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Objective:To evaluate the current situation of comprehensive medical and health services of primary medical institutions in a city under the policy of family doctor contracted service, and explore the influencing factors and put forward improvement strategies, for the reference to improve the medical and health service level of primary medical institutions.Methods:In January 2021, 18 primary medical institutions in 3 counties(cities, districts) of a city in Shandong province were selected by stratified sampling method, and 60-70 contracted residents were selected from each institution for questionnaire survey. The questionnaire covered two dimensions: service provision(19 items) and metion frequency of health problems(12 items). According to the principle of information saturation, qualitative interviews were conducted with 20 family doctors and 15 contracted residents to identify the current service needs and existing problems. Descriptive analysis was used for all data, and single factor analysis of variance and multiple linear regression analysis were used for influencing factors of comprehensive service scores of primary medical institutions.Results:1 098 contracted residents were included in this study, and the comprehensive service score was 3.15±0.42. The vaccination, maternal health care and health education scored higher with 3.80±0.54, 3.70±0.64, 3.78±0.57 respectively; The dermatology, mental health counseling and family sickbed scored lower, with 2.27±1.20, 2.97±1.01 and 1.92±1.18 respectively. Contracted institution, gender, age and marital status were the influencing factors of comprehensive service scores( P<0.05). Residents′ needs for family sickbeds, psychological counseling and fall prevention had not been met. Conclusions:The primary medical institutions of the city had provided better basic public health services, while unmet needs were demand for home sickbeds, psychological counseling and fall prevention. We should take effective measures to increase the service supply based on the needs of residents, and provide more comprehensive medical and health services for residents at primary medical institutions.
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Objective:To analyze the cognition and willingness of family physicians on contracted service, and to explore the implementation obstacles and feasible strategies of implementing contracted service of family physicians from the perspective of suppliers.Methods:From July to October 2020, 850 family physicians in community health service centers or township health centers in three cities of Shandong Province were investigated by questionnaire survey and key person interview. Descriptive analysis and binary logistic regression model were used to analyze the willingness of family physicians to provide contracted service. Through questionnaire survey and key person interview, the implementation obstacles and service optimization strategies of family physicians were discussed.Results:791 valid questionnaires were obtained, of which 688(87.0%) approved the implementation of family physician contract service, and 679(85.8%) expressed willingness to provide family physician contract service. Marital status, recognition of service policy, satisfaction of service operation effect, optimistic degree of service development prospect and residents′ first choice of illness were the factors influencing family physician′s service willingness.Conclusions:We should effectively improve the family doctor′s service intention and promote the efficient and orderly implementation of family doctor′s contract service policy through enriching policy supporting measures, innovating the application of " Internet plus" , increasing personnel training, optimizing performance appraisal work and creating favorable public opinion environment.
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Objective To study the implementation effects of China′s contracted service policy for family physicians. Methods Systematic evaluation method was used to extract, describe and analyze the literature information of the research on the implementation effect of family physicians contracted service policy. Results A total of 80 papers of four types were rounded up, including 47 on the effect of health management on patients with chronic diseases, 11 on the effect of health management on the elderly, 15 on the effect on the first diagnosis in the community, and 7 on the effect on the control of medical expenses.The research is mostly distributed in the developed areas in the east. The family physicians contracted service promotes the health management effect of patients with chronic diseases and the elderlies, improves the first visit ratio of residents at their community, and effectively controls the medical expenses.Existing research shows that such a service has achieved initial success.However, the research also identified such common problems as the shortage and low competence of family physicians, low quality, resource integration and inadequate policy publicity. Conclusions The contracted service policy in China has begun to play the role of " health gatekeeper" and " cost gatekeeper" to some extent.It is suggested to strengthen the training of general practitioners, establish and perfect incentive mechanism, and improve the construction of information platform, while the implementation effect of contracted services for family physicians deserve further study in a broader scope, deeper level and design specifications.
