Abstract: Under the vigorous implementation of the hierarchical medical system，grassroots medical institutions are generally responsible for providing healthcare（especially initial care） for common diseases and frequently-occurring diseases.As these settings designed to offer primary care including continued care for specific populations，building good and trustworthy relationships between patients and primary care physicians is of great significance in improving the service efficiency，enhancing the accessibility of primary care as well as promoting social stability.We analyzed the patient flow for seeking healthcare during the implementation of the hierarchical medical system，as well as the feasibility of building trustworthy relationships between patients receiving continued care and primary care physicians.Furthermore，we intensively evaluated the physician-patient relationship in primary care，analyzed the impact exerted by the implementation of hierarchical medical system on it，and put forward measures for building good and trustworthy physician-patient relationships in primary care using theory of repeated games.

Key words: Hierarchical medical system, Community health services, Physician-patient relations

摘要： 在当前分级诊疗制度大力推进的政策背景下，常见病、多发病的一般诊疗下沉至基层，基层医疗卫生机构将承担起更多的首诊功能。基层医疗卫生机构的服务群体具有相对固定性，医患之间存在连续就诊和重复博弈的可能，如何在重复博弈的环境下建立起良好互信的医患合作关系，对于提升基层医疗卫生机构的服务效率、改善居民就医可及性、增进社会稳定等具有重要意义。本文分析了分级诊疗制度下患者的就医流向，探讨了在基层医患存在重复博弈的前提下基层医患互信关系建立的可行性。进一步的研究可以在对基层医患关系进行深度测评的基础上，分析分级诊疗制度对基层医患关系的作用及影响，借助重复博弈理论探讨医患关系的建构对策。

关键词: 分级诊疗, 社区卫生服务, 医生病人关系