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

  目的  比较已签约和未签约居民卫生服务利用差异，为进一步优化家庭医生服务制度提供参考。  方法  利用2018年江苏省第六次卫生服务调查中家庭健康调查表中数据，采用2周患病率、高血压和糖尿病患病率、其他慢性病患病率反映卫生服务需求情况，采用2周就诊率、住院率、自我治疗率、自行购药率、医疗费用及就诊和住院机构反映卫生服务利用情况。  结果  签约居民2周患病率、慢性病患病率及高血压、糖尿病患病率均高于非签约居民，差异具有统计学意义（P < 0.05）；签约居民住院率、自我治疗率、自行购药率均高于非签约居民，差异具有统计学意义（P < 0.05）；签约居民与非签约居民在首诊机构和住院机构的选择上差异具有统计学意义（P < 0.05）。  结论  签约居民卫生服务需求更高，同时卫生服务利用水平也更高；签约居民更倾向于去基层就诊；签约对医疗费用的控制作用尚未体现。

Disparity in health service utilization between residents with and without contracted family doctor services in Jiangsu province

  Objective  To compare the disparity in health service utilization between the residents with and without contracted family doctor services and to provide evidences for improving family doctor service system.  Methods  The data of the study were from the Sixth National Health Service Survey conducted in 2008. Valid information on health service demand and utilization were collected via questionnaire interviews from a total 4 398 urban and rural residents living in 6 prefectures/counties/districts acorss Jiangsu province in 2008.  Results  The proportion of the residents with and without contracted family doctor services were 42.81% (n = 1 883) and 57.19% (n = 2 515), respectively. Compared to those without contracted family doctor services, the residents with the services reported significantly higher rate of two-week prevalence, the prevalence rates of chronic disease, hypertension and diabetes, and the rates of hospitalization, self medication and buying medicine by themselves (P < 0.05 for all).  Conclusion  In Jiangsu province, the urban and rural residents with contracted family doctor service have both higher health care demands and medical services utilization and the residents are more likely to visit doctors in grassroots medical institutions in comparison with the residents without contracted family doctor services. The effect of contracted family doctor services on reducing medical expenses is not yet observed.