我国家庭医生签约服务政策执行的制约因素与优化路径：基于史密斯政策执行过程模型

深化家庭医生签约服务是深化医药卫生体制改革、强化基层医疗卫生服务、实现"健康中国"战略目标的重要选择，也是当前更好维护人民群众健康的重要途径。为有效推进签约服务工作，国家陆续推出各项政策，全国各地也在积极进行实践探索，成效明显。但是，签约服务仍面临诸多问题，其中"执行难"是签约服务深度推进的一大困境。通过史密斯政策执行过程模型，结合签约服务政策执行过程，发现签约服务仍存在法治性不足、政策执行人员水平不高、激励不足、政策环境影响等诸多制约因素。因此，需要从法律和制度方面进行顶层设计、提升执行人员素质和职业认同、建立医患互信、优化政策执行环境等角度进行政策创新，探索家庭医生签约服务可持续发展的路径。

Barriers and Improving Paths to the Implementation of Contracted Family Doctor Services in China:an Analysis Using Smith's Policy Implementation Process Model

The contracted family doctor services(CFDSs)is a key action selected to be implemented to deepen the reform of the pharmaceutical and healthcare system,enrich primary care services,and achieve the strategic goals of health China.Moreover,the implementation of CFDSs is a main approach to better safeguarding people's health.To effectively promote the development of CFDSs,China has successively launched various relevant supportive policies,and the local governments have been actively exploring practicing approaches.So far,remarkable results have been achieved nationwide,yet there are still many challenges,among which implementation difficulty is a major factor influencing further promotion of CFDSs.We analyzed the implementation process of CFDSs using Smith's policy implementation process model,and identified many barriers to the implementation of CFDSs,such as lack of rule of law,low level of policy executors,insufficient incentives,and impact of policy environment.In view of this,we put forward the following recommendations on exploring innovative policies for sustainable development of CFDSs:designing top-level policy objectives for CFDSs development from perspectives of law and system,improving qualities and professional identity of providers of CFDSs,establishing mutual trust between doctors and patients,and optimizing the policy implementation environment.