Two-Way Referrals in Chinese Medical Consortia Under the Framework of Hierarchical Diagnosis and Treatment: Progress and Challenges.

The hierarchical diagnosis and treatment system's two-way referral mechanism is crucial for optimizing medical resource allocation, with medical consortia significantly enhancing this process. It evaluates the implementation dynamics of two-way referral systems within China's medical consortia from 2019 to 2024, focusing on policy evolution, regional disparities, and stakeholder engagement. Despite a positive overall trend, referral rates remain low, with notable regional and institutional disparities. The implementation outcomes span various dimensions, including referral metrics, specific services, timing, and costs; however, these effects are inconsistent and warrant further investigation. The current evaluation index system is diverse but tends to prioritize quantity over quality. Additionally, awareness and satisfaction levels among medical personnel and patients regarding the two-way referral system are uneven and influenced by multiple factors. Currently, China's two-way referral system faces challenges, including low referral volumes, an inadequate evaluation framework, limited research perspectives, and insufficient motivation for stakeholder participation. Future efforts should focus on strengthening primary care infrastructure, enhancing resource collaboration, advancing health insurance reforms, refining the evaluation system, and fostering synergy between hierarchical diagnosis and treatment, the Healthy China strategy, and referral model innovation to advance the hierarchical diagnosis and treatment system. Recommendations emphasize strengthening primary care capacity, reforming insurance payment models, and leveraging digital health technologies to align with the "Healthy China 2030" strategic goals.