From Family Doctor Contract Services to the Implementation and Optimization of the Tiered Diagnosis and Treatment System: A Case Study of Harbin

Abstract

Family doctor contract services are an important lever for implementing the tiered diagnosis and treatment system and for promoting first contact at the primary level and health management. Taking Harbin as a case, and adopting a dual perspective that coordinates the supply of medical services with the medical security system, this paper draws on policy text analysis and official statistical data to examine the positioning, progress, and obstacles of family doctor contract services in tiered diagnosis and treatment. The findings are as follows. First, the coverage of contract services in Harbin has continued to expand, and measurable progress has been achieved in the health management of key populations; in addition, a reimbursement gradient favoring the primary level has taken shape in medical insurance benefits. Second, owing to such factors as an inadequate supply of primary-level health workforce, low levels of residents' trust in and participation in the services, weak linkage between contract services and medical insurance benefits, and the lack of any constraint on "signing without engaging," the leveraging effect of contract services on tiered diagnosis and treatment remains limited. Accordingly, this paper proposes optimization pathways that include enhancing primary-level service capacity, strengthening residents' awareness and participation, deepening the reform of medical insurance payment methods and benefit-based guidance, and promoting the articulation between long-term care insurance and contract services.