As an efficient health care system ,the hierarchical medical system is characteristic of its continuation of the division of work at different levels of medical services in the diagnosis and treatment functions .Two major roadblocks hinder the building of such a system ,namely a serious shortage of primary service capabilities ,and lack of incentives in the referral from superior institutions .Success of such a system lies in enhancement of the service capabilities of primary medical institutions by all means , and smooth functioning of a dual referral system .