Hongoro C, Musonza T G, Macq J, Anozie A
Blair Research Institute, Harare, Zimbabwe.
Cent Afr J Med. 1998 Apr;44(4):93-7.
To qualitatively assess the referral system at district level from the consumers' point of view and assess implications it had on efficiency and effectiveness of service delivery.
Descriptive study.
Districts of Tsholotsho and Murewa.
Subjects of the study included community members, ward health team members outpatient department (OPD).
The nature and magnitude of the problem; health seeking behaviour; the perceived role of a hospital versus a health centre; knowledge on the referral system; user fees and the referral system and communication between the service and the community; and perceptions on the referral system.
The community does not know the functional differences between a hospital and a clinic. What is clearly known is the physical differences that exist between the two. That is one of the reasons why the choice of a point of entry into the health care delivery system is not always correct. People do understand the mechanics of referring a patient to higher levels of care but they were not happy with the high hospital charges. Although the majority are eligible for free treatment the issues of high transport and other indirect costs were mentioned. There is no effective communication system between the service and the users. This manifested itself through the lack of knowledge or the existence and role of ward health teams or clinic committees. This lack of communication seems to be a major determinant in the failures of many a good policy. The impact of the new fee structure of January 1994 was minimal at district level because the communities felt that although referred patients do not pay hospital consultation fees, once admitted the patient still has to pay or at least prove that he/she is eligible for free services. The inconvenience of proving eligibility for free care still exists.
In general, the community did not fully comprehend the purposes and intentions of the new user fees policy of January 1994 which was meant to rationalise the referral system. Generally, communities are seldom consulted in time to ensure effective policy implementation and realisation of the intended impact. Impressions generated on the impact of the problem of the referral system on resource use at hospital level show that it has been considerable, although this study did not quantify it. Unnecessary overloading of referral centres negatively affected the care of referral cases, which actually required hospital care, due to competition with primary care cases.
从消费者角度对地区层面的转诊系统进行定性评估，并评估其对服务提供效率和效果的影响。
描述性研究。
乔洛特绍和穆雷瓦地区。
研究对象包括社区成员、病房卫生团队成员及门诊部（OPD）。
问题的性质和严重程度；就医行为；对医院与健康中心作用的认知；对转诊系统的了解；用户费用与转诊系统以及服务与社区之间的沟通；对转诊系统的看法。
社区并不了解医院与诊所的功能差异。大家清楚知道的是二者存在的物理差异。这就是人们选择进入医疗服务提供系统的切入点时并不总是正确的原因之一。人们了解将患者转诊至更高护理水平的机制，但对医院高昂的费用不满意。尽管大多数人有资格享受免费治疗，但仍提到了高昂的交通和其他间接费用问题。服务与用户之间没有有效的沟通系统。这表现为缺乏对病房卫生团队或诊所委员会的了解，以及对其存在和作用的认知不足。这种沟通不畅似乎是许多良好政策失败的主要决定因素。1994年1月新收费结构在地区层面的影响微乎其微，因为社区认为，尽管转诊患者无需支付医院诊疗费，但一旦住院，患者仍需付费，或者至少要证明自己有资格享受免费服务。证明有资格享受免费护理的不便仍然存在。
总体而言，社区并未完全理解1994年1月旨在使转诊系统合理化的新用户费用政策的目的和意图。一般来说，很少及时征求社区意见以确保有效实施政策并实现预期影响。关于转诊系统问题对医院层面资源使用影响的印象表明，尽管本研究未进行量化，但影响相当大。由于与初级护理病例竞争，转诊中心不必要的过度负荷对实际需要医院护理的转诊病例的护理产生了负面影响。
