医保签约管理模式下的家庭医生制度绩效评价指标研制与结构过程评价

The design of performance evaluation process system for the family doctor system preparation and structure with medicare contract management mode

目的:设计医保签约管理模式下的家庭医生制度绩效评价模型,依托模型从结构和过程维度评估改革实施的情况,并提出完善建议。方法:对上海市长宁区通过考核认证并开展签约服务的154名家庭医生进行问卷调查,从改革的制度体系结构和过程行为转变维度对家庭医生签约服务与医保支付方式改革予以评估。结果:通过专家咨询法构建医保签约管理模式下的家庭医生制度绩效评估模型,评价模型遵循"结构—过程—结果"的逻辑,主要包括制度体系结构、行为转变过程、产出结果价值3个一级维度,下涵9个二级维度、25个三级维度。调查显示改革在供给模式、队伍建设、激励机制、服务模式、家庭医生的行为转变等评价维度均取得了较好的成效。结论:在结构与过程方面,改革取得了一定的成效,仍需加强人才建设、协同服务、激励机制等方面的建设。

Objective： To design a Performance Evaluation Model for Family Doctor System under medicare contract pattern relying on the evaluation process model assess the situation from the structural and process dimensions of the reform implementation,and make some relevant recommendations for improvement. Methods： Questionnaire Survey on 154 family doctors who are proved through certification examination and are exercising contract service in Changning District of Shanghai. The evaluation is based on institutional architecture and behavior change in reform process. Results： based on Expert Consultation Method,Family Doctor System Performance Evaluation Model following the ＂Structure-Process-Result＂logic,including 3 one-dimensions,i. e. institutional system structure,behavioral changes process and outcome value,9 two-dimensions and 25 three-dimensions. The survey suggests that the reform has positive effect in the supply mode,team building,incentive mechanism,service model,and family doctor behavior change. Conclusion： In terms of structure and process,the reform has achieved some success,but still needs to strengthen human resource through training of qualified personnel,to improve the collaboration services and incentive mechanisms,not neglecting other aspects of construction.