Research On The Problem Of "Signing Up But Not Contracting" In The Implementation Of Family Doctor Contracting Service Policy

The implementation of the family doctor contract service policy is an important way to protect and maintain the health of the public,a cornerstone of the Health China 2030 strategy,and an important measure to achieve graded treatment and rational use of medical resources.However,in the process of policy implementation,while the contracting rate of family doctors has been increasing,the problem of "signing but not contracting" is also prominent.Based on the M-Mc Laughlin model of mutual adjustment in policy implementation,this paper builds a "contextualinteraction" analysis framework and analyzes the problem of "signing up but not making an appointment" by taking S Community Health Service Center in Chengdu High-tech District as an example.This paper concludes that the reasons for "signing but not contracting" of family doctor contracting services can be explained in four aspects: First,in the political context,the health insurance system,incentive system,and assessment system implemented in the implementation of family doctor contracting services policy are not perfect,and the higher-level government departments and secondand third-level hospitals are not satisfied with the funding,manpower,and equipment of community health service centers.Secondly,in the economic context,the implementation goals of the family doctor contracting service policy are contradictory because of the different consideration of economic interests,political interests,personal interests,and costs among the subjects;thirdly,in the social context,the natural structure of the population,social structure,and geographical structure affect the implementation of the community health policy.Third,in the social context,the natural,social,and geographical structures of the population affect the choice of personalized contracting services in the community health service center,and the imbalance between supply and demand,as well as the social effect of acquaintances is limited to the contracting stage of the residents,which is not obvious in the compliance stage;fourth,in the cultural context,the profound influence of traditional concepts and the lack of policy publicity lead to the lack of active use of services by contracted residents.Through the analysis of the current situation of contracting services in S community health service center,the author proposes that in order to improve the current situation of "signing but not contracting",it is necessary to gradually improve the service mechanisms in the process of implementing the family doctor contracting service policy,such as constructing an effective incentive mechanism for contracting services,improving the contracting performance assessment mechanism and optimizing the contracting resource supply mechanism,so as to provide an effective implementation of the family doctor contracting service policy.In addition,we need to continuously improve the quality of medical and health services in community health service centers,introduce third-party private institutions,provide better,more and better services for contracted residents,build the competitiveness of community health service centers themselves,increase contracted income and meet economic Leveraging on science and technology,we build an "Internet+" home signing platform to break the social regional restrictions and provide residents with life-cycle health management services and intelligent medical and health care services,and at the same time open up the connection of the home signing platform between regions to solve the problems of cross-regional signing and medical consultation,and open up the platform connection between the medical and health system and the medical insurance system to give full play to the medical insurance system.The platform connection between the medical and health system and the medical insurance system will give full play to the role of the medical insurance system,so that the contracted residents can effectively enjoy the medical insurance benefits;continuously optimize the policy implementation environment of family doctor contracted services,enhance the awareness of the responsibility of family doctors,increase the policy publicity,improve the residents’ awareness and recognition of the policy,and gradually change the residents’ traditional concept of medical treatment.