Study On The Contract Service Models Of Family Doctor In China

As a new model of primary medical service,family doctor signing service is an indispensable and essential system to deepen the reform of medical and health system.To study the working mode of contracted services of family doctors around the country,and analyze the problems and crux of the current development of family doctor contract service,which is of great significance for the construction of new health service system in China.Objective Through a comprehensive analysis of the existing different contracting modes in all parts of China,summing up the experience of family doctor signing service and combining the experience of foreign countries,find out the difficulties and problems in the implementation,To explore the ideal mode of family doctor signing service in accordance with the national conditions of our country,and making the corresponding measures and policy suggestions.Methods Through literature analytical method,collect relevant documents,materials,and policies and regulations issued by the official website of government departments,and retrieve and collate historical research data of domestic and foreign contracted services implementation and evaluation.The field investigation and interview are carried out to understand the key and difficult points of carrying out the signing service of the family doctor.The data collected from the field survey and interview are analyzed in accordance with the methods,content,organization and population of the contract service.The questionnaire was issued for expert consultation of Delphi method,to construct the evaluation index system of family doctor signing service model.Results(1)The research on family doctor service abroad is of positive significance to the implementation of contract service in China.For example,the first consultation system of family doctors in Germany and Australia,the legal guarantee system of the British general practitioner signing service,the United States has clear service content nd accountability,the investment and use of Cuba’s contracting funds,the perfect performance appraisal and evaluation system in Britain and America,lay the foundation for the current situation and ideal mode design of family doctor contract service in China.(2)the status of family doctor signing service in China.in 2016,the contracting rate of family doctors in 10 pilot cities in China has reached 22.2%,and the contracting rate of key population has reached 38.8%.At the end of 2017,more than 95% of the cities nationwide carried out family doctor signing services,and the general population signing rate and the contract rate of key crowds reached 30% and 60% respectively,reaching the target of medical reform.(3)The main models in China: the community team service mode is based on the general practitioner as the backbone,building a team in the community health service institutions,and establishing Contractual service relationship with the community residents,it’s represented by Beijing and other places.The signing mode of medical institution combination refers to that residents and their families establish contractual service relationships with family doctors based on community health service centers,secondary hospitals and tertiary hospitals within their jurisdictions,to Shanghai and other places as the representative.Tablet medical responsibility system is based on map orientation,according to the concept of fragmentation,and provides health services for residents,represented by Zhengzhou.The main feature of the rural doctor’s contract mode is that the rural doctors take the role of the family doctor’s contacts,and sign a long-term and stable contractual service relationship with the villagers,it’s represented by Dafeng and other places.(4)Design the family doctor signing service ideal model.Clearly define the functional positioning of each subject in the signing service,and explore the core content of signing subject,signing contract,service content,payment mechanism,performance appraisal,and propose two modes of rural family doctor signing service and community family doctor signing service.(5)The Delphi method is used to study the evaluation index system of family doctor contract service mode,which includes 3 first-level indicators,8 second-level indicators and 36 third-level indicators.The coefficient of variation of the two rounds of expert opinions has remained at a level of 0.2 or below;the coordination coefficient of expert pinions has increased from 0.236 to 0.322,and the opinions have become more consistent and the degree of coordination is better,provide reference for the evaluation of family doctor contract service.Discussion and Suggestion Residents’ participation is the precondition of family doctor contract service.Improving the service ability is the necessary requirement for the sustainable development of the family doctor’s signing service.Establishing and perfecting the relevant operating mechanism is the core content of promoting the signing service of family doctors.The construction of health information system is the guarantee of the continuous development of family doctor’s signing service.Both material and spiritual incentives are the long driving force to promote the development of contract services.