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| 基于内容分析法的我国家庭医生签约服务政策分析 | |
| 引用本文： | 许航,曹志辉,吴爽. 基于内容分析法的我国家庭医生签约服务政策分析[J]. 中国全科医学, 2018, 21(22): 2647-2654. DOI: 10.12114/j.issn.1007-9572.2018.22.001 |
| 作者姓名： | 许航 曹志辉 吴爽 |
| 作者单位： | 063000河北省唐山市,华北理工大学管理学院 *通信作者：吴爽,讲师;E-mail：wushuang198555@126.com |
| 基金项目： | 基金项目：教育部人文社会科学研究青年基金项目（17YJCZH188）;河北省高等学校人文社科研究项目（SQ171017） |
| 摘 要： | 目的 比较和分析我国各省（自治区、直辖市）家庭医生签约服务的政策,为各地完善家庭医生签约服务政策提供参考。方法 采用典型抽样法,在我国31个省（自治区、直辖市）各抽取1~2个地级市（直辖市）,共45个市作为样本市,以各个市的家庭医生签约服务政策文件为研究对象。访问我国45个样本市的政府官方网站或同级卫生计生委官方网站以及中国知网（CNKI）和万方数据知识服务平台,以“家庭医生”/“全科医生”+“签约”为题名或关键词在官方网站和数据库进行检索,以获取与家庭医生签约服务相关的政策文件和相关文献。检索时间均为建库（网站）至2017-09-30。从纳入的文献中提取各地区家庭医生签约服务的政策措施和具体内容,并采用内容分析法进行分析。结果 共获取家庭医生签约服务相关的政策文献52篇、数据库文献5篇,共计57篇。第一、二、三、四批国家级公立医院改革试点市及非公立医院改革试点市分别有7、11、9、13、5个市。各市家庭医生签约服务政策的主要内容包括家庭医生签约服务覆盖率目标、签约对象与服务主体、签约服务内涵及收费机制、家庭医生的激励机制等方面。（1）45个市均明确了到2017年一般人群和重点人群的签约服务覆盖率目标。（2）45个市的家庭医生签约服务对象覆盖了一般人群及65岁以上老年人、糖尿病、高血压患者;45个市的家庭医生由基层医疗卫生机构全科医生担任;43个市实施团队签约形式,2个市实施个人签约形式。（3）45个市在签约服务内容上存在一定差异,提供一级服务包、二级服务包、三级服务包、分人群服务包、无具体分类服务的市分别有4、15、3、6、17个;45个市的家庭医生提供门诊和上门服务;28个市明确规定了签约服务收费标准,17个市未明确收费标准。（4）针对家庭医生的收入分配、人员编制、人员聘用、职称晋升、在职培训、评奖推优做出明确规定的城市分别有36、18、5、21、30、28个。结论 我国各地家庭医生签约服务政策优先覆盖重点人群,积极创新签约服务包与服务模式,签约服务提供主体较为单一,家庭医生的激励机制尚不完善,建议重视签约服务质量、强化签约服务技术支撑、提倡组合签约模式、完善家庭医生综合激励机制等。 |
| 关 键 词： | 家庭医生签约服务 卫生政策 比较 内容分析法 |
Content Analysis of China's Policies for the Delivery of Contracted Family Doctor Services |
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| XU Hang,CAO Zhi-hui,WU Shuang. Content Analysis of China's Policies for the Delivery of Contracted Family Doctor Services[J]. Chinese General Practice, 2018, 21(22): 2647-2654. DOI: 10.12114/j.issn.1007-9572.2018.22.001 | |
| Authors: | XU Hang CAO Zhi-hui WU Shuang |
| Affiliation: | College of Management,North China University of Science and Technology,Tangshan 063000,China *Corresponding author：WU Shuang,Lecturer;E-mail：wushuang198555@126.com |
| Abstract: | Objective To analyze and compare the supportive policies for the delivery of contracted family doctor services（CFDSs） across the provinces（autonomous regions/municipalities） in Chinese mainland,providing a reference for the development of such services.Methods Using typical sampling,we selected 45 sample cities〔consisting of 4 municipalities,and 41 prefecture-level cities selected from 27 provinces （autonomous regions） with the ratio of 1-2∶1〕.Using the terms "family doctor"/"general practitioner" + "singing a contract" as the title or key words,we searched the official municipal government websites or the same level commissions of health and family planning of these cities,CNKI and Wanfang Data Knowledge Service Platform for policy documents and studies about CFDSs delivered in these cities as of September 30,2017.Content analysis of the extracted data was performed.Results Totaled 57 consisting of 52 policy documents（from the government websites） and 5 articles（from CNKI and Wanfang Data Knowledge Service Platform） were included.CFDSs were delivered experimentally in public hospitals in 7 cities in the first round,11 cities in the second round,9 cities in the third round,13 cities in the fourth round,and in private hospitals in 5 cities．The policy documents in various cities mainly included coverage goal,receivers and providers,contents and charging mechanism of CFDSs,incentive mechanism of family doctors and so on.For more detail,the similarities of all the cities in delivering CFDSs are as follows：（1）The rates of general and priority populations enjoying CFDSs needed to be achieved as of 2017 were determined.（2）The service populations of CFDSs included the general population,those aged over 65,those with diabetes as well as those with hypertension.（3）CFDSs were offered by the general practitioner（GP） from grassroots medical institutions,either by a sole GP （in 2 cities） or a group of general practitioners （in 43 cities）．（4）Clinical-based and home-based CFDSs were offered.Moreover,differences in delivering CFDSs existed between these cities,which are demonstrated by the following：（1）Contents of CFDSs：4,15,3 cities delivered first-level service package,second-level service package,third-level service package,respectively,6 cities delivered population-specific service package,and 17 cities did not offer classified CFDSs.（2）Criteria for charging for CFDSs：28 cities clearly stipulated the charging criteria for CFDSs while other 17 did not.（3）Specific incentives for family doctors：income allocation,staffing,employment,title promotion,in-service training,awarding,and excellence appraisal for family doctors was defined explicitly in 36,18,5,21,30,28 cities,respectively.Conclusion The policies for the delivery of CFDSs attached importance to provide services for priority populations,and positively innovated the contracted service package and service forms,but the providers of CFDSs were not multiple and the incentives for family doctors were not satisfactory.In view of this,it is recommended to pay attention to improve the quality of CFDSs,strengthen the technical support for CFDSs,promote signing a contract with multiple-provider coordination team（for enjoying better CFDSs） and improve the incentive mechanism for family doctors. |
| Keywords: | Contracted family doctor services Health policy Comparison Content analysis |
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