关键词: 家庭医生签约服务, 医生代理理论, 支付方式, 激励

Abstract: Background　Promoting the delivery of contracted family doctor services is an important way to change the traditional delivery pattern of China's primary health services，and an important task for deepening the reform of the pharmaceutical and healthcare system，and a cornerstone of achieving the Healthy China 2030 goals. Reasonable incentive mechanism may significantly ensure that family doctors take initiative at work. However，there are no theoretical analyses of the impact of the current incentive mechanism，especially the changed health insurance reimbursement methods，on practice behaviors of family physicians. Objective　To build up a theoretical framework and a model of family physicians' practice behaviors under the implementation of family doctor system using the principal-agent theory in China. Methods　The principal-agent theory was used to develop a model for analyzing the practice behaviors of family physicians under different health insurance payment methods for family physicians，especially when fee-for-service（FFS） and capitation payments coexist. Results　If the FFS payment system is used，the moral hazard will be inevitable，and family physicians have no incentive to suppress patients' additional needs. If the capitation payment system is used，the total utility or benefit of family physicians will increase，but the utility obtained from patients' health will decrease. The global budget shall be implemented under the premise that the quantity and quality of health services are reasonably designed，otherwise family physicians will have the motivation to treat patients selectively so as to increase their benefits. The income of Chinese family physicians mainly comes from the medical earnings obtained in FFS and the contracted service fee obtained by capitation. Increasing the proportion of contracted service fee can improve the quality of care provided by family physicians. However，the increase in income may not necessarily have a positive effect on the health care quality，since the earnings obtained in FFS account for a large portion of the income. Conclusion　The payment system of family physicians in primary health institutions in China is suggested to be gradually transformed to payment by capitation. At present，family physicians can be encouraged to provide medical services of higher quality by enlarging the proportion of family physicians' contracted service fee in total income.

Key words: Contracted family doctor services, Physician agency theory, Payment mechanism, Incentive