Population aging is getting worse in our country. Family doctor contract service plays an important role in boosting the construction of hierarchical diagnosis and treatment system and establishing a reasonable and orderly medical order. Current research about family doctor contract service policy mainly focus on qualitative evaluation, and there are few researchers use tools to quantitatively evaluate each individual representative policy.
This study aims to quantitatively evaluate the pros and cons of six Chinese central government policies about family doctor contract service, thus, proposing strategies and measures to promote the high-quality development of our country's family doctor contract service, and helping the construction of healthy China.
We searched Peking University's PKULAW.com and websites of some relevant ministries of the State Council of China from January 1, 2015 to April 30, 2022. The key word was "family doctor". The software ROSTCM 6.0 was used for text mining. Based on the results, this study selected central government policies about family doctor contract services, then used the PMC index model to quantitatively evaluate these policies.
This study included thirty-two policies based on inclusion and exclusion criteria. The top five high-frequency keywords in the field of family doctor services are "contract service" (n=274) , "health" (n=272) , "medical" (n=264) , "family doctor" (n=225) , and "contract" (n=180) . They were marked as P1-P6, respectively. In terms of methods and other aspects, the scores of each dimension are relatively high. The results of quantitative evaluation showed that the ranking of policies is P1>P3>P2>P6>P4>P5. Three policies were rated as excellent, the other three were rated as acceptable. The scores were relatively high in the policy content, policy nature, policy evaluation, policy field and policy role.
Our country's family doctor contract service policy had a relatively broad content and is relatively mature. It is suggested to pay attention to the combination of long-term, medium-term and short-term validity of the policies, improve incentive approaches from multiple perspectives, enhance the sense of professional honor of family doctors, and use a variety of policy tools and policy action.
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.
With the continuous progress of the New Medical Reform, contracting service by family physicians has increasingly become an important guarantee for the basic medical care and health of the people, and the agreements of family doctors' contracting service has become the premise of achieving "everyone has a family doctor". However, the standardization and binding force of the agreement still remain to be studied.
By analyzing the agreements of family doctors' contracting services, we expected to further standardize the contracting services and improve the standardized management level of the services contracted by family doctors.
According to the purpose of the survey, the contracting agreements of the 14 community health service centers were finally selected as subjects by random sampling among 1-3 community health service centers in each of the nine main districts of Chongqing in July 2021. The main analysis framework was based on the contracting subject, contracted service, contracting fee mechanism, and the rights and obligations of the contracting subject. Finally, descriptive analysis of the agreements was performed by means of content analysis.
When compared the agreements in different districts, the contents of basic medical services and basic public health services were relatively similar (basic medical services included diagnosis and treatment services for common diseases, frequently occurring diseases and traditional Chinese medicine, etc., and basic public health services included establishing resident health files, providing health consultation, and vaccination, etc.) . There were differences in the terms of years of service, personalized services, etc. among family doctors in different regions of Chongqing: there were 12 agreements that specified a binding period of 1 year, 1 agreement whose duration was decided by the parties, and 1 agreement that did not specify the binding period. Among all agreements, the definition of the rights and obligations of contracting subjects and parties was vague. Among them, contracting subjects of 6 agreements included community health service centers, superior guidance hospitals, family doctors and representatives of heads of households or family representatives, 6 agreements included community health service centers, family doctors and representatives of heads of households or family representatives, 1 agreement included community health service centers and household heads, and 1 agreement did not specify the contracting subject.
It is necessary to further clarify the objects and agreements of contracting service, and improve the rights and obligations of the contracting subjects in Chongqing. Combined the experience of implementation of contracting services by family doctors of various regions, it is necessary to improve the performance effectiveness and the quality of the contracted services, and promote the implementation and development of the family doctors' contracting services.
