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Article(id=1241022949499654697, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412192, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733846400000, receivedDateStr=2024-12-11, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812528252, onlineDateStr=2026-03-18, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812528252, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812528252, creator=13701087609, updateTime=1773812528252, updator=13701087609, issue=Issue{id=1241022939957621542, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812525976, creator=13701087609, updateTime=1773815469296, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035285174219432, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035285174219433, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1074, endPage=1078, ext={EN=ArticleExt(id=1241022951307399761, articleId=1241022949499654697, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effect of family doctor contract on the service utilization of residents’ primary medical and health institutions: based on propensity score matching method, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the impact of family doctor contract on the utilization of services in primary medical and health institutions.

Methods

Logit model and propensity score matching method were used for analysis.

Results

The signing rate of family doctors was 75.8%, and the service utilization rate of primary medical and health institutions was 65.28%. The propensity scores matching results showed that after kernel matching and radius matching, ATT of family doctor contract on utilization of primary medical and health institutions was 0.052 4 and 0.068 3. The contracted services of family doctors had increased the utilization rate of primary medical and health institutions of residents with chronic diseases by 13.84%. The contract services of family doctors had no statistical significance on the utilization rate of primary medical and health institutions of non-chronic residents. The contracted services of family doctors had increased the average utilization rate of elderly residents to primary medical and health institutions by 9.25%. The contracted services of family doctors increased the average utilization rate of non-elderly residents to primary medical and health institutions by 5.98%.

Conclusion

The signing rate of family doctors and the utilization rate of primary medical and health institutions are both good. Contracted family doctors can promote the utilization of primary medical and health institutions by residents, and the contracted service of family doctors is more obvious to the utilization of primary medical and health institutions by people with chronic diseases and the elderly.

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目的

评估家庭医生签约对居民基层医疗卫生机构服务利用的影响。

方法

利用logit模型和倾向得分匹配法进行分析。

结果

家庭医生签约率为75.8%，基层医疗卫生机构服务利用率为65.28%。倾向得分匹配结果显示，在半径匹配和核匹配两种方法下，家庭医生签约对居民基层医疗卫生机构服务利用的ATT分别为0.052 4和0.068 3，说明签约家庭医生的居民在基层医疗卫生机构服务利用上平均分别增加了5.24%和6.83%。家庭医生签约对慢性病居民基层医疗卫生机构服务利用的概率平均提高13.84%，对未患慢性病居民的基层医疗卫生机构服务利用无统计学意义，对老年居民的基层医疗卫生机构服务利用的概率平均提高9.25%，对非老年居民的基层医疗卫生机构服务利用的概率平均提高5.98%。

结论

家庭医生签约率和基层医疗卫生机构利用率均表现良好。签约家庭医生能促进居民对基层医疗卫生机构服务的利用，家庭医生签约对患有慢性病人群和老年人群的基层医疗卫生机构服务利用的促进情况更为明显。

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于贞杰，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=n52SAK0+p0lmgm0Q/4DZUA==, magXml=COs2QM/FRQaNhckdh001Lw==, pdfUrl=null, pdf=VQ83AZVM9DrTRS1mPAPBBg==, pdfFileSize=596179, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=DMSkd5HPzhvNlvcKpvTTxg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=OC7fUMHEy44FMivuR15FkA==, mapNumber=null, authorCompany=null, fund=null, authors=

韩志鹏（1998—），男，硕士在读，研究方向：医药卫生政策与卫生经济学评价

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韩志鹏（1998—），男，硕士在读，研究方向：医药卫生政策与卫生经济学评价

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韩志鹏（1998—），男，硕士在读，研究方向：医药卫生政策与卫生经济学评价

