我国家庭医生签约服务费筹资与支付现状调查研究

Study on the Status of Financing and Payment Mechanism of Contracted Family Doctor Service Fee in China

目的:分析我国现阶段家庭医生签约服务费政策发布、收费标准、筹资渠道及落实情况,为进一步完善签约服务收付费机制提供科学依据。方法:采用卫生健康行政部门问卷对全国282个城市家庭医生签约服务费实施现状进行调查。结果:241个城市已出台明确签约服务费标准及筹资比例的政策文件,147个城市签约服务费纳入医保支付范围;各地现执行签约服务费标准范围为5~150元(人·年);基本公共卫生服务经费、医保基金和个人缴费筹资占比分别为41%、39%和20%。结论:我国签约服务筹资机制已初步建立,针对现阶段筹资水平不高、稳定性不足等问题,应在签约服务包基础上合理制定收费标准并明确付费方式,进一步探索与家庭医生签约服务联动的门诊按人头付费方式。

Objective:To investigate and analyze the current policies,rates,financing,and implementation of contracted family doctor service fees in China,in order to provide scientific grounds for improving the payment mechanism for contracted service.Meth-ods:Based on a survey addressed to the local health departments,an investigation was conducted on the implementation status of con-tracted service fees in 282 prefecture-level cities nationwide.Results:Currently,241 cities have introduced policies to clarify the rates and funding shares for contracted service,with 147 cities including contracted service fees in the scope of medical insurance pay-ments.There are significant differences in the rates for contracted services across regions,ranging from 5 to 150 yuan per year per per-son,with basic public health service funding still being the main source of funding(41%),followed by medical insurance(39%)and out-of-pocket payment(20%).Conclusion:In order to address the issues of unstable funding and inadequate payment of medical in-surance,the payment schemes should be further improved,including the demonstration of the formulation of rates on the basis of pack-age of services,also the capitation payment method for outpatients services matched with contracted family doctor service.