我国家庭医生签约服务背景下社区卫生服务机构诱导需求的防范和规制研究

诱导需求是世界各国均存在的医疗卫生服务现象，会导致患者的利益受损，医疗资源分配不均。近年来随着我国对基层医疗卫生投入增加，分级诊疗制度和家庭医生签约服务的推动和开展，卫生费用从大医院流入社区，契约式社区医疗服务的利益博弈与优化策略研究成为签约背景下的重要研究方向，关乎医改实施的成败。本文从社区卫生服务诱导需求入手，结合经济学理论对社区全科医生诱导需求进行分析，通过比较美国、澳大利亚、欧盟国家现状及相关研究，总结各国经验，分析我国当前家庭医生签约服务背景下社区卫生服务机构产生诱导需求的因素，并提出以下建议：通过扩大家庭医生群体数量，采用约束和监督与激励机制相结合的形式，对社区家庭医生进行防范和规制；通过市场竞争向医生传递压力，增加其诱导需求成本；加强对社区居民的健康教育力度，加快基层信息化建设，增加信息透明度，削弱诱导需求的影响，为患者提供更多的疾病知识和医疗选择。

Prevention and Restraining of Induced-demand for Community Health Services by Contracted Family Doctors in China

Physician-induced demand is a global medical phenomenon，which harms the interests of patients，and even leads to uneven distribution of medical resources. Recently in China，along with the increase in investment in primary care，the promotion and development of hierarchical medical system and contracted family doctor services，the shift in outpatient volume from tertiary hospitals to primary care settings has brought an increased growth of medical expenditure in primary care，and the profits and improvement strategies regarding contractual community medical services has become an important research direction，and has a bearing on the success of the healthcare reform initiated in 2009. We analyzed induced demand by community family doctors in China using economic theory of supply and demand，and identified factors associated with induced demand in community primary care during the promotion of contracted family doctor services. To address these factors，we put forward the following recommended solutions based on the coping experiences of the United States，Australia and EU countries summarized from studies concerning physician-induced demand in these countries：（1）Supervising practice behaviors and restraining induced demand behaviors of community family doctors while increasing the number of them and incentivizing them to improve service delivery to satisfy residents' healthcare needs.（2）Increasing the price paid for making decisions of induced demand in community family doctors by pressures from medical market competition.（3）Reducing the influence of physician-induced demand on residents by increasing their disease-related knowledge via strengthened public health education，improved transparency of healthcare through speeding up the construction of informatization in primary care，and by increasing the options of healthcare seeking.