Abstract: Background　The development of contracted family doctor services（CFDSs） has gradually entered the right track after pilot implementation and continuous practice.At present，the focus of our work is to evaluate the effect of CFDSs policies implementation，and to make amendments and improvements in many aspects according to the evaluation results.Thus，it can increase policy responsiveness and ensure the sustainable development of such services.Objective　To evaluate the implementation effect of CFDSs policies，providing a reference for the establishment of appropriate objectives and implementation model of CFDSs policies.Methods　By searching and reviewing articles about CFDSs published during 2011—2018 included in databases of CNKI and WANFANG Data in January 2019，we obtained a detailed understanding of the development of such services.Then，we conducted intensive individual interviews with a judgment sample of 50 family doctors from 10 community health centers selected from Xianning，Hubei Province by simple random sampling in March 2019，to explore their perspectives of family doctor practice and the development of CFDSs.After this，we carried out a questionnaire survey in a multi-stage stratified random sample of 400 community-dwelling residents to investigate their opinions of CFDSs，contracting status and evaluation of such services.Then，based on a model developed in accordance with the above results and the framework of McLaughlin's interactive model，we performed a policy-，policy executor-，policy receiver-，and implementation environment-level analysis and evaluation of the implementation of CFDSs policies.Results　Altogether，45（90.0%） family doctors who completed interviews and 320（80.0%） residents who returned responsive questionnaires were included in the final analysis.Interactive model-based analysis found the following problems in the implementation of CFDSs.Policy-level problems：insubstantiality and simplicity of some policies，poor support for CFDSs from the medical insurance program，unsound incentive mechanism for family doctors.Policy executor-level problems：insufficient publicity of related policies，unstandardized service procedure，insufficient professional capabilities and number of family doctors.Policy receiver-level problems：inadequate perceptions of the family doctor system，and nonuse of CFDSs but contracting only due to gift giving among contracted residents.Implementation environment-level problems：some residents' traditional ideas of seeking healthcare only in secondary or tertiary hospitals，and insufficient facilities in primary hospitals.Conclusion　The implementation effect of CFDSs is unsatisfied.And during the implementation，problems such as uneven promotion of the services，and unsatisfied quality of the services and so on are found.To balance the benefits of CFDSs policies in stakeholders dynamically，policy-，policy executor-，policy receiver-，and implementation environment-level improvements need to be done to perfect the contracting system.

Key words: Contract family doctor service, Health policy, Implementation effect, Effectiveness evaluation, Interactive model

摘要： 背景　家庭医生签约服务在经过前期试点推行和不断磨合实践后已逐渐步入正轨，目前的工作重点是评估政策执行效果，从多方面进行修正改善，增加政策响应度，保证签约服务持续稳定发展。目的　评价家庭医生签约服务政策执行效果，为适宜政策目标和政策执行模型的建立提供参考。方法　于2019年1月在中国知网和万方数据知识服务平台检索2011—2018年发表的与家庭医生签约服务相关的文献，以了解签约服务发展现状。于2019年3月，采用单纯随机抽样法在湖北省咸宁市抽取10家社区卫生服务中心，对经判断抽样法抽取的50例家庭医生进行个人深入访谈，主要了解其执业情况和家庭医生签约服务开展情况；对经多阶段分层随机抽样法抽取的400例社区居民进行问卷调查，主要了解其对家庭医生签约服务的知晓、签约及评价情况。以麦克拉夫林的互动模型为基础，结合文献研究、访谈及问卷调查结果，从政策、政策执行者、政策执行对象、政策执行环境角度对家庭医生政策执行效果进行评价与分析。结果　45例（90.0%）家庭医生完成了访谈，320例（80.0%）居民的问卷有效回收。基于调研结果，发现家庭医生签约服务的互动模型中，政策存在的问题包括政策表面、单一化，医保支撑作用弱，家庭医生激励机制不健全；政策执行主体存在的问题包括宣传力度不足，服务过程不规范，家庭医生能力不足、数量不够；政策执行对象存在的问题包括签约居民对家庭医生制度内涵认知存在偏差，存在物质动机；政策执行环境存在的问题包括传统观念阻碍政策执行，医疗设施不齐备。结论　家庭医生签约服务成效尚不明显，存在推进不平衡、服务质量有待提高等问题，签约服务制度有待从政策、政策执行主体、政策执行对象、环境因素4个方面进行调适完善，基于各方在政策上的共同利益，以实现利益的动态平衡。

关键词: 家庭医生签约服务, 卫生政策, 实施效果, 效果评价, 互动模型