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Guiding opinions of the General Office of the State Council on promoting the construction of graded diagnosis and treatment system[EB/OL]. [2025-02-05]. https://www.gov.cn/gongbao/content/2015/content_2937321.htm. (In Chinese), articleTitle=Guiding opinions of the General Office of the State Council on promoting the construction of graded diagnosis and treatment system, refAbstract=null), Reference(id=1241022961415672018, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[2], rfOrder=2, authorNames=中华人民共和国国家卫生和计划生育委员会, journalName=null, refType=null, unstructuredReference=中华人民共和国国家卫生和计划生育委员会．卫生计生委关于印发推进家庭医生签约服务指导意见的通知[EB/OL].[2025-02-05]. https://www.gov.cn/xinwen/2016-06/06/content_5079984.htm., articleTitle=卫生计生委关于印发推进家庭医生签约服务指导意见的通知, refAbstract=null), Reference(id=1241022961549889754, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[2], rfOrder=3, authorNames=The National Health and Family Planning Commission of the People’s Republic of China, journalName=null, refType=null, unstructuredReference=The National Health and Family Planning Commission of the People’s Republic of China. Notice of the Health and Family Planning Commission on issuing guidelines on promoting contracted services for family doctors[EB/OL]. [2025-02-05]. https://www.gov.cn/xinwen/2016-06/06/content_5079984.htm. (In Chinese), articleTitle=Notice of the Health and Family Planning Commission on issuing guidelines on promoting contracted services for family doctors, refAbstract=null), Reference(id=1241022961679913187, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2018, volume=21, issue=1, pageStart=1, pageEnd=4, url=null, language=null, rfNumber=[3], rfOrder=4, authorNames=刘利群, journalName=中国全科医学, refType=null, unstructuredReference=刘利群．推进家庭医生签约服务加强分级诊疗制度建设[J].中国全科医学，2018, 21(1): 1-4., articleTitle=推进家庭医生签约服务加强分级诊疗制度建设, refAbstract=null), Reference(id=1241022961788965095, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2018, volume=21, issue=1, pageStart=1, pageEnd=4, url=null, language=null, rfNumber=[3], rfOrder=5, authorNames=Liu LQ, journalName=Chinese General Practice, refType=null, unstructuredReference=Liu LQ. 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(In Chinese), articleTitle=Promoting contracted services of family doctors to strengthen the construction of hierarchical medical system, refAbstract=null), Reference(id=1241022961927377133, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2024, volume=27, issue=10, pageStart=1231, pageEnd=1237, url=null, language=null, rfNumber=[4], rfOrder=6, authorNames=姜晓利, 彭海波, 许凌烽, journalName=中国全科医学, refType=null, unstructuredReference=姜晓利，彭海波，许凌烽，等．家庭医生签约服务背景下签约居民基层首诊效果评价研究[J].中国全科医学，2024, 27(10): 1231-1237., articleTitle=家庭医生签约服务背景下签约居民基层首诊效果评价研究, refAbstract=null), Reference(id=1241022962090954996, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2024, volume=27, issue=10, pageStart=1231, pageEnd=1237, url=null, language=null, rfNumber=[4], rfOrder=7, authorNames=Jiang XL, Peng HB, Xu LF, journalName=Chinese General Practice, refType=null, unstructuredReference=Jiang XL, Peng HB, Xu LF, et al. 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(In Chinese), articleTitle=The doctor-patient trust in general practice service and its countermeasure suggestions based on trusted source model, refAbstract=null), Reference(id=1241022965278626102, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2019, volume=19, issue=4, pageStart=286, pageEnd=290, url=null, language=null, rfNumber=[12], rfOrder=22, authorNames=巫蓉, 朱亚, 陈家应, journalName=南京医科大学学报:社会科学版, refType=null, unstructuredReference=巫蓉，朱亚，陈家应，等．家庭医生签约服务下社区居民就医选择的相关因素研究[J].南京医科大学学报:社会科学版，2019, 19(4): 286-290., articleTitle=家庭医生签约服务下社区居民就医选择的相关因素研究, refAbstract=null), Reference(id=1241022965345734970, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2019, volume=19, issue=4, pageStart=286, pageEnd=290, url=null, language=null, rfNumber=[12], rfOrder=23, authorNames=Wu R, Zhu Y, Chen JY, journalName=Journal of Nanjing Medical University(Social Sciences), refType=null, unstructuredReference=Wu R, Zhu Y, Chen JY, et al. Research on relevent factors impacted on residents ’preference in health service seeking under the condition of family doctor contract services[J]. Journal of Nanjing Medical University(Social Sciences), 2019, 19(4): 286-290. (In Chinese), articleTitle=Research on relevent factors impacted on residents ’preference in health service seeking under the condition of family doctor contract services, refAbstract=null), Reference(id=1241022965446398269, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2021, volume=40, issue=8, pageStart=9, pageEnd=12, url=null, language=null, rfNumber=[13], rfOrder=24, authorNames=王锐, 梁旭, 马月丹, journalName=中国卫生经济, refType=null, unstructuredReference=王锐，梁旭，马月丹．整合型医疗卫生服务体系功能定位、建设现状与经验[J].