medical capabilities — including pediatric patients, cancer patients and those dealing with 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 treatment for acute diseases, the referral center of the tertiary hospital can coordinate with primary medical institutions in the same medical alliance to facilitate transfers.

"Zhejiang province has been advocating patients to undergo imaging, ECG and other clinical tests in township-level hospitals and then get diagnoses in tertiary ones. So far, the province's primary medical institutions have a total of 649,000 upward referrals, leading about 76 percent of patients to be transferred to county-level hospitals," said Wang Renyuan, director of the Zhejiang Provincial Health Commission.

Making use of information technology, Zhejiang has launched a "digital human" built on China's first large medical artificial intelligence model.

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

Zhejiang has also developed an online referral service platform that connects 2,647 medical institutions at the provincial, city, county and township levels.

"It enables efficient referral services across cities and between medical alliances," Wang added.

Xu Nuo contributed to this story.