School of Management, Jiangsu University, Zhenjiang 212013, China.
Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China.
Int J Environ Res Public Health. 2022 Aug 29;19(17):10744. doi: 10.3390/ijerph191710744.
The role of the family doctor contracted service system in China's medical and health system is increasing day by day. However, with the steady increase in contracting coverage, the phenomenon of "signing up but not contracting" has become common; to improve the current situation, the personalized signing service model has been strongly advocated. To promote the smooth implementation of the personalized contracted service model with family doctor competency as its core, this study used the signal game model to analyze the market equilibrium state of the signing service model. The results of this analysis reveal the following: (1) The camouflage of the number of contracts leads to distortion of the signal effect and to market failure, that is, the cost of competency camouflage is the primary factor affecting the equilibrium of contracted services. (2) The incompleteness of contracted services leads to quantity but not quality in the contracting market, that is, the payment of personalized service packages, the value-added utility of personalized services, and service gaps are the key factors that affect the decision-making behavior of the public. With this knowledge in mind, a compensation incentive mechanism that matches the competence level of the family doctor should be established, the formulation of contracted service agreements should be improved, and the participation of family doctors and residents should be encouraged, while the promotion of personalized contracted services should be enhanced and relevant supporting measures should be improved.
家庭医生签约服务制度在中国医疗卫生体系中的作用日益凸显。然而，随着签约覆盖面的稳步增加，“签而不约”的现象却越发普遍；为改善这一现状，大力倡导个性化签约服务模式。为推动以家庭医生能力为核心的个性化签约服务模式顺利实施，本研究运用信号博弈模型分析签约服务模式的市场均衡状态。该分析结果揭示出：（1）合同数量的伪装导致信号效应扭曲和市场失灵，即能力伪装的成本是影响签约服务均衡的主要因素；（2）签约服务的不完整性导致签约市场中只有数量而没有质量，即个性化服务包的支付、个性化服务的增值效用和服务差距是影响公众决策行为的关键因素。基于这一认识，应建立与家庭医生能力水平相匹配的补偿激励机制，完善签约服务协议的制定，鼓励家庭医生和居民的参与，同时加强个性化签约服务的推广，并完善相关配套措施。
