The Effectiveness of Supportive Policies for the Implementation of Contracted Family Doctor Services in China：Current Status and Potential Problem Analysis

doi:10.12114/j.issn.1007-9572.2019.00.539

Abstract

Abstract: 1.300070天津市，天津医科大学公共卫生学院　2.300387天津市，天津工业大学经济与管理学院
*通信作者：杜汋，讲师；E-mail：duyue@tmu.edu.cn
Background　At present，the contracted family doctor services are in full swing in the national primary medical institutions，and it is of great significance to scientifically and accurately evaluate the effect of the contracted family doctor services policy.Objective　To analyze the current situation and potential problems of supportive policies for the implementation of contracted family doctor services in China.Methods　In November 4，2018，the family doctor was used as the key word to search the literature related to the evaluation of the policy effect of the contract service of Chinese doctors in CNKI，and the retrieval time was from the establishment of the database to 2018.The publishing time，research object，data，research content，statistical methods and conflicts of interest were collected，and the existing problems from the macro and micro levels were analyzed.Results　Finally，27 articles were included to evaluate the effect of contracted family doctor services policy.Among them，16（59.3%） were community residents，10（37.0%） were chronic patients；17（63.0%） were in Shanghai and 6（22.2%） were in Beijing；22（81.5%） were using data from questionnaires which were not open to access，and 5（18.5%） were from internal data of government，hospitals and other relevant departments.Literature research mainly involves the impact of promoting contracted family doctor services on controlling the unreasonable growth of medical expenses，promoting the formation of hierarchical diagnosis and treatment pattern，and improving residents' satisfaction.Macro-level problems include unbalanced geographical distribution of the studies，and insufficient level of causal reasoning.Micro-level problems include significant differences between contracted and non-contracted groups，unrepresentative samples，inappropriate regression model construction and nonstandard research designs.Conclusion　In the future，the causal reasoning of relevant research should be strengthened，and the balance and sufficiency of related research should be emphasized.

Key words: Contracted family doctor services, Health policy, Assessment of policy effectiveness, Current status

摘要： 背景　目前，家庭医生签约服务在全国基层医疗机构开展得如火如荼，对家庭医生签约服务政策效应进行科学、准确地评估具有重要意义。目的　分析我国家庭医生签约服务政策评估现状及潜在问题。方法　于2018-11-04，采用“家庭医生”为主题词系统检索中国知网中与家庭医生签约服务政策效应评估有关的文献，检索时间为建库至2018年。收集合格文献的发表时间、研究对象、数据资料、研究内容、统计方法和利益冲突等，并从宏观和微观层面分析相关研究中存在的问题。结果　最终纳入27篇家庭医生签约服务政策效应评估文献。其中16篇（59.3%）文献研究对象为社区居民，10篇（37.0%）为慢性病患者；17篇（63.0%）文献研究地区为上海，6篇（22.2%）为北京；22篇（81.5%）文献使用的数据资料来源于不可开放获取的问卷调查数据，5篇（18.5%）来源于政府、医院等有关部门的内部数据；文献研究内容主要涉及推进家庭医生签约服务对控制医疗费用不合理增长、促进分级诊疗格局形成、提高居民满意度等方面的影响。从宏观层面上，相关研究存在着各地区发展不平衡，亟待强化因果推理等问题；从微观层面上，相关研究存在着签约群体与未签约群体组间不均衡、样本选择不具有代表性、回归模型设置错误、研究设计不规范等问题。结论　未来应强化家庭医生签约服务政策效应评估研究的因果推理，并注重相关研究的平衡性、充分性。

关键词: 家庭医生签约服务, 卫生政策, 政策效应评估, 研究现状

SUN Huajun1,ZHANG Lingling1,TIAN Hui2, et al. The Effectiveness of Supportive Policies for the Implementation of Contracted Family Doctor Services in China：Current Status and Potential Problem Analysis[J]. Chinese General Practice, 2019, 22(34): 4172-4178. DOI: 10.12114/j.issn.1007-9572.2019.00.539.
孙华君,张玲玲,田慧等. 中国家庭医生签约服务政策效应评估研究的现状和潜在问题[J]. 中国全科医学, 2019, 22(34): 4172-4178. DOI: 10.12114/j.issn.1007-9572.2019.00.539.

