基于供方视角的安徽省家庭医生签约服务研究  

A survey of the contracted family doctor services in Anhui Province from the perspective of the supplier

作　　者：吴燕[1] 邵芊 王子荆 秦侠[1] 陈若陵[1] 胡志[1,2] WU Yan;SHAO Qian;WANG Zijing;QIN Xia;CHEN Ruoling;HU Zhi(School of Health Management,Anhui Medical University,Hefei,Anhui 230032,China;Anhui Health Development Strategy Research Center,Hefei,Anhui 230032,China)

机构地区：[1]安徽医科大学卫生管理学院,安徽合肥230032 [2]安徽省健康发展战略研究中心,安徽合肥230032

出　　处：《中国农村卫生事业管理》2020年第5期312-318,共7页Chinese Rural Health Service Administration

基　　金：安徽省高校健康智库重点项目(0503011226)。

摘　　要：目的从供方视角了解安徽省家庭医生签约服务的实施概况,为更好推进签约服务提供依据。方法采用分层和偶遇随机抽样,关键知情人问卷和访谈调查。结果基层卫生机构方面:66.7%样本机构的每万人全科医师数超过2017年全国平均数值水平;样本机构的家庭医生团队医护比未达成1∶1;对家庭医生团队服务人员调查:82.2%成员认为工作时间有延长,60.7%人表示签约服务前后收入却没有变化。成员总体满意度得分为3.20±0.726,文化程度是满意度的影响因素,职业发展维度对满意度影响最大。通过关键知情人访谈得出,签约存在问题在于签约服务配套政策的不全面和不完善,需要强化政府在签约服务上的管理职能,完善考核奖惩机制和稳定基层医生队伍。结论安徽省家庭医生签约服务面临着卫生人力不足、结构不协调、家庭医生工作量大回报低、绩效激励机制不完善、信息平台机制不健全和经费补助分配权归属不明的问题,需要对提供方给予足够关注,提高团队成员的满意度,保证签约服务高质量运行。Objective To explore the general situation of the implementation of contracted family doctor services in Anhui Province from the perspective of the supplier, and to provide references for a better promotion. Methods Stratified and accidental random samplings were adopted for key informant questionnaire and interview surveys. Results In terms of primary health institutions, the number of general practitioners per 10,000 in 66.7% of the sample institutions exceeded the national average in 2017;the doctor-nurse ratio in family doctor team in the sample institutions did not reach 1 ∶1. The survey results showed that 82.2% of the team members thought that their working hours had been extended, and 60.7% said that their income did not change after signing of contract. The overall satisfaction score of members was 3.20 ± 0.726. Education level was the influencing factor of satisfaction, and the dimension of professional development had the greatest impact on satisfaction. Key informant interview indicated that the problem with signing of contract resulted from the incompleteness and imperfection of the supporting service policies, thus it was necessary to strengthen the government’s administrative function, improve the reward and punishment mechanism, and stabilize the grassroots doctor team. Conclusions Contracted family doctor services in Anhui Province face the problems including inadequate health manpower, imbalanced structure, heavy workload, low rewards, imperfect performance incentive mechanism, incomplete information platform mechanism, and unclear ownership of funding subsidies. Thus, the supplier needs to be given adequate attention to improve the satisfaction of team members and to ensure the high-quality operation of contracted services.

关 键 词：供方 签约服务 影响因素 发展挑战 

分 类 号：R192.3[医药卫生—卫生事业管理]