中国卫生经济，2021, 40(8): 9-12., articleTitle=整合型医疗卫生服务体系功能定位、建设现状与经验, refAbstract=null), Reference(id=1241022965534478657, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2021, volume=40, issue=8, pageStart=9, pageEnd=12, url=null, language=null, rfNumber=[13], rfOrder=25, authorNames=Wang R, Liang X, Ma YD, journalName=Chinese Health Economics, refType=null, unstructuredReference=Wang R, Liang X, Ma YD. The function positioning, construction status and experience of the integrated medical and health service system[J]. Chinese Health Economics, 2021, 40(8): 9-12. (In Chinese), articleTitle=The function positioning, construction status and experience of the integrated medical and health service system, refAbstract=null), Reference(id=1241022965601587524, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2020, volume=13, issue=5, pageStart=50, pageEnd=53, url=null, language=null, rfNumber=[14], rfOrder=26, authorNames=常园园, 徐鸿彬, 乔岩, journalName=中国卫生政策研究, refType=null, unstructuredReference=常园园，徐鸿彬，乔岩，等．国外家庭医生签约服务及其对我国的启示[J].中国卫生政策研究，2020, 13(5): 50-53., articleTitle=国外家庭医生签约服务及其对我国的启示, refAbstract=null), Reference(id=1241022965702250824, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2020, volume=13, issue=5, pageStart=50, pageEnd=53, url=null, language=null, rfNumber=[14], rfOrder=27, authorNames=Chang YY, Xu HB, Qiao Y, journalName=Chinese Journal of HealthPolicy, refType=null, unstructuredReference=Chang YY, Xu HB, Qiao Y, et al. Study on the foreign general practitioners’ contract-signing services and its Enlightenment to China[J]. Chinese Journal of HealthPolicy, 2020, 13(5): 50-53. (In Chinese), articleTitle=Study on the foreign general practitioners’ contract-signing services and its Enlightenment to China, refAbstract=null), Reference(id=1241022965765165386, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=3, pageStart=32, pageEnd=35, url=null, language=null, rfNumber=[15], rfOrder=28, authorNames=白兰, 孙红, 肖雨龙, journalName=卫生经济研究, refType=null, unstructuredReference=白兰，孙红，肖雨龙．南京市家庭医生签约服务现状及问题研究[J].卫生经济研究，2024, 41(3): 32-35., articleTitle=南京市家庭医生签约服务现状及问题研究, refAbstract=null), Reference(id=1241022965840662862, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=3, pageStart=32, pageEnd=35, url=null, language=null, rfNumber=[15], rfOrder=29, authorNames=Bai L, Sun H, Xiao YL, journalName=Health Economics Research, refType=null, unstructuredReference=Bai L, Sun H, Xiao YL. Study on the current status and problems of family doctor contracted services in nanjing city[J]. Health Economics Research, 2024, 41(3): 32-35. (In Chinese), articleTitle=Study on the current status and problems of family doctor contracted services in nanjing city, refAbstract=null)], funds=[Fund(id=1241022960643920035, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, awardId=72374156, language=CN, fundingSource=国家自然科学基金(72374156), fundOrder=null, country=null), Fund(id=1241022960765554859, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, awardId=GWY202363, language=CN, fundingSource=山东省2023年全省公共卫生体系建设研究课题(GWY202363), fundOrder=null, country=null), Fund(id=1241022960950104244, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, awardId=2023YJSCX032, language=CN, fundingSource=2023 年度研究生科研创新基金项目(2023YJSCX032), fundOrder=null, country=null), Fund(id=1241022961050767547, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, awardId=ZR2019MG028, language=CN, fundingSource=山东省自然科学基金(ZR2019MG028), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241022952821543633, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, xref=1．, ext=[AuthorCompanyExt(id=1241022952829932245, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, companyId=1241022952821543633, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China), AuthorCompanyExt(id=1241022952838320854, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, companyId=1241022952821543633, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1．山东第二医科大学管理学院，山东　潍坊　261053)]), AuthorCompany(id=1241022952922206944, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, xref=2．, ext=[AuthorCompanyExt(id=1241022952930595553, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, companyId=1241022952922206944, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2．山东第二医科大学护理学院)])], figs=[ArticleFig(id=1241022958035062848, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=EN, label=Fig.1, caption=Balance test results of propensity score matching, figureFileSmall=Kfotm3DpVmKi/6cz2vifiQ==, figureFileBig=DMSkd5HPzhvNlvcKpvTTxg==, tableContent=null), ArticleFig(id=1241022958131531846, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=CN, label=图1, caption=倾向得分匹配的平衡性检验结果, figureFileSmall=Kfotm3DpVmKi/6cz2vifiQ==, figureFileBig=DMSkd5HPzhvNlvcKpvTTxg==, tableContent=null), ArticleFig(id=1241022958362218585, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=EN, label=Table 1, caption=

