Study On The Performance Evaluation Index System Of Family Doctor Contracting Service In Guangzhou

1.Research BackgroundIn the early stage of the development of community health services,grassroots hospitals and some second-level hospitals were encouraged to transform into community health services institutions and set strict access conditions.The majority of clinicians were trained to general practitioners,whom provided independently outpatient services.In 2011,it began to build a system of general practitioners,and the practice mode of general practitioners was reformed in most parts of China.In 2016,the government reformed the supply model of community health services after summarizing the experience of general practitioner practice reform,and implemented family doctor contracting services.In addition,the Healthy China strategy marks a long-term plan for the development of health which puts forward new requirements for the development of community health services.In 2013,the municipal government started trying to implement family doctor services in Guangzhou,which was praised by the state council in 2018 due to the typical experience of creating high-quality service.With the gradual advancement and deepening of family doctor contracting service,how to monitor and evaluate the effect has become an important concern for municipal government.Judging from the current research on family doctor services,most of them focus on the implementation status,cognitive evaluation,utilization requirements,foreign general practice experience and effects,etc.In view of the fact that signing service is an innovative service mode of community health service,it have not been defined clearly about its connotation,policy value function and performance evaluation conceptual framework in previous studies.This study raises the following questions and carries out preliminary research:First,it sorts out the development process,evolution logic and policy values of family doctor contracting services in China.Second,it discusses the concept connotation and tries to proposing the conceptual framework of performance evaluation of family doctors contracting services in China.Third,an evaluation tool is constructed which is in line with reality and can measure the realization degree of family doctors contracting services in Guangzhou.2.Research ObjectivesIn order to design a tool of family doctor contracting service performance evaluation in Guangzhou,this study analyzes the development process,evolution logic and policy values of family doctor contracting services in China.It attempts to define the connotation of contracting services from the perspective of supply-side reform,,comes up with the conceptual framework of performance evaluation of family doctor contracting services.Based on the practice of family doctor services,a feasible index system of performance evaluation of family doctors contracting service is designed in Guangzhou.3.Research MethodsBy means of policy tool method and policy analysis model,it analyzes the development process,evolution logic and policy values of family doctor contracting services in China since 1997 with the help of the China Health Statistics Yearbook from 2003-2019.Diamond Model is used to define conceptual connotation.On the basis of a comparative analysis of common international frameworks for healthcare performance evaluation,the conceptual framework of performance evaluation of family doctor contracting service is established,which divided it into five subscales(structure,input,process,output,outcomes)using content analysis.Questionnaire survey is used to analyze the current situation of family doctors service and performance evaluation needs in Guangzhou:Through the investigation of 60 primary health institutions,the status quo and effectiveness of family doctor services were understand;An survey of 185 primary health managers whom are main stakeholders was conducted to investigate the cognition of the current situation and the demands of performance evaluation of family doctor contracting service.Delphi,ahp were used to design the performance evaluation tools of family doctors contracting service in Guangzhou.Statistical methods,such as descriptive analysis,chi-square analysis,structural equation model and other statistical methods were used to analyze and summarize the collected data.4.Research Results4.1 The study objectively analyzes the evolution and values of community health service policies in China:lt has gone through the service platform built stage centered on the function transition,the exploration and experimenting phase focused on structural improvement,the promotion and construction stage focused on the scale expansion,and the normalizely development centered on the improvement of service quality.lt follows the evolution logic of the policy formation mechanism dominated by the national institutional planning,the policy value orientation oriented by concentric development,the policy implementation process guaranteed by the policy tool as the strategy choice,and the policy discourse rules with the trend of diversification.The main challenges faced by the reform of primary health care including the unbalanced and insufficient supply of health service system,residents have a low sense of gain and a heavy burden of medical treatment due to the rapidly increasing in medical expenses,and the hierarchical medical order has not been formed with unreasonable behaviors seeking medical care.The practical significance and value including the important fulcrum of leveraging health service system reform,guarantee for the implementation of hierarchical medical,the means to adjust and control medical expenses,the way to improve health literacy and health status and the measure to implement the construction of healthy China and improve the sense of gain in health services.4.2 The conceptual framework of performance evaluation for family doctor contracting service was built.First,the concept connotation of family doctor contracting service:it is regarded as the supply-side reform to improve the competitiveness of community health services and the embodiment of the integrated reform in primary health.The internal elements of the concept:The factors of production are mainly general practitioners at community medical institutions,specialists in hospitals and the policy guarantee mechanism which is embodied in the aspects of financing,service chain and standard,compensation and effect supervision;The factors of demand condition mainly include the structure referring to the diverse needs of the contracted residents,scale referring to the number of people who sign up for service and content items that sign up for service and growth which means that the contracted residents’ pursuit of the content and quality of personalized health needs is improving day by day.Related and supporting industry elements are mainly based on the "four-ring linkage" service system of general practice in primary medical,which includes specialized medical service,public health service and grassroots autonomous organizations.Enterprise strategy,structure and competitive factors:it refers to how primary medical institutions innovate family doctor services,and how they cope with the competition of specialized medical and health services such as large hospitals.Second,It developed clear ideas for constructing the conceptual framework of performance evaluation of family doctor contracting service inciuding five subscales(structure,input,process,output,outcomes).The structure focuses on the implementation of government functions and roles,which is reflected in the arrangement and management of institutional resources.The input reflects the special resource.The process reflects the continuous service process such as service provision,acquisition and interaction.The output can be controlled by the service provider and focuses on the short-term service results.The outcomes focus on the influence of resource input after specific activities and the medium-and long-term service effect.4.3 The performance evaluation index system of family doctor contracting service was designed in Guangzhou.First,it comprehensively analyzed the current work and cognitive status of performance evaluation needs of Family Doctor Contracting Service in Guangzhou.It is known that:①Basic situation:the coverage rate of contracting services basically meets the national requirements,the supply and utilization of personality packages and basic packages are relatively low;The number of general practitioners per 10,000 residents population has basically reached the national requirement by 2020 while the proportion structure of the core members of the family doctor team(general practitioners,nurses and public health doctors)needs to be further improved.The family doctor’s performance income ratio is not high.The workload of contracting service is not high.The output of contracting services has certain results.②In terms of the current situation of work cognition,the vast majority of respondents believe that the cognitive degree of the demand side(knowledge and trust)and the quantity and quality of the supplier are the main factors restricting the work,the support to promote the contracting work should mainly focus on improving the organizational system and resource input of the contracting service;It is not effective quickly but play an important role in changing residents’ health behaviors,medical treatment behaviors and promoting graded diagnosis and treatment.③In terms of the demand for the content of performance evaluation,the vast majority of respondents believe that the key content should focus on the resource input and guarantee,improvement and implementation of organizational system and institutional system,publicity and promotion of contract service,the team building and the service quality.however,the assessment of the satisfaction,the changes of the health behavior and medical treatment behavior,the utilization and convenience of the contracting service should not be ignored.Second,the performance evaluation index system of Family Doctor Contracting Service in Guangzhou was designed.Based on the theory analysis of family doctor contracting service,the candidate index library of performance evaluation system was designed.Delphi method,AHP,field verification,subjective evaluation are used to design the performance evaluation tools of family doctors contracting service in Guangzhou,which contains 4 first-level indicators,10 second-level indicators and 34 third-level indicators,so as to provide a set of measuring tools for the government to monitor the effectiveness of family doctor service reform in Guangzhou.