我国基层门诊按人头付费与家庭医生签约服务结合的政策分析

Policy Analysis on the Combination of Capitation and Family Doctor Contract Service in Community-level Outpatient Department

目的深入分析我国基层门诊按人头付费与家庭医生签约服务结合的相关政策发布与实施进展,为完善家庭医生签约服务提供策略支持。方法系统检索和筛选我国门诊按人头付费相关政策文本,采用内容分析法对政策条目进行系统量化分析。结果纳入政策文件159份,全国共27个市(县)明确出台门诊按人头付费专项政策,6个市(县)明确“与家庭医生签约服务结合”相关细则。浙江、天津等地较早推进门诊按人头付费试点工作并完善有关技术规范,通过区分参保人员和家庭医生“签约”与“非签约”分配门诊基金打包额度,将人头定额标准、总额预算、年终决算、考核等要素与家庭医生签约指标挂钩,加强卫健、医保等相关部门协作等方式结合家庭医生签约制度进行探索,尝试建立以健康管理结果为导向的激励约束机制。结论我国基层门诊按人头付费处于试点探索阶段,与签约服务尚未形成有机结合,政策设计有待规范和完善。建议加强部门协作,建立健全按人头付费与签约服务结合机制,强化对按人头付费和签约服务相关指标的联动考核,完善结余留用分配机制等。

Objective To analyze the progress of policy release and implementation of the combination of capitation and family doctor contract service in the community-level outpatient department,and to provide strategic support for the improvement of family doctor contract service.Methods The content analysis method was used to perform a systematic quantitative analysis of policy items by systematically searching and sifting the relevant policy texts of the capitation.Results A total of 159 policy documents were included.Across the country,27 cities(counties)had issued special policies of capitation for outpatient services,and six cities(counties)had specified detailed rules for"the combination of capitation and family doctor contract service".Zhejiang,Tianjin and other regions promoted the pilot work of capitation for outpatient service earlier and improved the relevant technical specifications.By allocating the pac-kage amount of outpatient fund by distinguishing the"contract"and"non-contract"of insured personnel and family doctors,linking elements such as head quota standard,total budget,year-end final account and assessment with the signing index of family doctors,strengthening the cooperation between health and medical insurance departments and other related departments,these regions tried to establish an incentive and restraint mechanism guided by the results of health management.Conclusion Capitation is in the pilot stage,and has not yet been integrated with contract services.Policy design needs to be standardized and improved.It is proposed to strengthen cooperation between departments,establish and improve the mechanism for the combination of capitation and contracting services,streng-then joint evaluation of relevant indicators for contracting and contracting services,and improve the mechanism for allocation of balance retention.