签约服务费筹资现状及对家庭医生的薪酬补偿作用分析

目的:分析家庭医生签约服务费筹资现状及其对家庭医生的薪酬补偿作用,为进一步优化签约服务费政策提供依据。方法:在全国层面选择14个区/县开展现场调研,452名家庭医生及团队成员参与问卷调查。结果:平均每个团队获得签约服务费收入由2016年的2.78万元/年增至2018年的3万元/年;家庭医生人均月收入为7 897元,其中35.5%为签约服务费收入。以医保经费筹资为主的地区和有区/县财政经费筹资的地区,签约服务费对家庭医生的薪酬补偿作用较高,最高的地区实现占比61%。结论:签约服务费筹资渠道、体现形式、服务价格、分配机制以及筹资渠道稳定性是影响其薪酬补偿作用的关键。应加快推进各地签约服务费标准制定,形成以医保经费为主的筹资渠道;按城乡发展不同阶段,采取适宜的签约服务费筹资形式;建立科学的绩效薪酬分配机制,加快价格调整和定价机制的建立。

Study on status of contracting service fee and the effect of compensation for family doctors

Objective: To analyze the financing status of contract signing fee for family doctors and its effect on family doctors'' compensation, so as to provide a basis for further optimizing the contracted service fundraising policy. Methods: On-site surveys were conducted in 14 districts/counties nationwide, and 452 family doctors and team members participated in the questionnaire survey. Results: On average, the income generated from contracted service fees by each team of family doctors increased from 27,800RMB/year in 2016 to 30,000RMB/year in 2018; and the average monthly income of family doctors was 7,897RMB, of which 35.5% was from contracted service fee. In areas where medical insurance funding is the main source and in those with district/county financial funding, the contracted service fees have a higher effect on the compensation of family doctors, with the highest proportion accounting for 61%. Conclusions: The composition of financing channels, the form of fees, the price of contract signing, distribution mechanism, and stability of financing channels are the key factors affecting the compensation function of contracted service fees. The development of contracted service fee standards in various places should be speeded up and a financing channel mainly based on medical insurance funds should be formed; appropriate forms of financing the family doctor contract signing fee should be adopted according to different stages of urban and rural development; a scientific performance salary distribution mechanism should be established; and the construction of price adjustment and pricing mechanisms should be accelerated.