References

［1］国务院医改办.关于推进家庭医生签约服务的指导意见［EB/OL］．（2016-05-25）［2019-07-26］．http://www.gov.cn/xinwen/2016-06/06/content_5079984.htm.
［2］国家卫生健康委员会.关于规范家庭医生签约服务管理的指导意见［EB/OL］．（2018-09-29）［2019-07-26］．http://www.nhc.gov.cn/jws/s7874/201810/be6826d8d9d14e849e37bd1b57dd4915.shtml.
［3］刘向红．“合同式健康全程管理示范干预”效果及影响因素研究［J］．中国全科医学，2005，8（14）：1131-1133．DOI：10.3969/j.issn.1007-9572.2005.14.004．
LIU X H．A study of the effect and influential factors on the intervention demonstration of all the processes in a contract health management［J］．Chinese General Practice，2005，8（14）：1131-1133．DOI：10.3969/j.issn.1007-9572.2005.14.004.
［4］杜雪平，董建琴，钱宁．北京市月坛社区卫生服务中心家庭医生责任制实施效果评价［J］．中国全科医学，2008，11（19）：1811-1812．DOI：10.3969/j.issn.1007-9572.2008.19.038．
DU X P，DONG J Q，QIAN N．Effect of practicing family doctor responsibility system in Yuetan Community Health Service Center of Beijing［J］．Chinese General Practice，2008，11（19）：1811-1812．DOI：10.3969/j.issn.1007-9572.2008.19.038．
［5］罗红艳，陈硕，王伟，等．青羊区家庭医生服务效果的探索与实践［J］．中国卫生事业管理，2011，28（9）：653-661．DOI：10.3969/j.issn.1004-4663.2011.09.005．
LUO H Y，CHEN S，WANG W，et al．Studying on the effect of family doctor practicing in Qingyang District of Chengdu［J］．Chinese Health Service Management，2011，28（9）：653-661．DOI：10.3969/j.issn.1004-4663.2011.09.005．
［6］吴浩，贾鸿雁，刘秀梅，等．方庄家庭医生式服务团队的构建及服务效果研究［J］．中国全科医学，2014，17（7）：773-776．DOI：10.3969/j.issn.1007-9572.2014.07.011．
WU H，JIA H Y，LIU X M，et al．Construction and effect of the family doctor service model in Fangzhuang［J］．Chinese General Practice，2014，17（7）：773-776．DOI：10.3969/j.issn.1007-9572.2014.07.011.
［7］吴欢云，张伟东，吴菁，等．家庭医生责任制下城市远郊社区卫生服务模式的探索与实践［J］．中国全科医学，2014，17（1）：22-24．DOI：10.3969/j.issn.1007-9572.2014.01.008．
WU H Y，ZHANG W D，WU J，et al．Management of suburban community health services within a family doctor-based community healthcare system［J］．Chinese General Practice，2014，17（1）：22-24．DOI：10.3969/j.issn.1007-9572.2014.01.008．
［8］王皎，姜明霞，孙利华，等．家庭医生与贫困老人签约服务健康管理效果研究［J］．中国全科医学，2014，17（13）：1547-1550．DOI：10.3969/j.issn.1007-9572.2014.13.025．
WANG J，JIANG M X，SUN L H，et al．The effect of contracted health management service model between family physicians and the poor elderly［J］．Chinese General Practice，2014，17（13）：1547-1550．DOI：10.3969/j.issn.1007-9572.2014.13.025．
［9］肖筱，袁立，周昌明，等．推行家庭医生签约对社区卫生服务利用的影响［J］．中国卫生资源，2015，18（1）：64-67．DOI：10.13688/j.cnki.chr.2015.14158．
XIAO X，YUAN L，ZHOU C M，et al．Influence of family physician contract services on utilization of community health services［J］．Chinese Health Resources，2015，18（1）：64-67．DOI：10.13688/j.cnki.chr.2015.14158.
［10］沈世勇，吴忠，张健明，等．上海市家庭医生制度的实施效应研究［J］．中国全科医学，2015，18（10）：1132-1137．DOI：10.3969/j.issn.1007-9572.2015.10.008．
SHEN S Y，WU Z，ZHANG J M，et al．Effect of the implementation of family doctor system in Shanghai［J］．Chinese General Practice，2015，18（10）：1132-1137．DOI：10.3969/j.issn.1007-9572.2015.10.008．
［11］莫瑞豪，曾润颜，黄胜海，等．深圳市福田区家庭医生制服务对居民社区首诊率的影响研究［J］．中国全科医学，2015，18（10）：1142-1144．DOI：10.3969/j.issn.1007-9572.2015.10.010.