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Objective To analyze the policy texts related to the contracted service of family physicians, and probe into the key points and existing problems of the policy in the process of promoting the contracted service of family physicians in China, for the purpose of providing references for the optimization and perfection of the system. Methods A total of 54 relevant policy texts issued by the Central Government from 2011 to 2019 were selected, for establishing a two-dimensional analysis framework based on policy tools and stakeholders.By means of quantitative analysis of policy text and literature research method, we analyzed the relevant policy texts. Results Study of the 54 texts found 52.8% (124/235)mentioned commands and regulatory tool use, 27.2% (64/235) mentioned capacity building tool use, 13.2% (31/235) mentioned information and exhortation tool use, 5.1% (12/235)only mentioned incentive tool use, and 1.7% (4/235) only mentioned system change tool use; while most of them(34.3% and 32.7% )mentioned government and physicians, and only a few(17.6% and 15.4% )mentioned patients and medical entities. Conclusions It is suggested to optimize the policy tools mixture, and increase the use of incentive tools to physicians, and explore new forms of system change tools.It is also proposed to pay more attention to resource allocation of primary medical institutions, and to patient awareness and satisfaction.
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The family physicians contracted service is an important means to promote hierarchical diagnosis and treatment and realize healthy Chinese strategy. With the continuous introduction of family physicians contracted service policy, it is very important to raise awareness, effectively promote and put into place.This study analyzed the family physicians contracted service policy from the perspective of public policy, and used the multiple streams theory framework to analyze the driving factors of the policy proposed. In addition, it explored the influence of problem stream, policy stream, and political stream on the policy launch process.These efforts can help improvement the policy awareness in the process, and help ensure sustainable progress of the policy.
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Objective To evaluate the effect of family doctor contracted service system in Shenzhen and explore the influencing factors for families to contract their family doctors. Methods A total of 480 residents were selected from 12 first-class community medical rehabilitation centers in Luohu, Futian and Nanshan districts of Shenzhen. The contents of the survey included the contracting status between the contracted and non-contracted residents, the utilization of four basic public health services, and the difference of satisfaction with community medical rehabilitation centers.Meanwhile, logistic regression was used to explore the important influencing factors of the contracted family doctors. Results The overall contracting rate of residents was 51.9% (248/478), and the lowest contracting rate was 23.1% (27/117) (P<0.05), found among patients under 40 years old.The utilization rate of contracted residents for growth and development examination, maternal health care as well as guidance of chronic disease prevention and treatment was higher than that of non-contracted residents ( P <0.05 ). fees and medical environment, service attitude,medical fees was higher than that of non-contracted residents(P<0.05).The satisfaction for convenience in medical environment, service attitude,medical fees and access to medical service was higher than that of non-contracted residents(P<0.05).The results of binary logistic regression analysis showed that age, education level, occupation ( retirement ) and chronic diseases were important factors affecting the signing of contracts.Conclusions The family doctors tend to be embraced by residents better than before. Family doctors contracted service system is conducive to improving the utilization rate of basic health services, acceptance rate of health services and satisfaction of residents. At the same time, the young population at large requires greater efforts before they can embrace the family doctor system.
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Objective To explore the influence of policy support on attitude of staff toward contracted service in community health service ( CHS) centers in different areas of China. Methods A multi-stage stratified cluster sampling method was used to select participants, and questionnaire survey was conducted among 192 staff (99 from Chengdu and 93 from Xiamen) from 4 community health service centers in Chengdu and Xiamen. In addition, documents on contracted service in CHS were collected and analyzed. EpiData software was used to establish database. Double input and cross-check were implemented. SAS version 9.4 was used for data analyses. Results Differences were found in goals, financial modes and insurances coverage in contracted service in the two areas. Among the 192 participants, 80.7% considered that contracted service was worth to carry out; 90.8% supported the implementation of contracted service in local settings and 78.1% were willing to take more work load on contracted service. In contrary, only 41.6% wished their child work as a family doctor. The main reasons for the negative attitudes were that the performance-based salary system had not been well established or implemented, and there was much more work load that resulted from contracted service. Conclusions The majority of the study subjects held positive attitude toward contracted service, but there were disparities between the four study sites. Relative policy and financial support, proper human resource distribution were critical determinants of contracted service.
