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.

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