National Health Commission Releases First-Ever Guidelines on Family Doctor Contract Services, Outlining Ten Key Tasks Including Service Fees, Insurance Reimbursement, and Private Sector Participation
It is reported that on April 2, the National Health Commission released the “Notice on Doing a Good Job in Family Doctor Contracted Services in 2018” (hereinafter referred to as the “Notice”), which made specific arrangements for the objectives and content of family doctor contracted services. The “Notice” proposed thatEncourage Social Forces to Participate in Contracted Services, determine the signing fees to meet residents' multi-level and diversified health service needs.
So, what specific tasks and measures are there?
First, rationally define the objectives for contracted service work.Localities should determine work targets for contracted services in a realistic, scientific, and rational manner, based on their service capacity and resource allocation. While maintaining stable enrollment numbers and consolidating coverage, the focus should shift toward improving quality and efficiency, ensuring that each signed-up individual receives fulfilled and substantive services, thereby continuously enhancing residents’ sense of gain and satisfaction with contracted services. Blind pursuit of high enrollment rates should be avoided, as should the imposition of excessive additional requirements at successive administrative levels; meanwhile, measures should be implemented to prevent a decline in the number of contracted services.
Secondly, prioritize the delivery of contracted services for key population groups.In accordance with service specifications, provide health management services for the elderly, pregnant and postpartum women, children, and patients with chronic diseases such as hypertension, diabetes, and tuberculosis, as well as those with severe mental disorders; strengthen the integration of prevention and treatment, implement categorized interventions, and ensure access to basic medical and health services. Implement the “Three Batches” requirements of health-focused poverty alleviation, prioritize contract signing for impoverished populations, verify and confirm rural impoverished patients with chronic diseases, and design personalized contract service packages in areas with appropriate conditions. Provide basic medical and health services to persons with disabilities based on local realities, and encourage areas with appropriate conditions to include basic rehabilitation services within the scope of personalized contracts. Continue to provide contract signing services for members of special family planning households.
Finally, standardize the provision of family doctor contract services.Residents may voluntarily choose to sign service agreements with family doctor teams, which shall provide contracted services in accordance with the agreed terms. Contracted services are delivered through a team-based approach, encouraging the participation of pharmacists, health managers, psychological counselors, and social workers (including volunteers), while leveraging the roles of township/subdistrict health and family planning specialists and full-time commissioners for persons with disabilities in the provision of contracted services. Efforts should be made to gradually implement appointment-based consultations and targeted triage through assigned contracting physicians, conduct health self-testing and health education in health kiosks or waiting areas, optimize service workflows, and comprehensively provide continuous basic medical care and public health services. The assignment of assistants is encouraged to provide supportive services and alleviate the non-clinical administrative burden on family doctors.
Furthermore, non-governmental entities are encouraged to participate in contracted services.To expand the supply of contracted services, efforts should be jointly advanced by the state, collectives, and individuals. Private medical institutions are encouraged to play an active role in contracted services to meet residents’ multi-level and diversified health service needs. Support shall be provided for the development of commercial health insurance that aligns with basic medical insurance, thereby offering coverage for health management needs.
1. Coordinate the provision of basic medical care and basic public health services.All regions should actively innovate and enrich contracted service models, while coordinating the provision of basic medical care and basic public health services. Family doctor teams should align with the service needs of contracted residents to deliver integrated, comprehensive, and continuous healthcare services that combine medical treatment with disease prevention.
2. Enhance the capacity for diagnosis and treatment of common and frequently occurring diseases.Leverage the “High-Quality Services at the Grassroots Level” initiative to provide outpatient, emergency, and inpatient services for common and frequently occurring diseases, and targetedly enhance capabilities in outpatient disease consultation, diagnosis, and treatment. Prioritize strengthening specialized service capacities for hypertension, diabetes, and common pediatric conditions. Develop professional competencies in rehabilitation, stomatology, traditional Chinese medicine (TCM), and mental health, thereby improving comprehensive diagnostic and therapeutic capabilities at the grassroots level.
3. Promote appointment-based diagnosis and treatment services.Actively promote time-slot appointment services via mobile client apps, telephone, and the Internet to facilitate contracted residents’ access to health management services, including child healthcare, vaccination, health examinations, and chronic disease management. Establish an appointment-based consultation mechanism to guide contracted residents to prioritize the diagnostic and treatment services provided by their contracted family doctors.
4. Strengthen technical support for contracted services.Leverage the capabilities of hospitals at secondary level and above to provide primary healthcare institutions with services such as imaging and electrocardiogram (ECG) interpretation, remote consultations, and training. Establish independent regional medical laboratories, pathology diagnostic centers, and sterile supply centers to achieve shared utilization of regional resources. Prioritize pilot programs in impoverished areas to explore the application of clinical decision support systems for diagnostic assistance at the primary care level.
5. Ensure effective referral services.Strengthen close collaboration between family physicians and specialists at secondary hospitals or above, ensuring timely referrals or providing guidance on care pathways for patients who genuinely require referral. Secondary hospitals or above shall designate specific personnel to coordinate these efforts and establish expedited “green channels” for referred patients. Leveraging information technology, the range of referral options available to family physicians should be expanded, allocating to them a certain proportion of hospital resources, such as specialist appointments and reserved beds.
6. Ensure the availability of essential medications for contracted residents.Rationally equip primary healthcare institutions with pharmaceuticals and accelerate the improvement of medication coordination with secondary and tertiary hospitals. Regions with appropriate conditions may implement third-party drug delivery services to provide convenient access for contracted residents.
