法律视角下家庭医生签约服务双方的权责研究

目的　了解我国家庭医生签约服务相关法律法规,探讨在实施家庭医生签约服务过程中服务双方的法律权责。方法　于2017年7—8月,在浙江省、安徽省、北京市、上海市4个地区的12家社区卫生服务中心,抽取符合本研究目的的医务人员（家庭医生签约服务团队成员、行政管理人员）389例、社区居民360例进行问卷调查,内容包括受试者基本情况、对家庭医生签约服务权利义务的认知情况。结合问卷调查结果开展德尔菲法,邀请20名专家对家庭医生签约服务双方的权利义务及履行的责任进行评价、修改。结果　回收医务人员有效问卷320份,在列出的20项权利和14项义务中：重要程度排在前3位的权利为“人身安全不受侵犯的权利”（89.7%,287/320）、“获得健康安全工作环境的权利”（87.5%,280/320）、“要求签约患者提供自己真实的信息”（87.5%,280/320）;重要程度排在前2位的义务为“关心、爱护、尊重患者”（90.3%,289/320）、“保守患者的病情及个人隐私,未经允许不得向其他人透露”（90.0%,288/320）。回收社区居民有效问卷342份,在列出的7项权利和10项义务中：重要程度排在前2位的权利为“受到关心、爱护、尊重的权利”（91.5%,313/342）、“获得符合合同规定的诊疗服务的权利”（90.0%,308/342）;重要程度排在前4位的义务为“将自己的身体状况如实告知自己家庭医生团队”（96.5%,330/342）、“将自己身体的变化情况及时告知自己的家庭医生团队”（95.3%,326/342）、“尊重家庭医生团队”（91.8%,314/342）、“与自己的家庭医生团队保持有效沟通”（90.0%,308/342）。根据专家咨询结果,最终确定家庭医生签约服务提供方享有权利16项、履行义务15项;确定家庭医生签约服务接受方享有权利8项、履行义务11项;确定双方在签约服务过程中履行的责任有7项。结论　家庭医生签约服务双方对签约过程中权责的认知存在一定差异,应当理顺并明确家庭医生签约服务双方当事人的权责利关系。

Contractual Rights and Obligations of the Providers and Recipients of the Contracted Family Doctor Services from the Perspective of Law

Objective　To explore the contractual rights and obligations of the providers and recipients of the contracted family doctor services,increasing the perceptions of laws and regulations concerning the family doctor system implemented in China.Methods　The questionnaire surveys were conducted during July to August 2017.The enrolled participants consisted of 389 health workers（including members of the family doctor teams and health administration workers） taken from 12 community health centers（CHCs） in 4 provinces/municipalities（Zhejiang,Anhui,Beijing,and Shanghai） and 360 residents from the service areas of these CHCs.Two sets of self-developed questionnaires（one for the health workers and one for the residents,both including demographic data and perceptions of the contractual rights and obligations arising from the family doctor service contracts） were used in the survey.The contractual rights,obligations and responsibilities of the providers and recipients of contracted family doctor services identified by the surveys were reviewed and modified based on Delphi consultations with 20 experts.Results　Totaled 320 health workers returned responsive questionnaires.According to the survey results,of the 20 rights and 14 obligations listed in the questionnaire,"inviolability of personal safety"（89.7%,287/320）,"have a safe and healthy working environment"（87.5%,280/320）,and "request the contracted residents to provide true personal information"（87.5%,280/320） were ranked as the top three rights,and "concern and care for and respect patients"（90.3%,289/320） and "ensure the confidentiality of the patient's conditions and personal privacy,and only disclose the information to other people with the patient's consent"（90.0%,288/320） were ranked as the top two obligations．Totaled 342 residents returned responsive questionnaires.In accordance with the survey results,of the 7 rights and 10 obligations listed in the questionnaire,"obtain concern,care and respect from health workers"（91.5%,313/342）,and "get the contractual services"（90.0%,308/342） were ranked as the top two rights,and "faithfully inform the contracted family doctor team the conditions of one's own"（96.5%,330/342）,"timely inform the contracted family doctor team the changes in physical conditions of one's own"（95.3%,326/342）,"respect the family doctor team"（91.8%,314/342）,"maintain effective communication with the contracted family doctor team"（90.0%,308/342） were ranked as the top four obligations．With the help of Delphi expert consultations,we finally determined the contractual rights and obligations for the providers（16 rights and 15 obligations） and recipients（8 rights and 11 obligations） of the contracted family doctor services,and 7 contractual responsibilities that both of them should fulfill during the implementation of the family doctor service contracts.Conclusion　The residents and health workers signing the family doctor service contracts showed different perceptions of the contractual rights and obligations.Accordingly,the contractual rights,obligations and responsibilities for both contracting parties should be clearly defined.