分级诊疗作为深化医药卫生体制改革的重要举措，是实现有序就医的基础。本文基于结构-过程视角，从结构性约束、行为主体利益关联、社会互动、历时动态变化等，分析我国分级诊疗中存在的（医疗资源缺乏整合、医疗机构间缺乏良性互动、医保支付制度不完善及医患间互动运行偏差等）问题，并从结构和过程两方面提出加强分级诊疗体系建设和完善运行机制的建议，在保障病人利益的前提下引导有序就医，促进分级诊疗的顺利实施。

Hierarchical diagnosis and treatment，an important deepening reform of the medical and health system in China，is the foundation of orderly medical service. The problems of the hierarchical diagnosis and treatment system (lack of medical resources integration，shortage of positive interaction between medical institutions，imperfection in health care payment system and deviation of interaction between patients and physicians ) were investigated according to the structures and process from the aspects of structural constraints，different interests among stakeholders，social interaction and diachronic dynamic change. Then the proposals to strengthen construction and improve running system of the hierarchical diagnosis and treatment were put forward in order to promote the implementation of the hierarchical diagnosis and treatment.