Keywords
Policy analysis
Health management
Grassroots healthcare
Categories
How to Cite
Abstract
Family doctor contract services are a core component of China’s Healthy China strategy, designed to build a gatekeeper mechanism for tiered healthcare via primary care resource optimization and continuous health management. Taking District J in Nanjing as an empirical case, this study employs literature review, questionnaire, in-depth interview and policy analysis to examine policy effects, dilemmas and optimization paths. Since 2016, District J has completed pilot exploration, full promotion and quality improvement, forming 125 teams covering 420,000 residents with basic and personalized packages, achieving phased progress in key population contracting and health management. Three core contradictions are identified: supply-demand mismatch with packages poorly aligned to resident needs; spatial disparity in resource allocation between urban and suburban areas; and perception-policy goal deviation leading to “signing without engagement”. Root causes lie in imperfect contractual institutions, insufficient general practitioners and equipment, and quantity-oriented assessment. Accordingly, this study proposes a three-tier package system, “1+X” team model, suburban resource tilting, smart device elderly-friendly reform and targeted publicity, plus a quality-focused assessment and closed-loop management. It provides a “resource sinking-demand matching-effect evaluation” framework for similar regions and references for shifting family doctor services from full coverage to high-quality development.
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