Hubei Launches Family Doctor Contract Service Pilot in Five Cities: Wuhan, Xiangyang, Ezhou, Yichang, and Qianjiang
Recently, the Hubei Provincial Office of Healthcare Reform, the Health and Family Planning Commission, the Development and Reform Commission, the Department of Civil Affairs, the Department of Finance, the Department of Human Resources and Social Security, and the Price Bureau jointly issued the “Implementation Opinions on Promoting Family Doctor Contract Services in Hubei Province” (hereinafter referred to as the “Opinions”), deciding to launch family doctor contract services across the province starting in 2017. The initiative aims to further promote primary care at the grassroots level and tiered diagnosis and treatment, thereby providing the public with comprehensive, continuous, and coordinated basic medical and health services.
According to the "Guiding Opinions," pilot programs for family doctor contract services were initially launched in five cities, including Wuhan, Xiangyang, Ezhou, Yichang, and Qianjiang. These services were rolled out province-wide in 2017, with the goal of achieving full coverage by 2020. At the current stage, family doctor contract services prioritize coverage for key populations, including the elderly, pregnant and postpartum women, children, individuals with disabilities, as well as patients with chronic diseases such as hypertension, diabetes, and tuberculosis, and those with severe mental disorders. Coverage will then be gradually extended to the general population.
The “Opinions” stipulate that permanent resident families who have lived in the jurisdiction for more than six months may voluntarily select one family doctor team to sign a service agreement, with a signing period of one year in principle. Upon expiration, residents may renew the contract or choose to sign with another family doctor team. Meanwhile, residents or families are encouraged to voluntarily select a secondary or tertiary hospital that has established a cooperative relationship with the primary healthcare institution at the time of signing with the family doctor team, thereby establishing a “1+1+1” or “1+1” combined contracting service model. Patients seeking medical care within institutions under this combined model shall enjoy priority services such as appointment registration and hospital admission.
The “Opinions” clearly state that, at the current stage, the primary individuals responsible for contracted services are general practitioners registered with primary healthcare institutions, as well as qualified physicians in township health centers and village doctors. The primary healthcare institutions to which they belong serve as the main entities accountable for contracted services. Contracted services are delivered through a team-based approach, primarily comprising family doctors, community nurses, and public health physicians. Hospitals at level II and above provide technical support and professional guidance, while family doctors are responsible for task allocation and management among team members.
Family doctor teams provide contracted services to residents, collecting an annual service fee based on the number of enrolled individuals. This fee is shared among the basic medical insurance fund, funds for basic public health services, and payments made by the contracted residents. Specific standards and cost-sharing ratios are determined by local authorities based on factors such as the scope of contracted services, the demographic structure of enrolled residents, and the financial capacity of the basic medical insurance fund and public health funding. Individuals eligible under medical assistance policies shall receive aid in accordance with relevant regulations.
After signing the contract, residents can enjoy basic medical services provided by family doctor teams, including diagnosis and treatment of common and frequently occurring diseases using both traditional Chinese and Western medicine, rational drug use, guidance on medical care pathways, and referral appointments; public health services as stipulated by national basic and major public health service programs; as well as health management services such as health assessments, rehabilitation guidance, home hospital bed services, home nursing, traditional Chinese medicine “preventive treatment” services, remote health monitoring, and dietary and exercise guidance. They may also benefit from differentiated policies in areas such as medical consultations, referrals, medication, and medical insurance.
Meanwhile, Hubei Province encourages eligible regions and institutions to provide contracted residents with a variety of services—including comprehensive care, home visits, off-peak-hour services, and appointment-based services—in accordance with agreements, and to deliver health services related to home-based elderly care for key populations such as empty-nesters and families who have lost their only child. Urban public hospitals shall reserve no less than 20% of specialist appointments, scheduled registration slots, and inpatient beds for primary healthcare institutions engaged in paired collaboration, thereby facilitating priority outpatient consultations and hospitalization for contracted residents.
Primary healthcare institutions may issue prescriptions based on patients’ clinical needs and the medical orders from higher-level hospitals, without being restricted to the National Essential Medicines List. For contracted chronic disease patients with stable conditions and good adherence, family doctors may issue extended prescriptions and long-term prescriptions in accordance with the medical orders from higher-level hospitals, allowing a single dispensing supply of up to two months.