Basic information analysis results of survey objects

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量分类基层医疗卫生机构服务利用n（%）频数（占比%）卡方值P值
未利用利用
性别女778(27.3)454(15.9)1 232(43.2)4.3290.037
男1 085(38.0)537(18.8)1 622(56.8)
年龄（岁）≤34230(8.1)27(0.9)257(9.0)272.403<0.001
35~44246(8.6)35(1.2)281(9.8)
45~54342(12.0)104(3.6)446(15.6)
55~64428(15.0)219(7.7)647(22.7)
≥65617(21.6)606(21.2)1 223(42.9)
文化程度小学及以下643(22.5)572(20.0)1 215(42.6)201.475<0.001
初中620(21.7)285(10.0)905(31.7)
高中/中专339(11.9)116(4.1)455(15.9)
大专及以上261(9.1)18(0.6)279(9.8)
婚姻状况不在婚273(9.6)221(7.7)494(17.3)26.429<0.001
在婚1 590(55.7)770(27.0)2 360(82.7)
居住区域农村1 091(38.2)894(31.3)1 985(69.6)305.999<0.001
城市772(27.0)97(3.4)869(30.4)
人口类别流动209(7.3)20(0.7)229(8.0)74.196<0.001
常驻1 654(58.0)971(34.0)2 625(92.0)
家庭人均年收入（元）≤5 999267(9.4)294(10.3)561(19.7)213.404<0.001
6 000~11 999330(11.6)253(8.9)583(20.4)
12 000~19 999335(11.7)198(6.9)533(18.7)
20 000~33 332430(15.1)155(5.4)585(20.5)
≥33 333501(17.6)91(3.2)592(20.7)
是否患慢性病否1 511(52.9)409(14.3)1 920(67.3)466.237<0.001
是352(12.3)582(20.4)934(32.7)
是否患新发病否1 823(63.9)755(26.5)2 578(90.3)347.661<0.001
是40(1.4)236(8.3)276(9.7)
是否签约家庭医生否584(20.5)107(3.7)691(24.2)148.8790.000
是1 279(44.8)884(31.0)2 163(75.8)
), ArticleFig(id=1241022958446104671, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=CN, label=表1, caption=

