First, the overall goal
Through the development of family doctor contract service, promote the transformation of community health service to health management, and gradually establish a new system of dual gatekeepers that can not only protect health but also ensure expenses; Promote the actual income and treatment of family doctors to be linked to the number of contracted services, and promote the establishment of a new assessment and distribution mechanism for more work; Guide family doctors to improve their professional quality and strive to establish a new service model of first diagnosis and graded diagnosis and treatment in the community.
Second, the basic principles
(A) adhere to the nature of public welfare
Basic medical care and basic public health services are important contents for the government to provide public services for residents. We must firmly establish the consciousness of facilitating the people, benefiting the people and benefiting the people, and always adhere to the nature of public welfare.
(2) Adhere to the combination of prevention and control.
Guided by health management and comprehensive services, we will strive to improve the ability of primary medical and health services, promote the effective combination of medical care and prevention, and let residents enjoy convenient, fast, effective and safe basic medical and public health services.
(3) Adhere to voluntary signing.
Widely publicize and launch, fully inform the specific content of the contract service and the policy of benefiting the people. On the premise of fully understanding the connotation of contracted services, residents choose their own family doctors, sign service agreements and enjoy the agreed services.
(4) Adhere to gradual progress.
Priority coverage, priority signing and priority service for key groups. On the basis of completing the pilot project, we should sum up experience, improve the scheme and make steady progress in order to achieve practical results.
Third, the signing subject
The team of family doctors consists of clinicians with intermediate or above titles, community nurses, preventive health care doctors, rehabilitation doctors and community members of community health service centers, focusing on the elderly over 65, children aged 0-6, pregnant women, patients with chronic diseases and mental patients, and carrying out contract services. Community health service centers and health management teams assist and provide technical support.
Four. Rights and obligations of both parties
(1) Party A (the buyer)
Right: voluntarily choose to sign a family doctor; Enjoy the agreed service items within 30 working days after signing the contract; Supervise the implementation of contract service project specifications.
Obligation: Understand the particularity of family doctors' work, and support and cooperate with family doctors in their work; First visit in community health service institutions; Give priority to the choice of essential drugs and accept referral suggestions from family doctors; Take the initiative to pay the contract fee and participate in the evaluation of contracted services.
(II) Party B (service provider)
Rights: get the respect and objective evaluation of the signing masses; Enjoy the due labor income according to the contract service policy.
Obligation: earnestly fulfill the service promise as agreed; Strictly implement the diagnosis and treatment norms and provide high-quality and safe medical and health services; Strengthen learning and improve service ability; Implement the basic medical insurance policy for urban residents and control medical expenses; Accept the supervision and evaluation of the masses, and constantly improve the service quality and the satisfaction of the masses.
Verb (abbreviation of verb) signature method
(a) the signing object is the family, and the family members sign the service agreement with the family doctor team of their choice with the residence booklet or residence permit. In principle, each family can only sign one family doctor team, and it is appropriate for each family doctor team to sign no more than 500 families.
(two) the District Health and Family Planning Bureau shall formulate a unified service agreement, and clarify the specific service items, charging standards and compensation policies. Choose the signing object according to the actual demand? Service portfolio? . If there are other special needs, a supplementary agreement can be signed through consultation (the fee will be set separately).
(3) The contract signing period is in years, and the service period is from the date of signing the contract for the first time to 65438+February 3 1 in the following year, and thereafter to 65438+February 3 1 in each year. When the agreement expires, the contracted family can renew, terminate or choose another contracted doctor.
(IV) During the signing period, if Party B fails to fulfill the agreed service commitment and Party A requests to cancel the contract, the service agreement shall be terminated upon confirmation of both parties, and all the signing fees shall be returned in one lump sum.
(5) This agreement is made in duplicate, one for the family doctor team and one for the contracted family.
Service content of intransitive verbs
Focusing on basic medical services, basic public health services and personalized services, the following service combinations are formulated:
(1) basic service package (free)
The key points of this combination are: to provide basic public health services stipulated by the state for contracted family members, to provide graded diagnosis and treatment services for contracted family members, and to enjoy preferential settlement policies for families participating in basic medical insurance for urban residents. The main contents include:
1. Establish electronic family health records and personal health records of family members for contracted families.
2. Provide free medical and health consultation for contracted families, make an appointment for examination, and distribute no less than 4 health education materials every year.
