Abstract: Objective In order to put forward some suggestion to solve the existing problems, five community health service centers and five general corresponding hospitals were selected to understand the status of two-way referral by questionnaire survey, thus to optimize the design and implementation of the system. Methods A randomized cluster sampling was taken in each institution in Xi'an during August, 2015 to November, 2015. We collected 951 valid ones from 1 000 questionnaires for doctors, patients and administrators in each community hospital and the general hospital. Results Different educational backgrounds, professions and income levels had significant differences. The main reasons why patients didn't want to transfer to the general hospitals WERE cumbersome referral procedures, lack of recognition of the seriousness about their diseases, economic difficulties, no medical insurance, traffic inconvenience, etc; on the other hand, the main reasons why patients didn't want to go to the communities were cumbersome referral procedures, distrust in the doctors and medicine in communities, the small gap between Medicare reimbursement proportion, economic difficulties, lack of recognition of the necessity of continuing treatment, the lack of family beds and rehabilitation, etc. Medical workers believed that the main reasons why the two-way referral operation impeded were as follows, unclear referral criteria, unclear referral regulatory institutions and mechanisms, lack of basic medical insurance support, interest conflicts between medical institutions, incomplete information platform of two-way referral, and lack of recognition of two-way referral etc. Conclusion The present situation of the two-way referral is not ideal in Xi'an, and most of the referrals are from communities to the general hospitals. We should establish and improve two-way referral system, strengthen the leverage of medical insurance on two-way referral, and then we will have a better situation.