关键词: 家庭医生签约服务, 卫生政策, 比较, 内容分析法

Abstract: Objective　To analyze and compare the supportive policies for the delivery of contracted family doctor services（CFDSs） across the provinces（autonomous regions/municipalities） in Chinese mainland，providing a reference for the development of such services.Methods　Using typical sampling，we selected 45 sample cities〔consisting of 4 municipalities，and 41 prefecture-level cities selected from 27 provinces （autonomous regions） with the ratio of 1-2∶1〕.Using the terms "family doctor"/"general practitioner" + "singing a contract" as the title or key words，we searched the official municipal government websites or the same level commissions of health and family planning of these cities，CNKI and Wanfang Data Knowledge Service Platform for policy documents and studies about CFDSs delivered in these cities as of September 30，2017.Content analysis of the extracted data was performed.Results　Totaled 57 consisting of 52 policy documents（from the government websites） and 5 articles（from CNKI and Wanfang Data Knowledge Service Platform） were included.CFDSs were delivered experimentally in public hospitals in 7 cities in the first round，11 cities in the second round，9 cities in the third round，13 cities in the fourth round，and in private hospitals in 5 cities．The policy documents in various cities mainly included coverage goal，receivers and providers，contents and charging mechanism of CFDSs，incentive mechanism of family doctors and so on.For more detail，the similarities of all the cities in delivering CFDSs are as follows：（1）The rates of general and priority populations enjoying CFDSs needed to be achieved as of 2017 were determined.（2）The service populations of CFDSs included the general population，those aged over 65，those with diabetes as well as those with hypertension.（3）CFDSs were offered by the general practitioner（GP） from grassroots medical institutions，either by a sole GP （in 2 cities） or a group of general practitioners （in 43 cities）．（4）Clinical-based and home-based CFDSs were offered.Moreover，differences in delivering CFDSs existed between these cities，which are demonstrated by the following：（1）Contents of CFDSs：4，15，3 cities delivered first-level service package，second-level service package，third-level service package，respectively，6 cities delivered population-specific service package，and 17 cities did not offer classified CFDSs.（2）Criteria for charging for CFDSs：28 cities clearly stipulated the charging criteria for CFDSs while other 17 did not.（3）Specific incentives for family doctors：income allocation，staffing，employment，title promotion，in-service training，awarding，and excellence appraisal for family doctors was defined explicitly in 36，18，5，21，30，28 cities，respectively.Conclusion　The policies for the delivery of CFDSs attached importance to provide services for priority populations，and positively innovated the contracted service package and service forms，but the providers of CFDSs were not multiple and the incentives for family doctors were not satisfactory.In view of this，it is recommended to pay attention to improve the quality of CFDSs，strengthen the technical support for CFDSs，promote signing a contract with multiple-provider coordination team（for enjoying better CFDSs） and improve the incentive mechanism for family doctors.

Key words: Contracted family doctor services, Health policy, Comparison, Content analysis