Optimization Research On Contracted Service Model Of Family Doctors In Rural Areas Based On Contractual Governance Vision

The contracted service model of family doctors is the rational choice in the transformation of basic health service in rural areas,which has played an important role in realizing the objectives of ‘first treatment at the grass roots’,‘health equalities’ and‘comprehensive health’.The optimization model is beneficial to meet changing demands of rural residents,effectively improve accessibility of primary health care services and optimize residents’ treatment order.As a new health contracted model,contracted service model of family doctors has its specific value objectives,theory and policy basis.Several practical problems still exist because the model is conditioned by multiple factors.Innovations and improvements are needed so that the model operates effectively and achieves its goals.Introducing the concept and analytical framework of contractual governance and based on interview materials collected in Hubei,Anhui and Henan,the research is focused on the contracted service of family doctors in rural areas to find existing problems.Several deficiencies have been revealed.First is the deficiency in rights and interests’ protection of rural residents,including incomprehensiveness and insufficiency of health rights realization and lacking health ability of rural residents.Second is the deficiency in rights and interests’ protection of family doctors,including insufficient protection of economic interests,education and training,old-aged rights and interests and practice conditions.Third is that the fair values of the contracted service are not achieved adequately.All above inherently reveals that the contracted service model of family doctors in rural areas needs to be optimized.It is necessary to analysis the root causes of relative problems deeply and systematically when optimizing the contracted service model of family doctors in rural areas.The root causes of the problem are described as follows.Firstly,there are deviations during the formation process of contracts.Administrative departments have functioned obviously while interest coordination and interactive game are absent among contract subjects.Secondly,rights and responsibilities are set up in appropriately,since rights and responsibilities and interrelations are ambiguous among the government,rural health clinics,family doctors and rural residents.Thirdly,there is a lack of institutional guarantee.The legislative system of contracted service is of low rank and the policy provisions are arbitrary.Fourthly,weakness exists in the evaluation of performance management.Based on the analysis of the constraints and the root causes of the problems,this study summarizes the advanced experience at home and abroad,which provides essential support for the optimization of the model.It is believed that the optimization of the service model of rural family doctors can be started as the following steps.First of all,the optimization of contract formation process can be adjusted from administration-led to cooperative game.High attention should be paid to the participation rights of family doctors and residents in the process of contract formation,and a multi-party cooperation mechanism should be built.Secondly,the rights and responsibilities of administrative departments,family doctors and residents should be clarified in the contract.The objective of contracted service should be adjusted to improve residents’ physical and psychological health and health ability.Thirdly,in terms of optimizing the system guarantee,local governments should be encouraged to make regulations and normative documents according to the actual situation.And the state shall enact relevant legislation when needed to provide institutional guarantee for the development of contracted services.Fourthly,the performance ability and service effect of family doctors can be improved by strengthening performance appraisal,vertical assistance,information construction and social resource integration.The concept of contractual governance can provide a feasible analysis path for the innovation of service model of rural family doctors.The concept of contractual governance provides new systematic thinking for understanding the contract nature of health service from family doctors,and it also can provide thoughts to analyze the problems in practice,to explore the deep root causes of the problems,to explore the path to deal with the problems,in order to achieve the goal of health contractual governance.The future trend of optimizing the model is to improve the analysis framework of this paper and explore the integration of multiple relations of contract to achieve the goals of expanding the research content and finding solutions to new problems.