3. Provide standardized basic public health services for hypertension, diabetes, mental patients and the elderly.
4. Provide pregnant women and pregnant women in family members with pre-pregnancy guidance, in-hospital delivery guidance and postpartum visit, and guide them to local health centers for early pregnancy card building, regular prenatal examination and 42-day postpartum examination.
5. Visit newborns and guide children aged 0-6 to local health centers for vaccination, regular physical examination and oral health care.
6. Provide graded diagnosis and treatment services: After a contracted family member falls ill, the family doctor in the contracted team will make a preliminary diagnosis and treatment of the disease. If the disease cannot be effectively treated, the family doctor will contact the community health service clinic in the contracted team to assist the patient to transfer the patient to the community health service institution for diagnosis and treatment. If the condition is serious, the contracted team clinician will assist the patient to be transferred to the superior hospital through the green channel, and arrange experts for diagnosis and treatment.
7. Families participating in the basic medical insurance for urban residents enjoy preferential settlement policies: if the contracted patients seek medical treatment in the annual outpatient clinic of community health service, the individual pays part of the general medical treatment fee will be exempted.
(2) Personalized service package: charged separately according to regulations. Including (1) family sickbed service (2) family medical care (3) family nursing (4) family rehabilitation (5) visiting medical care (6) visiting medical care (7) health guidance and intervention.
This combination includes: 1, outpatient appointment service is implemented, and the contracted object enjoys the convenience of giving priority to medical treatment and is free of general medical treatment fees; 2. Priority appointment for referral and examination. The contracted object can be referred by a family doctor for priority treatment or hospitalized in a higher medical institution. 3. Establish a drug prescription system. If the contracted object really needs to continue the long-term medication orders of superior medical institutions (drugs outside the list of essential drugs) to maintain treatment, according to the medication suggestions of superior medical institutions, combined with clinical diagnosis and treatment subjects, the family doctor will apply to the center on behalf of the contracted object, and solve it by filing and purchasing, and implement the policy of online procurement and zero gross profit sales; Prescriptions that need to extend the dosage may be appropriately extended after being audited by the medical insurance office and reported to the medical institution for the record. 4. Establish a portfolio contract. That is, on the basis of choosing a family doctor to sign a contract, residents in this area choose 1 designated comprehensive tertiary hospital (including Chinese medicine hospital) to sign a contract according to the health needs and medical habits of the contracted object; The contracted object can choose any medical institution for treatment according to his own condition in the contracted medical institution portfolio, and can enjoy various preferential policies for contracted medical treatment. Due to the actual situation, residents who need to go to medical institutions (including specialist medical institutions) other than contracted medical institutions can go through the referral procedures in the contracted family doctor's office (or contracted medical institutions) and continue to enjoy various preferential policies for contracted medical care.
Seven. Implementation steps
(1) Select the pilot unit (2017 65438+1early October)
On the basis of voluntary declaration, choose 1 community health service institutions to carry out contract services (provincial demonstration community health service centers give priority to contract services).
(II) Establishment of the signing team (2017 65438+1mid-October)
Pilot community health service institutions select clinicians with intermediate or above titles to form a team of family doctors.
(III) Implementation of contract services (from mid-October of/kloc-0, 20 17, 17)
On the basis of extensive publicity, the signing service pilot was officially launched. Family doctors in the family doctor team sign contracts with customers in combination with daily diagnosis and treatment and health care management services. We can start with the elderly, patients with chronic diseases, women and children, mental patients and other key groups and gradually expand the scope. Clinicians in the family doctor team participated in the contract signing and provided technical guidance. The team of family doctors should conscientiously perform the contract according to the contents of the contract, standardize the service, make corresponding records and report the contract service monthly report in time. The District Health Planning Bureau conducts regular supervision and guidance to find and solve problems encountered in the service process in time to ensure the smooth implementation of the contracted service.
(4) gradually expand regional promotion (starting from 20 17 10 1)
On the basis of the pilot, revise the implementation plan and promote it in the whole region. Community health service institutions choose 2-3 communities with good foundation to carry out family doctor contract service, and gradually expand the scope to all residents.
Eight. job requirement
(A) to strengthen organizational leadership
Family doctor contract service is an important task to further deepen the reform of medical and health system, a key entry point to establish a graded diagnosis and treatment model, and an important measure to realize the transformation of primary medical and health service model. The District Health and Family Planning Bureau and the District Finance Bureau jointly set up a leading group to be responsible for the organization and implementation of the signing work in the whole region. Community health service institutions should also set up corresponding organizations, clarify the division of functions, and promote the steady development of family doctor contract service. The referral hospital at a higher level should set up a referral reception desk or a graded diagnosis and treatment office, which is responsible for the reception and triage of patients referred by community health service institutions, and guide the contracted patients to receive medical services through graded diagnosis and treatment.