MO R H，ZENG R Y，HUANG S H，et al．Effect of family doctor service on ratio of community first diagnosis of contracted patients in Futian District，Shenzhen［J］．Chinese General Practice，2015，18（10）：1142-1144．DOI：10.3969/j.issn.1007-9572.2015.10.010.
［12］邱宝华，黄蛟灵，梁鸿，等．家庭医生签约服务利用与满意度的比较研究［J］．中国卫生政策研究，2016，9（8）：31-36．
DOI：10.3969/j.issn.1674-2982.2016.08.006．
QIU B H，HUANG J L，LIANG H，et al．A comparative study on the health services utilization and satisfaction of the family doctor service［J］．Chinese Journal of Health Policy，2016，9（8）：31-36．DOI：10.3969/j.issn.1674-2982.2016.08.006.
［13］裴宇慧，王刚．社区慢性病人家庭医生服务路径干预效果评价［J］．中国公共卫生，2016，32（7）：972-974．DOI：10.11847/zgggws2016-32-07-25．
PEI Y H，WANG G．Intervention effect of family doctor service approach among community chronic disease patients［J］．Chinese Journal of Public Health，2016，32（7）：972-974．DOI：10.11847/zgggws2016-32-07-25．
［14］陈翔．家庭医生制服务模式实施前后家庭病床服务情况的比较研究［J］．中国全科医学，2016，19（4）：466-469．DOI：10.3969/j.issn.1007-9572.2016.04.023．
CHEN X．Comparative study of home sickbed service between before and after the implementation of family doctor service system［J］．
Chinese General Practice，2016，19（4）：466-469．DOI：10.3969/j.issn.1007-9572.2016.04.023．
［15］高文娟，陈碧华，赵立宇．社区“三色阶梯”长处方管理模式的探索与效果研究［J］．中国全科医学，2016，19（7）：757-761．DOI：10.3969/j.issn.1007-9572.2016.07.004．
GAO W J，CHEN B H，ZHAO L Y．Exploration and effect of
"tricolor ladder" long-prescription management mode in community［J］.Chinese General Practice，2016，19（7）：757-761．DOI：10.3969/j.issn.1007-9572.2016.07.004．
［16］芦炜，张宜民，梁鸿，等．基于需方的家庭医生签约服务实施效果评价：以慢性病为重点［J］．中国卫生政策研究，2016，9（8）：23-30．DOI：10.3969/j.issn.1674-2982.2016.08.005.
LU W，ZHANG Y M，LIANG H，et al．The performance evaluation based on the demand side of the family doctor contract service：a focus on chronic diseases［J］．Chinese Journal of Health Policy，2016，9（8）：23-30．DOI：10.3969/j.issn.1674-2982.2016.08.005.
［17］陈翔，黄蛟灵，田文华．家庭医生制度实施后居民社区门诊就诊状况分析［J］．中国卫生资源，2017，20（2）：142-145.DOI：10.13688/j.cnki.chr.2017.16310．
CHEN X，HUANG J L，TIAN W H．The analysis of residents community outpatient medical condition under family doctor system
［J］．Chinese Health Resources，2017，20（2）：142-145．DOI：10.13688/j.cnki.chr.2017.16310.
［18］朱兆芳，赵梦，孙广宁，等．北京市社区居民家庭医生式服务干预效果评价［J］．中国全科医学，2017，20（13）：1549-1553．DOI：10.3969/j.issn.1007-9572.2017.13.005．
ZHU Z F，ZHAO M，SUN G N，et al．Evaluation of interventional effects of family doctor service on community residents in Beijing
［J］．Chinese General Practice，2017，20（13）：1549-1553．
DOI：10.3969/j.issn.1007-9572.2017.13.005.
［19］蔡利强，侯进，陆新建．家庭医生签约服务对2级高血压患者血压和费用的效果评价［J］.中国全科医学，2017，20（s2）：245-247．DOI：CNKI:SUN:QKYX.0.2017-S2-094．CAI L Q，HOU J，LU X J． Effect of family doctor signing service on blood pressure and cost in patients with grade 2 hypertension［J］.Chinese General Practice，2017，20（s2）：245-247．DOI：CNKI:SUN:QKYX.0.2017-S2-094．
［20］魏学娟，吴浩，于海洋，等．方庄社区家庭医生式服务推进分级诊疗的实践效果研究［J］．中国全科医学，2017，20（13）：1558-1563．DOI：10.3969/j.issn.1007-9572.2017.13.007．
WEI X J，WU H，YU H Y，et al．Practical effect of family doctor service on promoting hierarchical diagnosis and treatment in Fangzhuang Community［J］．Chinese General Practice，2017，20（13）：1558-1563．DOI：10.3969/j.issn.1007-9572.2017.13.007.
