Effects and Implications of Introducing Competition Mechanisms in the Delivery of Contracted Family Doctor Services

doi:10.12114/j.issn.1007-9572.2022.0529

Abstract

Abstract:

Promoting contracted family doctor services is an important way to implement tiered diagnosis and treatment, and to safeguard people's health, as well as a cornerstone of achieving Health China 2030 goals. However, the development of this system is constrained by some problems, such as contracting a family doctor but making no appointments. Many countries have introduced competition mechanisms in the supply of contracted services in different degrees to enhance the quality of family doctor services. However, China is now lack of theoretical and empirical studies about introducing competition mechanisms inthe delivery of contracted family doctorservices. We reviewed the latest developments in theoretical and empirical studies involving the use of competitive mechanisms in the provision of contracted family doctor services, which will contribute to the study and implementation of family doctor system in China.

Key words: Contracted family doctor services, Competition policy, Salaries and fringe benefits, Reform of payment mode, Incentive mechanism, Performance appraisal

摘要：

推行家庭医生签约服务是实施分级诊疗、保障人民健康的重要途径，也是实现"健康中国2030"的重要基石。但是，家庭医生"签而不约"等问题制约了这一制度的发展。国际上许多国家已在签约模式中不同程度地引入竞争机制，以提高家庭医生服务质量。然而，国内目前尚缺乏基于家庭医生签约背景引入竞争机制的理论与实证研究。本文从家庭医生签约服务引入竞争机制这一发展方向入手，梳理了各国相关理论和实证研究进展，以期为我国家庭医生签约制度研究和实践提供依据。

关键词: 家庭医生签约服务, 竞争机制, 薪金和附加福利, 支付方式改革, 激励机制, 绩效考核

LI Xinyan,HAN Youli. Effects and Implications of Introducing Competition Mechanisms in the Delivery of Contracted Family Doctor Services[J]. Chinese General Practice, 2023, 26(04): 447-452. DOI: 10.12114/j.issn.1007-9572.2022.0529.
李心言,韩优莉. 家庭医生签约服务中引入竞争机制的影响及其启示[J]. 中国全科医学, 2023, 26(04): 447-452. DOI: 10.12114/j.issn.1007-9572.2022.0529.

Figures/Tables 1

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国家	政策背景	政策导向	支付方式	政策效果
英国	就诊等候时间过长	CCG改革扩大患者选择权	CAP	减少政府行政成本，提高了NHS基金运行效率
挪威	医疗支出过高，等候时间长	患者自由签约	CAP+FFS	会诊时间延长，且会诊等待时间缩减，患者满意度提升
德国	门诊和住院严重分离	未实施基层首诊，患者自由签约	CAP+FFS	护理质量改善

国家	政策背景	政策导向	支付方式	政策效果
英国	就诊等候时间过长	CCG改革扩大患者选择权	CAP	减少政府行政成本，提高了NHS基金运行效率
挪威	医疗支出过高，等候时间长	患者自由签约	CAP+FFS	会诊时间延长，且会诊等待时间缩减，患者满意度提升
德国	门诊和住院严重分离	未实施基层首诊，患者自由签约	CAP+FFS	护理质量改善