Abstract: Despite the progress in contracted family doctor services（CFDSs） has been made in recent years，there still exist contracts with little consumption，which affects the implementation of the hierarchical medical system.We analyzed the reasons of residents signing the contract with family doctors but not making an appointment from a supply-demand perspective，which include the following：supply-side factors：family doctors are in serious shortage and underpaid，the implementation of the CFDSs lacks of corresponding supports as well as reasonable assessment mechanism；demand-side factors：residents lack of a good knowledge of the CFDSs and distrust the capabilities of family doctors，and medical insurance policies have underplayed their role in guiding health-seeking behaviors of residents properly.Therefore，we proposed the following recommendations：making the general practice as a career be more attractive，expanding the workforce and improving the capabilities of general practitioners；advancing the attractiveness of the CFDSs，and formulating the service standards and procedures；Giving full play to the lever role of medical insurance in promoting the development of the CFDSs；intensifying the publicity of the CFDSs.

Key words: Contracted family doctors services, Hierarchical medical system, Grassroots medical institutions, Singing without appointment

摘要： 近年来我国的家庭医生签约服务开展已取得一定进展，但“签而不约”的现象依然存在，直接影响了分级诊疗制度的实施效果。本文分别从供方和需方角度对家庭医生签约服务“签而不约”的原因进行分析，包括：全科医生总体数量严重不足、收入与工作量不符，签约服务缺乏配套支持，考核机制不合理；居民对签约服务缺乏深入了解，对全科医生不信任，医保政策未充分发挥引导患者作用。建议进一步提升全科医生的岗位吸引力，壮大全科医生队伍，提升全科医生的服务能力；提升签约服务吸引力；制定签约服务标准和服务流程；充分发挥医保的“杠杆”作用；加大宣传力度。

关键词: 家庭医生签约服务, 分级诊疗, 基层医疗卫生机构, 签而不约