Abstract
Objective To build a multi-level hierarchical structure model of the influencing factors for hierarchical medical system, to identify the role relationship between all the factors and transmission pathways, and to recommend on developing China's hierarchical medical system. Methods Thirty influencing factors were identified in a screening based on literature review for the hierarchical medical system. On such basis, 16 influencing factors were identified by three health policy experts, which affect operations of the current system. Interpretative structural modeling was called into play in the end to analyze the hierarchy relationship between various influencing factors and the conduction loops. Results There exist among the 16 factors a3-level hierarchical structureand two conduction loops. The factor directly limiting the hierarchical medical system istwo-way referral, and most internal core drivers arehuman resources developmentandgovernance mechanism. By means of self-growth and external constraints, they exert their influence on the operation of hierarchical medical system. Conclusions There are interactive hierarchical effects among the factors, merging into three node elements offunctional role,inter-entity relationshipandpatient participation. Key words: Hierarchical medical system; Influencing factors; Interpretative structural modeling
Published Version
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