Research On Influencing Factors And Promotion Strategies Of The Utilization Of General Practitioner Contracted Services

Faced with the challenges of population aging and the high incidence of chronic diseases,and the uneven distribution of medical and health resources,the traditional "treatment-centred" medical service model of China is unable to meet the health needs of residents,while as an important part of primary medical and health services,general practitioner contracted service has a positive impact on promoting the construction of hierarchical diagnosis and treatment and Healthy China,promoting the rational utilization of medical and health resources,and accelerating the transformation of the medical service model to "focusing on people’s health".To this end,Chinese government has issued a series of policy documents to promote the development of general practitioner contracted services actively and give full play to the role of general practitioners as "health gatekeepers".Under the strong promotion of the government,the whole country explores actively and forms distinctive contracted service models,establishing general practitioner contracted service system initially,and achieving a rapid increase in the contracting rate.However,along with the steady increase of the contracting rate,the phenomenon of "signing but not contracting" is widespread,which hinders the deepening of medical and health system reform and the construction of Healthy China.How to improve the utilization rate of general practitioner contracted services so as to promote the high-quality development of contracted services becomes an urgent problem to be studied at present.Based on Andersen’s behavioral model and evolutionary game theory,the thesis adopts the methods of questionnaire survey,empirical analysis,evolutionary game and numerical simulation,and focuses on the research theme of "the utilization of general practitioner contracted services" to conduct researches.Firstly,the thesis starts from the current situation of the utilization of general practitioner contracted services to analyze the existing practical problems.Secondly,combined with Andersen’s behavioral model,investigating the influencing factors of the utilization of general practitioner contracted services.Thirdly,based on the influencing factors,identifying the relevant influencing subjects,constructing the tripartite evolutionary game model of general practitioners,residents and grassroots medical and health institutions,and analyzing the behavioral evolution process and evolutionary stability strategy to study the influencing factors of positive strategies.Finally,combined with the above analysis,this thesis puts forward measures to improve the utilization of general practitioner contracted services,so as to provide reference for solving the realistic dilemma of "signing but not contracting" and improving the quality of general practitioner contracted services.Based on the above research,the following conclusions are drawn:(1)The utilization of general practitioner contracted services is affected by propensity factors(gender and age),enabling factors(walking time to medical and health institutions),demand factors(chronic disease conditions),health policy factors(whether the medical insurance payment policy meets the demand),and satisfaction factors(service ability of general practitioners,service items of general practitioners,medical equipment of grassroots medical and health institutions,drug equipment of grassroots medical and health institutions).(2)The utilization strategy of residents is jointly influenced by the strategies of general practitioners and grassroots medical and health institutions.The positive interaction(general practitioners provide high-quality services,residents utilize,and grassroots medical and health institutions implement actively)is conducive to promoting residents to utilize general practitioner contracted services.In addition,government policy support has a direct role in guiding residents to utilize general practitioner contracted services.(3)The potential loss to residents which is brought by low-quality services of general practitioners leads residents to evolve towards the non-utilization strategy,which means that the utilization strategy of residents needs to be driven by general practitioners’ strategy of high-quality services,while the additional cost,performance gain,extra benefit of high-quality services,and the performance difference between high-quality services and low-quality services provided by general practitioners have a significant impact on the strategy choice of general practitioners.(4)The additional benefit to residents which is brought by active implementation of grassroots medical and health institutions leads residents to evolve towards the utilization strategy,which means that the utilization strategy of residents needs to be driven by the active implementation strategy of grassroots medical and health institutions,while the performance gain of active implementation,government support,and punishment play an important role in the strategy choice of grassroots medical and health institutions..Finally,combined with research results,proposing the strategies to improve the utilization of general practitioner contracted services.First,optimizing the publicity and security policy to strengthen residents’ awareness and benefits of contracted services.Second,improving the supervision and incentive mechanism to improve the binding force and enthusiasm of general practitioners.Third,strengthening the quality of service supply to enhance the execution of contracted services in grassroots medical and health institutions.