分级诊疗的治理逻辑与农村居民认知偏差效应分析

自分级诊疗政策实施以来，部分地区农村基层首诊率不增反降，在自由择医的政策环境下，农村居民在无法确定疾病严重程度时倾向于选择高级别医疗机构就诊。本文从政策视角梳理了我国农村分级医疗服务体系的发展历程、剖析了分级诊疗的适配逻辑以及当前分级诊疗治理的政策困境。并在此基础上剖析了疾病不确定感对居民首诊选择的影响，界定了农村居民认知偏差效应。最后提出了推进互联网首诊服务的发展、加强基层医疗卫生机构宣传，以提升基层首诊意愿的建议。

Governance logic of hierarchical medical system and the effect of cognitive bias of rural residents

Since the implementation of the hierarchical medical policy in China, the primary diagnosis rate has declined rather than increased. In the environment of free medical choice, the existence of disease uncertainty makes residents often tend to choose higher-level medical institutions. Based on the policy perspective, this paper summarizes the development process of rural medical classification system, then analyzes the governance path and shackles of hierarchical medical policy, including the adaptation logic of hierarchical layout and the origin of current hierarchical medical management problems. On this basis, the influence of disease uncertainty on residents'' choice of first diagnosis was analyzed and the cognitive bias effect was defined. Finally, suggestions were put forward to promote the development of Internet first diagnosis service and strengthen the publicity of primary medical institutions, so as to enhance the willingness of primary first diagnosis.