关键词: 家庭医生签约服务, 签而有约, 签约率, 社区卫生服务

Abstract:

Background　In response to the phenomenon of blindly pursuing the contract rate，the national and local governments have issued a series of policy documents，the focus of which has shifted from the pursuit contracting rate to making and keeping the contracted services. Objective　To investigate the status of making and keeping an appointment in residents contracting services delivered by family doctors from a subdistrict of Shanghai，to promote the development of such services. Methods　Data mainly about the contracting of family doctor services，healthcare-seeking in contracted and non-contracted residents in a subdistrict of Shanghai's Jing'an District during 2017—2020 were collected from the subdistrict information system，Jing'an District hospital information system，electronic health records of patients created by family doctors，the online platform of contracted family doctor services，annual reports of community health centers，and so on. Results　The number of contracted residents in the subdistrict in 2020 increased compared to that of 2017（24 485 vs 8 554），so did the contracting rate（36.3% vs 13.8%）. Moreover，the contracting rate in older people increased from 38.7% in 2017 to 70.9% in 2020. The number of contracted hypertension patients rose from 3 409 to 7 271，and that of contracted diabetes patients rose from 1 463 to 3 088. In 2018，the visits of contracted residents in hospitals in the subdistrict numbered 162 640，accounting for a larger percentage of the total patients compared to non-contracted residents. In 2019，the visits of contracted residents in hospitals in the subdistrict numbered 232 772，which also accounted for a larger percentage of the total patients compared to non-contracted residents. During 2017 to 2020，the percentage of contracted residents visiting community health centers（healthcare settings） was above 60% in each year，but that for 2020 showed a decrease compared to that for 2017（62.4% vs 66.5%）. But the percentages of contracted residents visiting secondary and tertiary hospitals ranged from 26%-30%，and 6%-9%，respectively，without significant changes. The annual healthcare cost of contracted residents in community health centers in Jing'an District increased steadily during 2018—2020，with 13.9%，and 14.0% year-over-year growth for 2019，and 2020，respectively. The annual healthcare costs （after conversion） of contracted residents in secondary hospitals in Jing'an District in 2018，2019，and 2020 were 21 854 472.1 yuan，24 843 680.2 yuan，and 26 556 426.3 yuan，respectively，with 13.7%，and 6.9% year-over-year growth for 2019，and 2020，respectively. The healthcare cost status of contracted residents in this district was similar to that of contracted residents in Shanghai. Conclusion　The number of contracted residents in the subdistrict of Jing'an District increased during the period，and more than 60% of them sought healthcare in designated healthcare settings. Moreover，the healthcare cost of them in community health centers showed a stable increase. Although the absolute value of healthcare cost of them in secondary and tertiary hospitals also showed an increase，the growth rate was controlled.

Key words: Contracted family doctor services, Contract and service, Contraction rate, Community health services