| 摘要: |
| 目的:梳理我国家庭医生签约服务的激励机制，分析存在问题，并基于英国质量与产出框架（QOF）提出政策建议。方法：通过专题小组座谈和深入访谈了解卫生行政部门人员及基层医务人员对签约服务激励机制的认识与反应性；通过问卷调查了解基层医务人员的签约服务绩效考核、分配与满意度。结果：（1）调研地区签约服务费主要有医保投入、政府专项投入和收费三种类型；仅有40.9%的基层医生认为收入中有签约服务费；而英国基于政府税收的国家卫生服务为QOF的实施提供了单一且稳定的筹资来源。（2）81.8%的基层医生反映薪酬小于付出，薪酬满意度较低；英国QOF的实施提高了基层医生的积极性与卫生服务效率。（3）基层医生对绩效考核满意率为85.2%，且调研地区存在差异。QOF基于完善的信息系统形成了科学的绩效考核制度，促进了以结果为导向的分配激励机制。结论：与英国相比，我国签约服务费用来源多样但缺乏稳定性，基层医务人员的积极性尚未充分调动，绩效考核仍然存在缺陷。建议一是提高基层医务人员薪酬水平；提高医务人员签约积极性；二是完善绩效考核与分配机制，强化考核结果的应用；三是加强基层卫生信息系统建设，促进绩效考核实施。 |
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| Incentive System Analysis of Family Doctor Contracted Services in China Based on QOF of England |
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| Abstract: |
| Abstract: Objective: To analyze incentive system of family doctor contracted services in China compared with the Quality and Outcome Framework of the UK (QOF), and put forward policy recommendations for the Chinese government. Methodology: Both qualitative and quantitative methods are used in this study, including literature review, typical areas surveys in China and a study visit to the UK. Results: (1) There were mainly three types of funding for contracted services in research areas: the first is funded by health insurance; the second is funded by the government; and the third is from out of pocket payment by receivers. However, only 40.9% of family doctors agreed with that they had been paid on contracted services delivery. QOF is funded by the general taxation and national insurance. (2) 81.8% of the surveyed family doctors stressed that their remuneration could not match their workload, while the QOF had promoted productivity and work efficiency of general practitioners in England. (3) The general satisfaction rate on performance evaluation of family doctors was 85.2, but there was an obvious regional difference. The QOF may provide reference as a better performance evaluation system with result-oriented revenue allocation. Conclusion and recommendations: The funding source was multi-channeled and not stable in China; the family doctors are still not active in implementing contracted services; and the performance system for service delivery needs improvement. It is recommended that investment and funding should be increased to raise family doctors’ income, establish an outcome-oriented performance evaluation and revenue distribution system, and further improve health information system of primary care. |
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