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Objective To learn the current doctor-patient trust in contracted service of family physicians in suburban Beijing, and analyze its influencing factors from residents′ perspectives to propose countermeasures. Methods A total of 197 contracted residents were sampled from 12 community health service centers in 4 out of 10 suburb districts of Beijing, for a questionnaire survey using stratified random sampling method. Items of the questionnaire cover residents′knowledge of the family physicians′ contracted service, their trust of family physicians′ competence, and their trust level of the ethics and the influencing factors. Measurement data were calculated form the mean value, while the count data were subject to proportion analysis, frequency description and rank ordering. Results 175(88.8% )and 156(79.2% )of the contracted residents trust the ethics and competence of their family physicians. Whether the ethics trust exists between doctors and patients was decided by if residents′respect, care, and interests considerations taken into account by the physicians; the factors influencing the competence trust of the residents were the age, education of the residents, and whether the physicians display respect, care. Conclusions Upgrading the medical competence and ethical conduct is conducive to the establishment of doctor-patient trust. In the establishment of the family physicians contracted service, it is necessary to improve acceptance of the contracted residents. At the same time, medical ethics issues such as respect for care, privacy protection, and maximum interests of the residents in the process of medical treatment deserve further attention.
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Taking Dafeng county of Jiangsu province as a pilot, this paper analyzed the mechanism of the family physicians′contracted service for achieving the hierarchical medical system. Such a system is designed to promote the contracted service of family physicians, comprising health management, convenient medical treatment, opinion leader, IT-based power, and capability enhancement. Authors of the paper rounded up data of the sample township from 2015 to 2017, and the practical effect of the family physicians′contracted service in promoting the hierarchical medical system. Their recommendations include:currently focusing on targeted groups and population of chronic diseases; elevating the contracting rate of pregnant women and children; motivating countywide medical communities in the promotion of the family physicians′contracted service, for joint efforts in developing the hierarchical medical system; leveraging the showcase of Dafeng for achieving the hierarchical medical system fitting local needs.
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Objective:The objective of this study is to construct the evaluation indicator system of family doc-tors contracted service,to evaluate the main current family doctor contracted service in China from different aspects of health services. Methods:literature research method,field survey method and expert consultation method were used for the preliminary screening of the evaluation indicator; after consultation with Delphi experts to conduct a primary health care service management,using statistical analysis was used to build a family doctor evaluation indicator sys-tem. Results:The results show that the evaluation indicator system of family doctors contracted service was deter-mined,and consists of three first-level indicators,which were respectively preparatory,procedural and outcome eval-uation indicators;eight secondary indicators,which mainly include human resources input,basic medical treatment, basic public health,service efficiency and satisfaction and so on;and thirty-nine tertiary indicators,such as the num-ber of doctors per 10,000 population,the rate of first diagnosis,the rate of medical malpractice and the incidence of medical disputes of contracted residents,etc. Conclusions:The indicator system constructed in this study is sensitive and feasible,and it can comprehensively evaluate the work of family doctor contract,and provides a reference for the management,assessment and evaluation of family doctor contract service.
