SHI YU/CHINA DAILY

China is accelerating the rollout of a nationwide tiered diagnosis and treatment system designed to decongest top-tier urban medical centers and bring high-quality healthcare closer to residents, according to a guideline released by the State Council in April.

Under a tiered healthcare system, patients with common or frequently occurring illnesses will seek care at primary-level facilities, while those with acute or severe conditions will be treated at higher-level hospitals, said Zheng Zhe, vice-minister of the National Health Commission.

"This system not only makes healthcare more accessible, but also helps ease the (financial and time) burden on patients," he said at a news conference following the release of the guideline.

Zheng said that China has more than 1.1 million medical and healthcare institutions, and over 90 percent of residents can reach the nearest provider within 15 minutes.

He added that rural clinics and community health service centers have expanded their clinical service offerings, upgraded facilities and equipment, and improved the overall patient care environment.

Last year, primary healthcare institutions recorded 5.56 billion patient visits, accounting for 52.6 percent of the national total. Meanwhile, the number of referral medical visits between large and small hospitals continued to grow, increasing by more than 50 percent from 2020 to 2025.

"The tiered diagnosis and treatment system is taking shape, and we are transitioning from the stage of building a basic framework to one focused on improving quality and overall efficiency," he said.

According to the guideline, efforts will be made to ensure that every neighborhood has access to a community health center, with the goal of "eliminating any existing gaps" in primary-level healthcare service coverage.

The guideline emphasizes that secondary hospitals — the middle tier of the nation's three-tier hospital system — will strengthen their capacity to treat common diseases while expanding services in rehabilitation, nursing, palliative care, and integrated medical and elderly care.

Tertiary hospitals will focus on critical and complex diseases and enhance services for referred patients, as well as those requiring multidisciplinary consultations or hospitalization. At the same time, they will gradually scale back routine outpatient services — such as follow-up visits for common diseases and stable chronic conditions with clear diagnoses — to achieve a more efficient utilization of high-quality medical resources.

The document also calls for upgrading partnerships that link higher-level hospitals with smaller institutions by establishing resource-sharing centers for medical imaging, examinations, sterilization, laboratory testing and drug supply services.

To encourage patients to seek their initial diagnosis at the primary level, the guideline requires higher-level hospitals to set up outpatient clinics for common and chronic diseases — including high blood pressure, diabetes and chronic obstructive pulmonary disease — at primary-level institutions within their medical consortia.

"The provision of specialist and expert clinics should also be extended to the primary level," it said. "For eligible chronic disease patients, primary-level healthcare institutions are allowed to issue long-term prescriptions covering up to 12 weeks of medication in a single visit."

It added that more medical professionals will be regularly dispatched to grassroots facilities, and additional mobile medical teams will be deployed to underserved areas.

In Shouguang, a city of 1.17 million people in Shandong province, 92.3 percent of residents choose to seek medical treatment within the city, and 77.4 percent of all healthcare services are delivered at the grassroots level, according to local authorities.

Li Peng, Party secretary of Shouguang, said that a key initiative in the city's recent push to bolster grassroots healthcare services has been to enhance convenience for patients with chronic conditions such as high blood pressure and diabetes, as well as for people with disabilities.

"We aim to deliver six key types of services at the village level — chronic disease patient registration and medication dispensing, regular monitoring, routine tests, hospital admission and rehabilitation care," he said. "All villagers can apply for chronic disease certification and receive up to 36 lab tests, including blood and urine tests, without leaving their village. Those with limited mobility are provided with door-to-door nursing care and home-based rehabilitation guidance."

Li Shuliang, a Shouguang resident, used to find it troublesome to arrange medical visits for his 88-year-old father, who has high blood pressure and diabetes.

"Now, my father can take basic tests at the village clinic, and blood samples for more complex tests are picked up and sent to higher-level hospitals for analysis," he said.

Li said that village doctors now make regular home visits to provide guidance on diet and medication. They also compile monthly medication lists for chronic patients, stock adequate supplies and issue prescriptions lasting up to three months — eliminating the need for patients to make monthly trips to a major hospital.

Jiao Yahui, head of the National Health Commission's primary health department, said that efforts will be made to explore the application of artificial intelligence-assisted diagnostic tools, smart prescription review technologies and other digital solutions to further improve primary-level healthcare.

She underscored the importance of establishing grassroots chronic disease management centers, which are expected to provide integrated services for patients from prevention and screening all the way through to diagnosis and rehabilitation.

Contact the writers at wangxiaoyu@chinadaily.com.cn