7. Promote the implementation of long-term prescription policies for chronic disease medications.Under the premise of being “reasonable, safe, and effective,” the single dispensing quantity may be appropriately extended for contracted patients with chronic diseases who have stable conditions and good adherence. Relevant departments shall be coordinated to explore the formulation of standards and norms for long-term prescriptions for chronic diseases. When patients referred upward by family doctors return to primary healthcare institutions for treatment, medications prescribed by tertiary hospitals may be continued based on the patient’s condition and the medical orders from the higher-level hospital.
8. Implement personalized contract-based services.Provides, includingPersonalized services such as health consultations, assessments, behavioral interventions, and medication guidance.Encourage the implementation of “menu-style” services based on practical conditions to enhance the precision of contracted services. Actively support family doctor teams in providing contracted services to functional communities such as enterprises, public institutions, nursing homes, and schools. Under the premise that policies, technology, and medical safety assurances are adequately in place, clearly define the list of home-visit service items and improve service standards and specifications.
9. Leverage information technology to maintain close contact with contracted residents.Accelerate the development and application of intelligent information platforms for contracted services. Leveraging websites, mobile applications, and other channels, establish an interactive communication platform between family doctors and contracted residents to provide online contracting, appointment scheduling, consultations, health management, chronic disease follow-up, and report inquiry services. Regularly deliver targeted health education information based on varying service needs, seasonal characteristics, and disease prevalence trends.
10. Strengthen internal division of labor and collaboration within the institution.Building on the provision of general practice diagnosis and treatment services, family doctor teams should strengthen division of labor and collaboration with internal departments such as immunization, maternal and child health care, traditional Chinese medicine, and rehabilitation within their affiliated institutions, thereby promoting effective integration between specialized services and contracted services.
1. Improve comprehensive incentive policies.Implement the “Notice on Improving the Performance-Based Pay Policy for Primary Healthcare Institutions to Safeguard Family Doctor Contract Services” (Ren She Bu Fa [2018] No. 17). In accordance with the “Two Permissibles” requirement, coordinate with relevant departments to balance the relationship between performance-based pay levels at primary healthcare institutions and those at county-level public hospitals in the same locality. Reasonably determine the total amount and level of performance-based pay for primary healthcare institutions, giving preference to those that deliver high-quality and efficient services, achieve high patient satisfaction, and effectively fulfill their designated functions and tasks. Where conditions permit, establish a general practitioner allowance within the internal distribution of performance-based pay, listed as a separate item. Raise the wage level of general practitioners to align with that of clinicians with comparable qualifications at local county-level public hospitals.
2. Reasonably determine the contract signing service fee.Localities must clarify the fee standards for contracted services and collect service fees on an annual basis according to the number of residents under contract. The fees for contracted services shall be shared among the basic medical insurance fund, basic public health funding, and payments by contracted residents. Full play should be given to the supplementary role of social capital—including funds from civil affairs departments, disabled persons’ federations, women’s federations, poverty alleviation offices, enterprises and public institutions, public welfare foundations, commercial health insurance, and long-term care insurance—in purchasing contracted services. Fees for contracted services, as part of the revenue of primary healthcare institutions where family doctor teams are based, may be used for personnel compensation distribution.
3. Improve medical insurance support policies.All regions shall coordinate with relevant departments to establish basic medical insurance reimbursement policies that are practical and conducive to enhancing the appeal of family doctor contract services. These policies should fully leverage the incentivizing role of medical insurance funds by implementing differentiated payment mechanisms—such as lowering deductibles, allowing cumulative calculation of deductibles, and increasing reimbursement rates for hospitalizations following referrals—thereby guiding residents to seek care at primary healthcare facilities.
(4) Promote adjustments to service prices. Localities shall coordinate with price regulatory authorities to reasonably adjust the prices of services related to contracted care, particularly by adding and adjusting the pricing for services such as home visits, home hospital beds, and home nursing care, which fully reflect the technical and labor value provided by family doctor team members.
Regarding performance assessment, all regions shall establish an evaluation mechanism for family doctor contract services, incorporate it into the comprehensive performance appraisal of primary healthcare institutions, conduct regular assessments, and link the assessment results to the total performance-based wage pool of primary healthcare institutions and the remuneration of their principal leaders.
Adopt a goal-oriented approach to improve the evaluation and assessment indicator system, with core metrics including the number and composition of contracted individuals, service quality, health management outcomes, resident satisfaction, control of medical and pharmaceutical costs, and the proportion of contracted residents seeking primary care at grassroots institutions. Strictly guard against bureaucracy and formalism. Fabrication of contract service agreements and other fraudulent practices shall be seriously corrected and investigated. By the end of May 2018, all localities shall organize a quality supervision inspection based on self-examination and self-assessment conducted at the grassroots level, and our Commission will conduct supervisory inspections as appropriate.
In terms of management assessment, primary healthcare institutions shall establish and improve internal management and performance appraisal mechanisms, leveraging information technology to enhance the authenticity and accuracy of data collection, analysis, and utilization.Assessment results shall be linked to the performance-based compensation distribution for family doctor teams and individuals, adhering to the principles of “more pay for more work” and “higher pay for better performance.”
Meanwhile, efforts should be intensified to promote and publicize contracted services. Localities should make full use of various information dissemination media to enhance residents’ awareness and utilization rates. It is essential to maintain consistent messaging in publicity campaigns, enabling residents to understand the connotations and standards of contracted services at the current stage, and to reasonably manage their expectations.
May 19, 2018, marked the 8th “World Family Doctor Day.” Localities are required to organize centralized thematic publicity campaigns, highlight exemplary practices of outstanding family doctors and family doctor teams, promote the concept of enhancing health management through contracted services, and foster a favorable social atmosphere for widespread participation in and support of contracted services.