A circular on guidelines to promote family doctor contracting services

7. Where does the signing service fee come from? How to bring into play the role of family doctors in reasonable fee control?

The family doctor team provides the agreed contract service for the residents, and the contract service fee is charged annually according to the number of signed services, which is shared by the medical insurance fund, the basic public health service funds and the payment of the signed residents. The specific standards and share ratio shall be determined by the local health and family planning, human resources and social security, finance, price and other departments according to the content of contracted services, the structure of contracted residents, and the bearing capacity of basic medical insurance funds and public health funds.

The family doctor team maintains the health of the contracted residents through contracted services, which is an important measure to control medical costs from the source. At the same time, where conditions permit, areas can explore the possibility of paying the outpatient funds of contracted residents per capita to primary medical and health institutions or family doctor teams, and for patients referred to hospitals by the grassroots, the grassroots or family doctor teams will pay a certain referral fee, further enhancing the power of family doctor teams to control fees. In addition, we can also explore the implementation of total medical insurance payment for the division of labor and cooperation mode such as vertical cooperative medical consortiums, give play to the role of family doctors in the control of medical insurance payment, and rationally guide two-way referral.

8. How to motivate the family doctor team to better provide contracted services?

It is necessary to take various incentive measures to mobilize the service enthusiasm of family doctor team. In terms of income distribution, it is necessary to comprehensively consider factors such as performance appraisal, including contract services, and reasonably determine the total amount of performance salary in primary medical and health institutions, so that family doctors can reasonably improve their income level by providing high-quality contract services. In the internal performance pay distribution of primary medical and health institutions, it can be inclined to staff who undertake front-line clinical tasks such as contracted services by setting up general practitioners' allowances. Grassroots medical and health institutions can withdraw the surplus part of the incentive fund according to regulations, encourage more work, more pay, excellent performance. Hospitals above the second level should also tilt the distribution of performance pay to doctors who participate in contracted services, and encourage doctors at hospitals above the second level to join the family doctor team. Where conditions permit, financial support and guidance can also be provided to family doctor teams and doctors from secondary hospitals and above who participate in contracted services.

At the same time, it should focus on general practitioners in the aspects of staffing, personnel recruitment, professional title promotion, on-the-job training, award promotion, etc., speed up the construction of general practitioners, and improve the level of contracted services. First, excellent personnel will be included in the scope of preferential policies for talent introduction by governments at all levels to enhance the career attractiveness of general practitioners. The second is to implement the "Guiding Opinions on Further Reforming and Improving the Evaluation of Professional titles of Grass-roots health Professionals and Technicians" (Ministry of Human Resources and Social Security issued [2015] No. 94), reasonably set the proportion of senior and intermediate posts for general practitioners in grass-roots medical and health institutions, expand the promotion space of professional titles, and focus on personnel with excellent contract service assessment. The evaluation results of contracted services are taken as an important factor for professional title promotion. The third is to commend the outstanding family doctors and their teams in accordance with national regulations, and vigorously publicize advanced models. The fourth is to expand training channels at home and abroad, establish and improve the system of doctors from secondary hospitals and above to carry out business guidance at the grassroots level regularly and family doctors to study in clinical teaching bases regularly. Strengthen the continuing medical education of family doctors and team members to improve the quality of contracted services.

9. How to strengthen the performance assessment of contracting services?

The establishment of scientific performance appraisal mechanism is the key to promote family doctors to provide quality service. First, improve performance appraisal standards. Local health and family planning, traditional Chinese medicine management, human resources and social security, finance and other departments should improve contract service standards and management norms. Establish a contract service evaluation index system with the number and composition of the contract object, service quality, health management effect, residents' satisfaction, medical cost control, and the proportion of basic medical treatment of the signed residents as the core. Second, we will carry out regular assessment. Encourage family doctor representatives, contracted resident representatives and social representatives to participate in the assessment, and disclose the specific assessment and evaluation results of the family doctor team to the public in a timely manner. Third, establish a linkage mechanism. Performance appraisal results are linked to medical insurance payments, public health service funding allocations, and team and individual performance allocations. For the team of family doctors with unqualified evaluation results and outstanding public opinions, a corresponding punishment mechanism shall be established. Fourth, we will give play to the role of public oversight. Establish a feedback and evaluation system with contracted residents as the main body and open to the public, and smooth the channels of public supervision, so that the service quality and level of the family doctor team can get timely feedback and evaluation from the residents, and serve as an important basis for performance assessment and an important reference for residents to choose the family doctor team.