Objective  To examine existing problems in the construction of medical alliances under the background of tiered diagnosis and treatment in Nanjing and Huai'an city of Jiangsu province.

  Methods  We collected the data on the construction of medical alliances and the implementation of tiered diagnosis and treatment in Nanjing and Huai'an city from Health Statistics Yearbook of Jiangsu Province published during years of 2014 – 2017. The status quo of medical alliance construction and tiered diagnosis and treatment in the two cities were analyzed and compared based on the information retrieved.

  Results  The number of people seeking medical service at grass-roots medical institutions increased yearly and the gap in disease diagnosis and treatment between grass-roots and high level medical institutions were narrowed during the 4-year period, indicating a good implementation of tiered diagnosis and treatment. However, there were still weaknesses such as low service capability, obsoleteness of equipment and shortage in professional staff for the grass-roots medical institutions and the dual referral scheme still needs to be improved.

  Conclusion  The results of the study suggest that a long-term funding mechanism should be established to improve the infrastructure construction of grass-roots medical institutions and a coordination mechanism for reasonable benefits distribution among partners of a medical alliance also should be established.