Objective  To examine policy characteristics and implementation process of the tiered diagnosis and treatment (TDT) strategy in China.

  Methods  We selected four public hospital reform demonstration regions (Qidong district in Jiangsu province, Tianchang city in Anhui province, Youxi county in Fujian province and Huzhu Tu autonomous county in Qinghai province) for the study. Published data and information on the implementation of TDT of the four regions were collected through literature reviews and interviews of relevant personnel and classified the processes of TDT implementation in the four regions into three different modes. Then we performed a comparative analysis on the three modes based on the six components (diagnosis and treatment model, human resources, information technique, medical skill, medical security/medicine/medical device, and management mechanism) of a medical system proposed by World Health Organization.

  Results  Although different measures were adopted, the combined administrative regulation with economic incentive was generally utilized to promote the implementation of TDT in the four regions. The three modes of TDT implementation included the administration by a medical group in Qidong district in Jiangsu province, the administration by an integrated medical community in Tianchang city in Anhui province and Huzhu Tu autonomous county in Qinghai province, and the tripartite (medical institutions, medical security, and medicine supply) agreement administration executed by a governmental medical fund management center in Youxi county in Fujian province.

  Conclusion  Tiered diagnosis and treatment should be promoted in all regions step by step based on comprehensive assessment of local development of health care system in China and international experience could be used for references in determining implementation mode of tiered diagnosis and treatment.