| 引用本文：田亚艳,连婷慧,师新宇,等.农村地区家庭医生签约服务模式动态演进的纵向案例研究[J].中国卫生政策研究,2025,18(6):51-57 |
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| 农村地区家庭医生签约服务模式动态演进的纵向案例研究 |
| 投稿时间：2025-05-03 修订日期：2025-06-10 PDF全文浏览 HTML全文浏览 |
| 田亚艳1，连婷慧1，师新宇2，李建涛1 |
| 1.山西医科大学管理学院 山西太原 030001;2.山西医科大学第二医院 山西太原 030001 |
| 摘要:目的 探讨农村地区家庭医生签约服务模式的发展脉络与演进机制，为相关部门持续优化家庭医生签约服务政策提供参考。方法 基于理论抽样原则，选取列为国家基层卫生健康综合试验区之一的S省J市作为案例研究对象，通过访谈与文献梳理搜集资料，用NVivo11软件进行扎根编码。结果 梳理出74个初始概念、24个副范畴以及9个主范畴，经选择性编码形成核心范畴，农村地区家庭医生签约服务历经乡村医生个体签约、团队签约以及县域医共体下的团队签约三个阶段，其演进条件依次经历了签约形式化、服务能力化、效能协同化，制度三要素适配行动依次呈现制度脱嵌下的差序执行、结构嵌入下的协同阻滞与系统耦合下的协同执行，由此逐步实现从责任建构到能力提升再到责任、能力、利益的系统耦合。结论 农村地区家庭医生签约服务模式演进机制体现为政治情境、社会情境、政策情境条件下的动态性适配，基于制度三要素差异化进阶逐步实现责任、能力、利益三要素闭环。 |
| 关键词:家庭医生签约服务 动态演进 纵向案例研究 扎根理论 农村地区 |
| 基金项目:山西省社会科学界联合会“山西大健康学会联合体”专项课题（JKZX2025040） |
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| A longitudinal case study on the dynamic evolution of rural family doctor contract service mode |
| TIAN Ya-yan1, LIAN Ting-hui1, SHI Xin-yu2, LI Jian-tao1 |
| 1.School of Management， Shanxi Medical University， Taiyuan Shanxi 030001， China;2.The Second Hospital， Shanxi Medical University， Taiyuan Shanxi 030001， China |
| Abstract:Objective To explore the development context and evolution mechanism of family doctor contract service mode in rural areas， and provide reference for relevant departments to continuously optimize the family doctor contract service policy.Methods Based on the principle of theoretical sampling， J City in S Province， which is listed as one of the national primary health comprehensive pilot areas， was selected as the case study object， and the data were collected through interviews and literature review， and then grounded and coded with NVivo11 software.Results 74 initial concepts， 24 sub categories and 9 main categories were sorted out， and the core categories were formed through selective coding. The signing service of family doctors in rural areas has gone through three stages： individual signing of rural doctors， team signing and team signing under the county medical community. Its evolution conditions have gone through the formalization of signing， service capability and efficiency synergy in turn. The three elements of the system adaptation action successively presents differential execution under the system de embedding， collaborative block under the structure embedding and collaborative execution under the system coupling， so as to gradually realize the system coupling from responsibility construction to ability improvement， and then to responsibility， ability and interest.Conclusion the evolution mechanism of the contracted service mode of family doctors in rural areas reflects the dynamic adaptation under the conditions of political situation， social situation and policy situation， and gradually realizes the closed-loop of the three elements of responsibility， ability and interest based on the differentiation of the three elements of the system. |
| Key words:Family doctor contracting service Dynamic evolution Longitudinal case study Grounded theory Rural areas |
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