摘要
目的基于全国典型地区工作实践,分析不同地区家庭医生签约服务政策执行进展。方法2019年4—10月,对14个调研地区开展现场调研,收集区/县家庭医生签约服务政策制定和实施情况、签约服务组织形式和服务内容、激励机制和能力培养等,并通过关键人物访谈了解区/县政策执行的客观背景、政策落实情况及存在的困难等。计量资料采用均数表示,定性资料通过语义分析提取关键内容。结果我国家庭医生签约服务已由试点探索逐步向规范性推进,71.0%的调研地区签约主体为家庭医生团队;签约服务费逐步体现家庭医生劳务价值,东、中、西部地区平均签约服务费分别为125、31.25和42.5元/人/年。多数地区综合激励措施和医保政策发挥着对签约服务的助力作用。结论需进一步建立家庭医生健康守门人、权益交换人和资源协调人的管理理念,强化家庭医生专业化培养和能力建设,落实签约服务费内涵和经济激励作用等,切实发挥家庭医生签约服务政策对构建以健康为中心服务体系的基础性作用。
Objective To analyze the policy implementation of family doctors′contracted services in different regions based on practices in typical regions.Methods From April to October 2019,we conducted field investigations in 14 regions,collected data on policy formulation and implementation,organizational form and service content of contracting service,incentive mechanism and capacity development.By means of key persons′interview,we tried to understand the background of district/county policy implementation,as well as policy delivery and existing difficulties.The measurement data were expressed by means,and the qualitative data were used to extract the key content through semantic analysis.Results The policy of family doctors′contracted services had been promoted from pilot exploration to normative development.71.0%of responsible entities of the contracted services in research regions were family doctor teams.Contraction fee has begun to reflect the value of family doctors′work,while the average contracted service fees in the eastern,central and western regions were 125,31.25 and 42.5 yuan/person/year respectively.Comprehensive incentives and health insurance policies in some regions played a role in promoting contracted services.Conclusions It is necessary to establish the family doctors′"three roles"management concept,namely health gatekeeper,rights exchanger and resource coordinator;strengthen the professional training and capacity promoting of family doctors,implement the connotation of contracted service fees and economic incentives,in order to play the policy′s basic role in constructing a health-centered system.
作者
田淼淼
王芳
贾梦
袁莎莎
杜词
赵敏捷
杨琳琳
Tian Miaomiao;Wang Fang;Jia Meng;Yuan Shasha;Du Ci;Zhao Minjie;Yang Linlin(Center for Health System and Policy,Chinese Academy of Medical Sciences,Beijing 100020,China;Peking Union Medical College,Beijing 100730,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2020年第7期549-552,共4页
Chinese Journal of Hospital Administration
基金
中国医学科学院医学与健康科技创新工程项目(2016-I2M-3-018)
国家卫生健康委员会基层卫生健康司委托项目(2019)。
关键词
家庭医生
签约服务
政策执行
激励机制
Family doctors
Contracted services
Policy implementation
Incentives
mechanism