调查对象基本情况分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量分类基层医疗卫生机构服务利用n（%）频数（占比%）卡方值P值
未利用利用
性别女778(27.3)454(15.9)1 232(43.2)4.3290.037
男1 085(38.0)537(18.8)1 622(56.8)
年龄（岁）≤34230(8.1)27(0.9)257(9.0)272.403<0.001
35~44246(8.6)35(1.2)281(9.8)
45~54342(12.0)104(3.6)446(15.6)
55~64428(15.0)219(7.7)647(22.7)
≥65617(21.6)606(21.2)1 223(42.9)
文化程度小学及以下643(22.5)572(20.0)1 215(42.6)201.475<0.001
初中620(21.7)285(10.0)905(31.7)
高中/中专339(11.9)116(4.1)455(15.9)
大专及以上261(9.1)18(0.6)279(9.8)
婚姻状况不在婚273(9.6)221(7.7)494(17.3)26.429<0.001
在婚1 590(55.7)770(27.0)2 360(82.7)
居住区域农村1 091(38.2)894(31.3)1 985(69.6)305.999<0.001
城市772(27.0)97(3.4)869(30.4)
人口类别流动209(7.3)20(0.7)229(8.0)74.196<0.001
常驻1 654(58.0)971(34.0)2 625(92.0)
家庭人均年收入（元）≤5 999267(9.4)294(10.3)561(19.7)213.404<0.001
6 000~11 999330(11.6)253(8.9)583(20.4)
12 000~19 999335(11.7)198(6.9)533(18.7)
20 000~33 332430(15.1)155(5.4)585(20.5)
≥33 333501(17.6)91(3.2)592(20.7)
是否患慢性病否1 511(52.9)409(14.3)1 920(67.3)466.237<0.001
是352(12.3)582(20.4)934(32.7)
是否患新发病否1 823(63.9)755(26.5)2 578(90.3)347.661<0.001
是40(1.4)236(8.3)276(9.7)
是否签约家庭医生否584(20.5)107(3.7)691(24.2)148.8790.000
是1 279(44.8)884(31.0)2 163(75.8)
), ArticleFig(id=1241022958542573672, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=EN, label=Table 2, caption=

Results of binary and multi-factor logistic regression analysis of service utilization in primary medical and health institutions

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量对照组BS.E.WaldP值OR(95% CI)
性别
男女-0.1170.1031.2800.2580.890(0.727~1.089)
年龄（岁）
35~44≤34-0.5270.3272.5950.1070.590(0.311~1.121)
45~54-0.0800.2940.0730.7870.923(0.519~1.644)
55~640.0650.2870.0510.8211.067(0.608~1.874)
≥650.4750.2882.7160.0991.607(0.914~2.826)
文化程度
初中小学及以下-0.0440.1250.1270.7220.957(0.749~1.221)
高中/中专0.0210.1640.0170.8961.022(0.741~1.408)
大专及以上-0.7490.3245.3610.0210.473(0.251~0.891)
婚姻状况
在婚不在婚-0.2490.1353.4140.0650.780(0.599~1.015)
居住区域
城市农村-1.2660.16657.981<0.0010.282(0.204~0.391)
人口类别
常驻流动0.7140.2916.0320.0142.042(1.155~3.610)
家庭人均年收入（元）
6 000~11 999≤5 999-0.1430.1421.0100.3150.867(0.656~1.145)
12 000~19 999-0.1360.1540.7790.3780.873(0.646~1.180)
20 000~33 332-0.3990.1616.1220.0130.671(0.489~0.920)
≥33 333-0.3270.1942.8230.0930.721(0.493~1.056)
是否患慢性病
是否1.5990.106226.914<0.0014.946(4.017~6.090)
是否患新发病
是否2.8390.207187.418<0.00117.091(11.384~25.661)
是否签约家庭医生
是否0.3380.1505.0720.0241.402(1.045~1.882)
), ArticleFig(id=1241022958643236978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=CN, label=表2, caption=

