健康中国背景下家庭医生签约服务发展中的问题与对策研究  

Problems and Countermeasures in the Development of Contracted Family Doctor Services in Achieving Healthy China Goals

作　　者：付英杰 王健 俞乐欣 闫卫华 孔悦佳 FU Yingjie;WANG Jian;YU Lexin;YAN Weihua;KONG Yuejia(School of Health Care Management/NHC Key Laboratory of Health cEonomics and Policy Research,Shandong University,Jinan 250012,China)

机构地区：[1]山东大学医药卫生管理学院国家卫生健康委员会卫生经济与政策研究重点实验室

出　　处：《中国全科医学》2019年第19期2296-2300,共5页Chinese General Practice

基　　金：国家自然科学基金资助项目(71273156);山东大学齐鲁医学院研究生教育创新计划项目(2017Y03)

摘　　要：家庭医生签约服务是我国新医改的重要任务之一,对实现基层首诊、推进分级诊疗、转变医疗卫生服务模式具有重要意义。本文以健康中国为背景,通过梳理我国家庭医生签约服务的发展历程和相关文献,从家庭医生签约服务的供方、需方及运行机制3个角度,分析其在发展过程中存在的主要问题,包括:基层医疗卫生资源数量及质量不高,居民对签约服务的接受度不高,全科医生培养与培训机制不健全,考核激励机制欠缺,医保支付机制导向性不强,沟通宣传机制和信息化建设不完善。建议进一步提升基层医疗卫生机构的服务能力,完善签约服务政策支持,建立健全考核激励机制,积极推进"互联网+社区医疗"。As one important measure for achieving the medical reform launched in 2009 in China,the delivery of contracted family doctor services plays a key role in the realization of initial consultation in primary care,promotion of hierarchical medical system,and transformation of healthcare delivery models.On the basis of the reviewing of the development and related literature of contracted family doctor services in China,from three perspectives(supplier,demander and implementation mechanism),we analyzed the following major problems existing in the development of the services during the implementation of the Healthy China Initiative:insufficient quantity and inadequate quality of primary healthcare resources,residents’ unsatisfactory acceptance of contracted family doctor services,inadequate growing and training mechanisms for general practitioners(GPs),lack of performance assessment and incentive mechanisms for GPs,insufficient strength of medical insurance payment mechanism in guiding patients’ healthcare seeking in primary care,and imperfect publicizing mechanism and information construction for contracted family doctor services.Accordingly,we put forward the following suggestions:further enhancing the service capacities of primary healthcare institutions,improving the policy support for the implementation of contracted family doctor services,establishing and improving the performance assessment and incentive mechanisms for GPs,and actively promoting the development of Internet-based community healthcare.

关 键 词：家庭医生签约服务 分级诊疗 社区卫生服务 健康中国 发展历程 现状 问题 对策 

分 类 号：R197[医药卫生—卫生事业管理]