A Research On Current Situation And Strategy Of Family Doctor System In Anhui Province

Background: Family doctor system have received extensive attention as an important measure to promote graded diagnosis system,improve the quality of medical services,and control the rise of medical expenses.As a pilot province for medical reform,Anhui Province has taken the lead in the exploration of family doctors' contracting services and innovated the combination signing under the county medical community.Since the implementation of the signing policy,it has begun to show results.Aim: Under the background of actively exploring family doctors' contracting services,this paper analyzes the implementation of family doctors' contracting services in Anhui Province,finds out the factors and problems that affect policy implementation,and provides theoretical support for promoting the sustainable development of contracting services.Method: Develop on-site questionnaires through literature review and expert discussions.According to the geographical distribution of Anhui Province,3 counties and 6 districts were selected as the survey site to conduct on-site investigations and interviews with key insiders.After the data collection,the data was entered using Epidata3.1 software,and the data was statistically analyzed using SPSS23.0 software.Results:(1)Family doctor system operation(1)The family doctor contract service system was initially established;(2)For the survey of primary health institutions,83.4% of the institutions' total contracting rate is higher than 30%,50% of the institutional key population signing rate is higher than 60%,the filing rate is higher than 75%,and 11 institutions have a contracted rate of more than 10%;(3)The high-pressure standard management rate and the diabetes standard management rate of the survey institutions exceeded 60%;the hypertension control rate and diabetes control rate exceeded the relevant levels of the China Cardiovascular Disease Report2017 and the National Primary Diabetes Care Management Guide(2018);(2)Family doctor system provider analysis(1)The number of general practitioners per 10,000 people in 8(66.7%)sample institutions exceeded the national average of 2017;the family doctors' care ratio of half of the sample institutions failed to reach 1:1;(2)82.2% of the family doctor team members considered that the working hours were extended,and 60.7% of the members indicated that there was no change in income before and after the signing service;(3)The overall satisfaction score of family doctor team members is 3.20±0.726,and the team relationship satisfaction is the highest;the education level is the influencing factor of satisfaction;(4)Multiple linear regression analysis shows that the biggest and smallest dimensions of satisfaction for team members are career development and contract training opportunities.(3)Family doctor system beneficiary analysis(1)The family doctors and family doctors have a good understanding of contracting services,among which the awareness rate of health check is 100%,and the referral service is the lowest,69%;(2)The highest utilization rate of health check(96.2%),low utilization rate of appointment service(9.8%),and low utilization rate of referral service(31%);medical service guidance,appointment service,on-site service,and rational use of drugs for more than 5 times of service Service guidance and health education;(3)The overall satisfaction score of the contracted residents was 4.23±0.686,and the satisfaction of service attitude was the highest.The contract payment was the influencing factor of the overall satisfaction of the contracted residents;(4)Multiple linear regression analysis found that the biggest and smallest dimension of satisfaction with contracted services was contracting to facilitate medical treatment and doctors' technical level.(4)Interview results Health administrators and family doctors have a positive attitude towards the contracted service policy.They also believe that there are factors such as the lack of leverage in medical insurance,imperfect performance incentives,and insufficient grassroots health workforces,which affect the development of contracted services.It is proposed to strengthen government management functions and improve assessment.Suggestions on reward and punishment mechanisms,strengthening team building,etc.Conclusion:(1)Since the signing of the contract,Anhui Province has initially established a mode of operation for family doctors,and the number of beneficiaries of contracted services has increased.The effect of the contract service was obvious,and the residents' awareness,utilization rate and satisfaction level of the contract service were higher,and the health management effect was achieved in the slow patient group.However,there is no regulation of medical insurance regulation,imperfect performance incentive mechanism,uncoordinated structure of health workforce,inadequate information platform mechanism,inadequate policy propaganda,low return of family doctors,and lack of competition and funding for contract service providers.The issue of unclear distribution rights.(2)Team members are generally satisfied with the signing work,and the factors affecting satisfaction are only cultural.Career development has the greatest impact on team member satisfaction,and the impact of signing training opportunities is relatively small.Therefore,the team members should be given enough attention,it is recommended to design a career development plan that meets the expectations for the family doctor,and appropriately tilt the family doctors in the promotion,thereby improving the satisfaction of the team members and ensuring the high quality operation of the contract service.(3)Contracted residents have higher overall satisfaction with contracted services,and the factors affecting residents' satisfaction are only contracted.Contracting to promote medical treatment has the greatest impact on the satisfaction of contracting services.The technical level of contracted doctors has a relatively small impact on the satisfaction of contracted services.Therefore,the next step should be to improve the effectiveness of the promotion and contracting services,and improve residents' perception of contracting.