基层医疗卫生机构服务利用的二元多因素logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量对照组BS.E.WaldP值OR(95% CI)
性别
男女-0.1170.1031.2800.2580.890(0.727~1.089)
年龄（岁）
35~44≤34-0.5270.3272.5950.1070.590(0.311~1.121)
45~54-0.0800.2940.0730.7870.923(0.519~1.644)
55~640.0650.2870.0510.8211.067(0.608~1.874)
≥650.4750.2882.7160.0991.607(0.914~2.826)
文化程度
初中小学及以下-0.0440.1250.1270.7220.957(0.749~1.221)
高中/中专0.0210.1640.0170.8961.022(0.741~1.408)
大专及以上-0.7490.3245.3610.0210.473(0.251~0.891)
婚姻状况
在婚不在婚-0.2490.1353.4140.0650.780(0.599~1.015)
居住区域
城市农村-1.2660.16657.981<0.0010.282(0.204~0.391)
人口类别
常驻流动0.7140.2916.0320.0142.042(1.155~3.610)
家庭人均年收入（元）
6 000~11 999≤5 999-0.1430.1421.0100.3150.867(0.656~1.145)
12 000~19 999-0.1360.1540.7790.3780.873(0.646~1.180)
20 000~33 332-0.3990.1616.1220.0130.671(0.489~0.920)
≥33 333-0.3270.1942.8230.0930.721(0.493~1.056)
是否患慢性病
是否1.5990.106226.914<0.0014.946(4.017~6.090)
是否患新发病
是否2.8390.207187.418<0.00117.091(11.384~25.661)
是否签约家庭医生
是否0.3380.1505.0720.0241.402(1.045~1.882)
), ArticleFig(id=1241022958727123065, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=EN, label=Table 3, caption=

Results of average treatment effect of service utilization in primary medical and health institutions

, figureFileSmall=null, figureFileBig=null, tableContent=
结果变量匹配方法签约组未签约组ATTS.E.t值
最近邻匹配0.401 20.352 90.048 30.034 51.40
基层医疗机构服务利用情况半径匹配0.401 20.348 80.052 4a0.026 81.96
核匹配0.401 20.332 90.068 3b0.025 32.70
), ArticleFig(id=1241022960220295297, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=CN, label=表3, caption=

基层医疗卫生机构服务利用的平均处理效应结果

, figureFileSmall=null, figureFileBig=null, tableContent=
结果变量匹配方法签约组未签约组ATTS.E.t值
最近邻匹配0.401 20.352 90.048 30.034 51.40
基层医疗机构服务利用情况半径匹配0.401 20.348 80.052 4a0.026 81.96
核匹配0.401 20.332 90.068 3b0.025 32.70
), ArticleFig(id=1241022960350318727, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=EN, label=Table 4, caption=

Heterogeneity analysis results of chronic diseases and old age in the population

, figureFileSmall=null, figureFileBig=null, tableContent=
分组匹配方法签约组未签约组ATTS.E.t值
患慢性病人群最近邻匹配0.659 10.520 70.138 4a0.082 21.68
半径匹配0.658 60.552 10.106 40.068 81.55
核匹配0.659 10.562 60.096 50.665 01.45
未患慢性病人群最近邻匹配0.251 90.220 20.031 70.029 51.08
半径匹配0.252 50.235 00.017 40.024 90.70
核匹配0.251 90.240 50.113 70.245 20.46
老年人群最近邻匹配0.510 80.400 30.110 5b0.053 72.06
半径匹配0.510 50.443 10.067 40.044 11.53
核匹配0.510 80.430 90.079 9b0.040 21.99
非老年人群最近邻匹配0.235 90.163 00.072 8b0.035 32.06
半径匹配0.236 50.178 80.057 6a0.031 11.86
核匹配0.235 90.186 90.049 0a0.029 41.67
), ArticleFig(id=1241022960484536466, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949499654697, language=CN, label=表4, caption=

