从“单兵”到“团队”：农村家庭医生签约服务模式动态演进的纵向单案例研究

Objective: To explore the development lineage and evolution mechanism of the family doctor contracting service model in rural areas, and to provide reference for the relevant departments to continuously optimize the family doctor contracting service policy. Methods: Based on the principle of theoretical sampling, City J of Province S, which is listed as one of the National Comprehensive Primary Health Care Pilot Zones, was selected as a case study, and primary data were collected through on-site interviews and secondary data were included, and imported into the NVivo11 software to programmatically grounded-code them. Results: Based on the three-level coding, 71 initial concepts, 24 sub-categories and 9 main categories are sorted out, and the core categories are formed by selective coding. The contracting service of family doctors in rural areas has gone through three stages, namely individual contracting by rural doctors, team contracting, and team contracting under the county medical community, and the conditions of its evolution have gone through the contracting formality, the service capability, and the synergism of effectiveness in turn, and the action of system adaptation of the three elements has shown poor execution under system disembedding, synergistic blockage under structural embedding, and synergistic execution under system coupling. The three elements of the system are adapted to the action in order of poor order of implementation under the system de-embedding, synergistic blockage under the structural embedding, and synergistic implementation under the system coupling, based on which the institutionalization of the policy responsibility of the family doctor is gradually realized, the ability to structurally jump up, and the community of interest is deepened. Conclusion: The mechanism for the evolution of the contracted service model of family doctors in rural areas is reflected in the dynamic adaptation of the conditions of the political, social, and policy contexts, and the gradual realization of the closed loop of responsibility, capacity, and benefits based on the differentiated progression of the three elements of the system.