(B) to create a good atmosphere
Family doctor contract service is a new thing, and the awareness of it in all walks of life, including medical staff, is still low. All units should make full use of local resources, carry out extensive publicity and launch activities through various channels such as distributing materials, social media, banners and slogans, improve the general public and the whole society's awareness and acceptance of family doctor contract service, and create a good public opinion atmosphere for the smooth promotion of family doctor contract service.
(3) Strengthen supervision and assessment.
Establish a performance appraisal system with the number of contracted households, the number of service projects, the actual service quantity, the completion degree of service standards, the service effect and the satisfaction of the masses as the core indicators, and allocate subsidy funds through performance appraisal. The District Health and Family Planning Bureau will pay a random telephone call back to the contracted customers of family doctors regularly to verify the authenticity of the contract and service satisfaction, and promote a virtuous circle of contract signing.
20 17 implementation plan of family doctor contract service is to further deepen medical reform, change medical and health service mode and service concept, build a new harmonious doctor-patient relationship, give full play to the network function of village clinics and community health service stations in the three-level medical and health system, and be a healthy gatekeeper. Role, according to the National Health and Family Planning Commission "on the implementation of rural doctors contract service pilot" and the spirit of the relevant documents of the province and city, combined with the actual city, the development of this program.
First, the overall goal
By developing the contracted service of family doctors, we will promote the transformation of village-level health services to health management and gradually establish a new system of dual gatekeepers in rural areas, which can not only protect health, but also ensure expenses; Promote the actual income and treatment of rural doctors to be linked to the number of contracted services, and promote the establishment of a new assessment and distribution mechanism for more work; Guide rural doctors to improve their professional quality and strive to establish a new model of village-level first diagnosis and graded diagnosis and treatment services.
Second, the basic principles
(A) adhere to the nature of public welfare
Basic medical care and basic public health services are important contents for the government to provide public services for residents. We must firmly establish the consciousness of facilitating the people, benefiting the people and benefiting the people, and always adhere to the nature of public welfare.
(2) Adhere to the combination of prevention and control.
Guided by health management and comprehensive services, we will strive to improve the ability of primary medical and health services, promote the effective combination of medical care and prevention, and let residents enjoy convenient, fast, effective and safe basic medical and public health services.
(3) Adhere to voluntary signing.
Widely publicize and launch, fully inform the specific content of the contract service and the policy of benefiting the people. Under the premise of fully understanding the connotation of contracted services, residents choose their own family doctors, sign service agreements and enjoy the agreed services.
(4) Adhere to gradual progress.
Priority coverage, priority signing and priority service for key groups. On the basis of completing the pilot project, we should sum up experience, improve the scheme and make steady progress in order to achieve practical results.
Third, the signing subject
A team of family doctors is composed of 1 clinicians with intermediate titles or above and 1 rural doctors in township hospitals (in principle, each clinician in township hospitals can team up with at most 3 rural doctors), with the elderly over 65 years old, children aged 0-6 years old, pregnant women, patients with chronic diseases and mental patients as the key contracting targets, to carry out contracting services. Township hospitals and health management teams assist and provide technical support.
Four. Rights and obligations of both parties
(1) Party A (the buyer)
Right: voluntarily choose to sign a family doctor; Enjoy the agreed service items within 30 working days after signing the contract; Supervise the implementation of contract service project specifications.
Obligation: Understand the particularity of family doctors' work, and support and cooperate with family doctors in their work; The first visit was in the village clinic; Give priority to the choice of essential drugs and accept referral suggestions from family doctors; Take the initiative to pay the contract fee and participate in the evaluation of contracted services.
(II) Party B (service provider)
Rights: get the respect and objective evaluation of the signing masses; Enjoy the due labor income according to the contract service policy.
Obligation: earnestly fulfill the service promise as agreed; Strictly implement the diagnosis and treatment norms and provide high-quality and safe medical and health services; Strengthen learning and improve service ability; Implement the basic medical insurance policy for urban and rural residents and control medical expenses; Accept the supervision and evaluation of the masses, and constantly improve the service quality and the satisfaction of the masses.