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

摘要： 背景　针对盲目追求签约率这一现象，国家与地方层面相应出台了一系列政策文件，同时政策重心也从追求“签约率”向做实签约服务转变。目的　以做实签约服务为切入点，以上海市某区域为例，探讨家庭医生签约服务是否做到了“签而有约”。方法　本研究以上海市静安区某街道为例，抽取了2017—2020年该街道平台与静安区平台医院信息系统（HIS）、家庭医生健康档案数据库、家庭医生签约服务平台、社区卫生服务中心年度报表等研究相关数据资料。结果　2017—2020年，本街道签约居民由8 554人上升至24 485人，签约率从13.8%上升至36.3%，老年人签约率从38.7%上升至70.9%。同时，高血压患者签约人数由3 409人上升至7 271人，糖尿病签约人数也由1 463人升至3 088人。2018—2020年签约居民本街道就诊人次由2018年的162 640人次上升至2019年的232 772人次，其就诊比例始终高于未签约居民。从就诊结构上看，签约居民超过60%选择在社区卫生服务中心或站点就诊，二级医院与三级医院就诊人次比例分别稳定在26%~30%与6%~9%。但是从趋势上看，随着时间推移社区卫生服务中心就诊比例略有下降，从66.5%下降至62.4%。签约居民在静安区内社区卫生服务中心就诊形成的费用增长平稳，2019年与2020年增幅分别为13.9%与14.0%。在区内二级医院就诊总医疗费用近三年分别是21 854 472.1、24 843 680.2、26 556 426.3元（折算后），增幅分别为13.7%、6.9%。而在全市范围内也出现了同样现象。结论　家庭医生签约人数逐渐增长的同时，吸引超过六成签约居民定点就诊。同时，签约居民医疗费用在社区卫生服务中心保持稳定增长，二、三级医院虽然绝对数值仍然保持增长但是增长率得到遏制。

关键词: 家庭医生签约服务, 签而有约, 签约率, 社区卫生服务