研究目的：

基于家庭医生签约服务相关理论和国内外实践模式的总结梳理，了解典型案例地区家庭医生签约服务的政策措施和运行机制，应用已建立的家庭医生签约服务评价指标表来分析家庭医生签约服务实施效果以及存在的问题，并提出完善家庭医生签约服务的政策建议，为分析家庭医生签约服务政策效果和完善制度建设提供参考和借鉴。

研究内容:

一是分析典型案例地区家庭医生签约服务现状；二是评价典型案例地区家庭医生签约服务的实施效果；三是提出完善家庭医生签约服务的政策建议。

研究方法：

本研究利用文献研究法，梳理家庭医生签约服务政策目标及内涵；通过现场调研利用调查问卷、个人深入访谈及焦点小组讨论，调研典型案例地区家庭医生签约服务现状及效果情况；采用统计分析和对比分析法，描述和分析典型案例地区家庭医生签约服务实施效果。

研究结果：

1.典型案例地区签约服务现状

各地区均已出台相应的家庭医生签约服务政策，包括如何推进签约服务，签约服务的实施意见以及相应的签约服务绩效考核等。建立了团队形式的签约服务主体，团队以家庭医生为主体、同时配备一名护士及一名公卫人员；基本以辖区内常住的参保居民为签约对象，重点人群为主要签约对象；服务内容涵盖基本医疗服务、基本公共卫生服务、个性化健康管理服务，服务包类型大致分为无偿包和有偿包两部分。基本建立起家庭医生签约服务筹资、考核及激励机制。

2.典型案例地区家庭医生签约服务总体概况、政策执行和目标效果情况

按照家庭医生签约服务评价指标表对典型案例地区家庭医生签约服务的效果进行评价。各地区家庭医生签约服务签约主体及内容已基本具备；十类重点人群都有适宜的签约服务的比例，签约服务内容较为完善；筹资机制基本建立，人均签约服务费标准及签约服务费筹资渠道较为合理；各地区激励机制及技术保障基本具备；各地也基本上建立起家庭医生签约服务管理平台并在不断的完善平台建设，且已经建立家庭医生团队工作制度及制定家庭医生签约服务团队考核和内部分配考核的方案；家庭医生签约及续约情况较好；基层机构服务能力不断增强；签约服务的利用及健康管理有一定的效果；居民部分了解签约服务，比较满意签约服务；基层医务人员对签约服务满意度一般。

结论：

本研究基于家庭医生签约服务的内涵及政策目标，应用已建立的家庭医生签约服务评价指标表，并在此基础上对典型案例地区即浙江东阳市、浙江德清县、安徽包河区、安徽蒙城县、四川武侯区、四川新津县进行了研究，对其签约服务实施现状及效果进行了描述和对比分析。得出以下结论供其他地区参考：各地家庭医生签约服务签约主体和内容基本具备；各地已建立家庭医生签约服务激励机制但作用有限；县域医共体对家庭医生签约服务有一定的促进作用；家庭医生签约服务促使基层医疗服务能力的提升及改善居民的健康状况；信息化建设进程缓慢制约家庭医生签约服务的发展；基层人力资源及能力不足仍然是家庭医生签约服务发展的掣肘；供需双方的对家庭医生签约服务的认知还需进一步加强。

为了进一步推进家庭医生签约服务，应该完善家庭医生团队的收入与考核激励机制；推进紧密型医联体对家庭医生签约服务的支持作用；强化签约服务信息化建设以提高服务效率；加大全科医生的培养，提高基层医疗卫生机构服务能力；多渠道宣传以增强签约服务供需双方的认识。

关键词：家庭医生；签约服务；实施效果

ive:

based on the theory of contract services of family doctors and the summary of domestic and foreign practice models, understand the policy measures and operational mechanism of contract services of family doctors in typical case areas, and apply the established contract services of family doctors evaluation index table to analyze the effect of contract services of family doctors implementation. as well as the existing problems, and put forward the policy recommendations to improve the contract services of family doctors, provide reference and reference for analyzing the effect of contract services of family doctors policy and improving the system construction.

contents:

analyze the status quo of contract services of family doctors in typical cases; evaluate the implementation effect of contract services of family doctors in typical cases; propose policy recommendation to perfect contract services of family doctors.

methods:

this study uses the literature research method to sort out the goals and connotations of the contract services of family doctors policy; investigate the typical case area family through the field survey using questionnaires, personal in-depth interviews and focus group discussions to get the status quo and effect of contract services of family doctors; statistical analysis and comparative analysis method were used to describe and analyze the implementation effect of contract services of family doctors in typical case areas.

outcome:

1. typical case regional contract services of family doctors status

the corresponding contract services of family doctors policies have been issued in all regions, including how to promote contracting services, implementation opinions of contracting services, and performance evaluation of corresponding contracting services. a team-based signing service entity has been established. the team is mainly a family doctor, and is equipped with a nurse and a public health personnel. the insured residents who live in the area are basically the target of the contract, and the key groups are the main contractors. covering basic medical services, basic public health services, and personalized health management services, the types of service packages are broadly divided into two parts: unpaid and paid. fundraising, assessment and incentive mechanisms for f contract services of family doctors have been basically established.

2. the overall overview, policy implementation and target effect of contract services of family doctors in typical case areas

according to the contract services of family doctors evaluation indicator, the effect of the contract services of family doctors in the typical case area is evaluated. the main body and content of the contract services of family doctors in all regions are basically available; the ten key groups have the proportion of suitable contracting services, and the content of contracting services is relatively complete; the fundraising mechanism is basically established, and the per capita contracted service fee standard and the contracted service fee financing channel are relatively reasonable; incentives and technical guarantees are basically available in all regions; local governments have basically established a contract services of family doctors management platform and are constantly improving the platform construction, and have established a family doctor team work system and developed a contract services of family doctors team assessment and the plan for internal assessment and assessment; the signing and renewal of contract services of family doctors is better; the capacity of primary health care institutions is continuously enhanced; the utilization of contracted services and health management have certain effects; the degree of residents understand contracting services is partial and residents are satisfied with contracting services; grassroots medical staffs’ satisfaction with contracting services is average.

conclusion:

this study is based on the connotation and policy ives of contract services of family doctors, and applies the established contract services of family doctors evaluation index table. based on this, the typical case areas are zhejiang dongyang city, zhejiang deqing county, anhui baohe district, anhui province. city county, sichuan wuhou district, and sichuan xinjin county conducted research and described and compared the status and effects of the signing service. the research and comparison of the implementation status and effects of the contract service were carried out. the following conclusions can be drawn for reference in other regions: the contracting parties and contents of contract services of family doctors are basically available; the incentive mechanism for contract services of family doctors has been established in various places, but its role is limited; the county medical community has a certain role in promoting the contract services of family doctors; the contract services of family doctors promotes the improvement of primary medical service capacity and improves the health status of residents; the process of informatization construction slows down the development of contract services of family doctors; the lack of human resources and capacity at the grassroots level is still a constraint to the development of contract services of family doctors; the awareness of contract services of family doctors needs to be further strengthened.

in order to further promote the contract services of family doctors, we should improve the income and assessment incentive mechanism of the family doctor team; promoting the supportive role of the close medical community in signing services for family doctors; strengthen the informatization construction of contract service to improve service efficiency; increase the training of general practitioners, improve the service capacity of primary health care institutions; enhance the understanding of both the supply and demand sides of the contract service.

keywords: family doctor；contract service；implementation effect