Objective To understand the cognition of doctors and patients on graded healthcare, and to explore the factors affecting the patient's willingness to seek medical treatment and the awareness of the doctors and patients on the classification and treatment. Methods The accidental sampling method was adopted. One hundred and eighty-three patients and 92 medical staff of a tertiary hospital in Binzhou were investigated with questionnaires and unstructured interviews. According to logistic regression, the factors affecting the cognition of both doctors and patients on graded healthcare were analyzed. Results Among the surveyed subjects, 38.2% of the patients said they understood the hierarchical diagnosis and treatment system, and 44.1% of the patients chose the primary hospital for the first consultation when they were sick.The higher the educational background, the higher the awareness of graded diagnosis and treatment (P<0.001).And patients who understand the hierarchical diagnosis and treatment system are more inclined to choose primary hospitals for the first diagnosis.70.6% of medical staff said they understood the hierarchical diagnosis and treatment system, but medical staff in different positions have different perceptions of hierarchical diagnosis and treatment, and clinicians have higher awareness of hierarchical diagnosis and treatment (P<0.001). Conclusion The awareness of both doctors and patients on hierarchical diagnosis and treatment needs to be improved, and the willingness of patients to choose primary care at the grassroots level is also low.Both doctors and patients should strengthen the promotion of graded diagnosis and treatment, increase the awareness of both doctors and patients, and increase investment in primary medical institutions, actively improve the primary diagnosis and treatment environment, comprehensively improve primary service capabilities, and attract patients to choose primary diagnosis.