目的 探讨家庭医生服务制度下的医生弹性薪酬模型及影响因素,为医疗改革、家庭医生服务制度实施提供支持。方法 根据家庭医生服务制度、家庭医生薪酬制度相关政策文件,将家庭医生服务制度下医务人员的弹性薪酬分为医保基金按人头打包预付后的结余、糖尿病和高血压等慢性病按病种打包服务费、传统按项目付费的医疗收入3个部分,参考Handbook of Health Economics中的医生净收益函数,构建医务人员的弹性薪酬模型,并分析其影响因素。于2016年10月在海淀区家庭医生服务制度试点机构选取居民3 182例,分析患者年龄、患病情况与医疗支出的关系。结果 根据构建出的弹性薪酬模型发现,医保支付方式、医生行为、患者特征会影响医务人员的弹性薪酬,当医生的生产力达到最大且服务对象病情较轻、医疗支出较少时,其弹性薪酬达到最大。对海淀区的实证研究发现,随年龄的增长,居民的医疗支出大体上呈上升趋势;就诊频率大、病情重的少部分患者是影响医保控费和医生薪酬的重点人群。结论 建立符合家庭医生服务制度特点的医务人员弹性薪酬模型是必要的,采用混合支付方式、提升医疗服务质量、利用信息化和数据化手段进行患者细分和个性化绩效考核是实现医保、医生、患者三方共同利益的合理途径。
Objective To explore the model of incentive system for physicians under the family doctor services system and its influencing factors,so as to provide support for medical reform and the implementation of family doctor services system.Methods Following a literature search on policies of family doctor services system and salary system for medical staff,the incentive salary model for family doctor services was divided into 3 parts:the balance of medical insurance fund according to the prepaid package,package service fee of chronic diseases such as diabetes and high blood pressure,and traditional medical income paid by inspection items.We then constructed the incentive salary model and analyzed its influencing factors according to doctors'net income function from Handbook of Health Economics.A total of 3 182 residents were selected in the Haidian District Family Doctor Pilot Program to analyze the relationship between the patient's age,illness and medical expenses in October 2016.Results Based on the established incentive salary models,we found that health insurance payment methods,doctor behavior and patient characteristics affected incentive salaries of medical staff.The incentive salary was maximized when the productivity of the doctor reached the maximum,the service subject had minor illness with less medical expenditure.Based on the study in Haidian District,medical expenses rose as the patient ages.A small number of patients with frequent visits and serious illnesses were key determinants of medical insurance control and incentive salary.Conclusion It is necessary to establish a flexible salary model for medical staff that meets the characteristics of the family doctor services system.Combination of payment methods,improvement of medical services quality,information technology,and data-based means can realize patient segmentation and personalized performance assessment to achieve common interests of health insurers,doctors and patients.
Chinese General Practice
Family doctor services system
Supplier payment method