Study On The Problem Of Residents With Insufficient Participation In The Implementation Of Family Doctor Service System

As an important part of the grassroots health service system,community family doctor contract service system plays the role of “gatekeeper” of public health service,and is also an important cornerstone of the reform of China's medical and health service system.In the report of the 19 th national congress of the communist party of China on the implementation of health strategy,it further proposed that family doctor service system should be taken as an important part of deepening the reform of grassroots medical and health service system and building healthy cities and communities.Since the implementation of family doctor contract service in 2016,China has made significant achievements.However,some problems have been exposed in the implementation.Outstandingly,the effective implementation of family doctor contract service in a few regions is also insufficient.In particular,the participation willingness and participation degree of community residents are not high,and there are some problems of signing without appointment.From the perspective of system,active and effective participation of community residents,as the service demander,is of decisive significance to the implementation of family doctor contract service system.The problem of signing without appointment caused by residents' passive participation will eventually lead to the failure of family doctor contract service system.However,from the perspective of the subject,the problem of signing without appointment is essentially determined by the participation of community residents in the decision-making of the system,which involves a series of complex factors.Taking Zhenjiang city as an example,firstly,this paper illustrates the core concepts and related theories;secondly,analysing the implementation status and effect of family doctor service system of Zhenjiang city in recent years;And then,based on the questionnaire survey of community residents,revealing the problem of signing without appointment in the implementation of family doctor contract service in Zhenjiang city and their performance characteristics,and explaining the practical reasons for its occurrence.On this basis,based on the perspective of evolutionary game theory,the decision-making behavior game model of community residents participating in contract service under different service projects is constructed,and the key game elements and evolutionary path affecting residents participating in contract service are further discussed,from which the formation mechanism of signing without appointment is analyzed.Finally,puting forward some suggestions to promote community residents to participate in family doctor contract service.The conclusions of this paper include: Firstly,family doctor contract service in Zhenjiang city has made great progress in many aspects,such as the signing rate of community residents,the scale of service team and the type of service package,but also exposed the service effective utilization rate is not high,especially the problem of signing without appointment.Secondly,the basic characteristics of signing without appointment are the low awareness of service content,the low rate of the first diagnosis in the community and the low satisfaction with service.Moreover,based on the perspective of evolutionary game,the essence of signing without appointment is a negative behavior of residents' participation in decision-making,and its formation mechanism is subject to different forms of game equilibrium mechanism and evolutionary path conditions between the demand side(community residents)and the supply side(community family doctors).This paper puts forward the following countermeasures to promote effective participation in family doctor contract service,including: cultivating residents' self-health management awareness and strengthening the concept of paying for health;enhancing the attraction of family doctor contract service,and constantly improving the satisfaction of signed residents;strengthening the construction of family doctor team,to improve the service ability of family doctor team;formulating reasonable price for personalized service projects;improving the incentive mechanism.