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Objective To investigate the implementation status quo of the contracted family doctor system in Wangcheng District of Changsha City. Methods Sixty-three health workers and 185 medical residents were selected from 6 township health centers in Wangcheng district which implementing the contracted family doctor system and performed the questionnaire survey on the implementation status quo of the contracted family doctor system and its influencing factors.. Implementation status of contracted family doctor system and its influencing factors were investigated by using questionnaires. Results The total satisfaction of the residents in Wangcheng District to township hospitals was 49.44%;the satisfaction differences to different institutions were analyzed,the results showed that the medical environment, service attitude and medical equipments had statistical difference among 6 township health center(P<0.05);Logistic regression analysis results showed that queuing time for consultation, medical price, service attitude, explain of disease state,technological level and medical effect were the main influence factors affecting the residents' satisfaction (P<0.05) ;the development prospects,distribution of workload and time, equity and work risk were the influence factors for the medical workers' satisfaction (P<0.05). Conclusion Many problems and influencing factors exist in the implementation process of the contracted family doctor system in Wangcheng District, which can be perfected in the aspects of the job responsibility of family doctors,performance assessment of family doctors and distribution of medical insurance reimbursement ratio.
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The paper introduced the practice of family doctor′s contracted service in Zhenjiang,Jiangsu province over the past six years.By exploring the tiered family doctor′s contracted services,namely 3+X teamwork responsible for household health,health insurance contracting with chronic disease patients,and personalized contracts,the city highlights the cornerstone role of primary care in the Healthy Zhenjiang 2015 Campaign.The campaign aims at providing fair,accessible,systematic and uninterrupted health services.Outcomes of the campaign have proved that the 3+X teamwork model helps building acquaintances relationship with residents by means of contracting,hence motivating both the sector and individuals in the health promotion and building a healthy Zhenjiang.
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In 2012, the contracted service with the general practitioners ( rural doctors) was implemented in Zhejiang Province. This paper conducted an analysis on the existing problems in the contracted service from three as-pects of policy background, policy objective, main measures and the following suggestions have been put forward:Strengthening the whole family team of doctors and information construction, and improving the multi sectoral coopera-tion mechanism in order to establish the classified diagnosis and treatment system as targeted to lay a good foundation.
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This paper describes the implementation background for the rural doctors’ contracted services in Jiangsu province, focusing on the main approaches and promoting measures. The main objective was to analyze the effects of the transform from the perspectives of implementing the basic public health services welfare, promoting the rural doctors’ incentives and incomes, establishing a balance between the supply and demand, establishing a hierar-chical clinic system in the rural areas, understanding the impacts of New Rural Cooperative Medical Scheme, and so forth. Based on the analysis, three conclusions were drawn:(1) Rebuild the trust in the relationship between doctors and patients and improve the working environment for the rural doctors with contracted services as a starting point. (2) Organize the medical services supplies focusing on the patient requirements, thereby ensuring that the primary health care providers take the first diagnosis responsibility. This helps in establishing a reasonable medical order as well as improved capital efficiency. (3) Return to the origin of primary health care by mainly focusing on health man-agement, and improve the health condition for the country dwellers.
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Objectives: The paper aims to analyze the practice and outcome for the rural doctors’ contracted service in Dafeng and Shengzhou counties. Methods:The methods used were typical sampling which played in selec-ting Dafeng and Shengzhou counties and interviews conducted with the director of the bureau of health in Dafeng and Shengzhou counties, the dean of the township health centers ( two for each county) and the rural doctors ( four for each county) . We adopted descriptive statistics to analyze the quantitative data and incentives. Results: The rural clinic and/or township health centers were the main contracted service providers and services were supplied to all in-habitants, especially to the target patients such as those suffering from NCDs. The individual benefit packages were designed to coordinate with local demands and the security and incentive mechanisms were established. Conclusions:Contracted service brought several benefits such as meeting the individual demands of inhabitants, rural doctors were inspired and the basic rural health system consolidated, the basic public health service quality was improved, and the function was intensified for the primary health institutions. The rural doctors’ contracted service is helpful to advance rural health care reforms, and provides more evidence in setting up the local rural health policies. It still needs fur-ther perfections. Suggestions:The rural doctors’ team construction should be strengthened and the incentive mecha-nism, summary and evaluation of their contracted service should be improved timely.