［21］高凤娟，王培玉，史宇晖，等．德胜社区家庭医生式服务新模式的效果研究［J］．中国全科医学，2017，20（13）：1563-1567．DOI：10.3969/j.issn.1007-9572.2017.13.008．
GAO F J，WANG P Y，SHI Y H，et al．Effect of the new mode of family doctor service in Desheng Community［J］．Chinese General Practice，2017，20（13）：1563-1567．DOI：10.3969/j.issn.1007-9572.2017.13.008．
［22］李婷，林其意，黄涛，等．慢性病长处方政策对签约患者医疗质量的短期影响及政策建议［J］．中国全科医学，2017，20（25）：3084-3087．DOI：10.3969/j.issn.1007-9572.2017.25.005．
LI T，LIN Q Y，HUANG T，et al．Short-term effect of chronic disease patients with long-term prescription policy on the healthcare quality of contracted patients and policy recommendations［J］．Chinese General Practice，2017，20（25）：3084-3087．DOI：10.3969/j.issn.1007-9572.2017.25.005.
［23］黄蛟灵，邱宝华，梁鸿，等．签约家庭医生对居民医疗费用的影响分析［J］．中国卫生经济，2018，37（5）：46-49．DOI：10.7664/CHE20180512．
HUANG J L，QIU B H，LIANG H，et al．Analysis on the effect of family doctor contraction on residents' medical expenses［J］．
Chinese Health Economics，2018，37（5）：46-49．DOI：10.7664/CHE20180512.
［24］黄蛟灵，方帅，梁鸿，等．家庭医生签约服务协同改革对居民健康管理的影响［J］．中国卫生资源，2018，21（4）：329-341．DOI：10.13688/j.cnki.chr.2018.17930．
HUANG J L，FANG S，LIANG H，et al．Effect of the collaborative reform of family doctor contract service on residents' health management［J］．Chinese Health Resources，2018，21（4）：329-341．DOI：10.13688/j.cnki.chr.2018.17930．
［25］林其意，易春涛，黄涛，等．慢性病长处方政策对居民就诊费用及行为的影响［J］．卫生经济研究，2018，35（2）：57-60．DOI：10.14055/j.cnki.33-1056/f.20180206.005．
LIN Q Y，YI C T，HUANG T，et al．The effect of long prescription policy of chronic diseases on the medical cost and behavior of residents［J］．Health Economics Research，2018，35（2）：57-60．DOI：10.14055/j.cnki.33-1056/f.20180206.005.
［26］王彤，陈丹妮，徐霞，等．社区门诊病人社区签约率及对社区卫生服务评价［J］．中国医院管理，2018，38（7）：23-25.
WANG T，CHEN D N，XU X，et al．Contract rate and assessment on community health services of outpatients in community health centers in Shanghai City［J］．Chinese Hospital Management，2018，38（7）：23-25．
［27］葛敏，江萍，朱敏杰，等．家庭医生签约服务联动改革对有序诊疗格局的作用效果研究［J］．中国全科医学，2018，21（4）：415-419．DOI：10.3969/j.issn.1007-9572.2018.04.009．
GE M，JIANG P，ZHU M J，et al．Effects of coordinated reform in the delivery of contractual services by family doctors on the orderly diagnosis and treatment pattern［J］．Chinese General Practice，2018，21（4）：415-419．DOI：10.3969/j.issn.1007-9572.2018.04.009.
［28］刘姗姗，葛敏，江萍，等．家庭医生签约服务对社区居民就诊行为的影响研究［J］．中国全科医学，2018，21（4）：407-410．DOI：10.3969/j.issn.1007-9572.2018.04.007．
LIU S S，GE M，JIANG P，et al．Effects of contractual services from family doctors on the healthcare-seeking behavior among community residents［J］．Chinese General Practice，2018，21（4）：407-410．DOI：10.3969/j.issn.1007-9572.2018.04.007.
［29］戴卫东，陈岑．家庭医生签约制度的分级诊疗效果研究［J］.中国公共卫生，2018．［Epub ahead of print］．DOI：10.11847/zgggws1119299．
DAI W D，CHEN C．Effect of contracted family doctor service on hierarchical diagnosis and treatment［J］．Chin J Public Health，2018．［Epub ahead of print］．DOI：10.11847/zgggws1119299.

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