人群慢性病情况和老年情况的异质性分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
分组匹配方法签约组未签约组ATTS.E.t值
患慢性病人群最近邻匹配0.659 10.520 70.138 4a0.082 21.68
半径匹配0.658 60.552 10.106 40.068 81.55
核匹配0.659 10.562 60.096 50.665 01.45
未患慢性病人群最近邻匹配0.251 90.220 20.031 70.029 51.08
半径匹配0.252 50.235 00.017 40.024 90.70
核匹配0.251 90.240 50.113 70.245 20.46
老年人群最近邻匹配0.510 80.400 30.110 5b0.053 72.06
半径匹配0.510 50.443 10.067 40.044 11.53
核匹配0.510 80.430 90.079 9b0.040 21.99
非老年人群最近邻匹配0.235 90.163 00.072 8b0.035 32.06
半径匹配0.236 50.178 80.057 6a0.031 11.86
核匹配0.235 90.186 90.049 0a0.029 41.67
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家庭医生签约对居民基层医疗卫生机构服务利用的影响研究——基于倾向得分匹配法
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韩志鹏 1 , 陈星 1 , 王煜琳 1 , 王广通 1 , 于贞杰 1 , 井淇 1 , 胡善菊 1 , 于颖荣 2
现代预防医学 | 基层卫生服务 2025,52(6): 1074-1078
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现代预防医学 | 基层卫生服务 2025, 52(6): 1074-1078
家庭医生签约对居民基层医疗卫生机构服务利用的影响研究——基于倾向得分匹配法
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韩志鹏1, 陈星1, 王煜琳1, 王广通1, 于贞杰1 , 井淇1, 胡善菊1, 于颖荣2
作者信息
  • 1．山东第二医科大学管理学院，山东　潍坊　261053
  • 2．山东第二医科大学护理学院

    • 韩志鹏（1998—），男，硕士在读，研究方向：医药卫生政策与卫生经济学评价

通讯作者:

于贞杰，E-mail：
Effect of family doctor contract on the service utilization of residents’ primary medical and health institutions: based on propensity score matching method
Zhi-peng HAN1, Xing CHEN1, Yu-lin WANG1, Guang-tong WANG1, Zhen-jie YU1 , Qi JING1, Shan-ju HU1, Ying-rong YU2
Affiliations
  • School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China
出版时间: 2025-03-25 doi: 10.20043/j.cnki.MPM.202412192
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摘要
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目的

评估家庭医生签约对居民基层医疗卫生机构服务利用的影响。

方法

利用logit模型和倾向得分匹配法进行分析。

结果

家庭医生签约率为75.8%，基层医疗卫生机构服务利用率为65.28%。倾向得分匹配结果显示，在半径匹配和核匹配两种方法下，家庭医生签约对居民基层医疗卫生机构服务利用的ATT分别为0.052 4和0.068 3，说明签约家庭医生的居民在基层医疗卫生机构服务利用上平均分别增加了5.24%和6.83%。家庭医生签约对慢性病居民基层医疗卫生机构服务利用的概率平均提高13.84%，对未患慢性病居民的基层医疗卫生机构服务利用无统计学意义，对老年居民的基层医疗卫生机构服务利用的概率平均提高9.25%，对非老年居民的基层医疗卫生机构服务利用的概率平均提高5.98%。

结论

家庭医生签约率和基层医疗卫生机构利用率均表现良好。签约家庭医生能促进居民对基层医疗卫生机构服务的利用，家庭医生签约对患有慢性病人群和老年人群的基层医疗卫生机构服务利用的促进情况更为明显。

家庭医生签约  /  基层医疗卫生机构服务  /  倾向得分匹配法
Objective

To evaluate the impact of family doctor contract on the utilization of services in primary medical and health institutions.

Methods

Logit model and propensity score matching method were used for analysis.

Results

The signing rate of family doctors was 75.8%, and the service utilization rate of primary medical and health institutions was 65.28%. The propensity scores matching results showed that after kernel matching and radius matching, ATT of family doctor contract on utilization of primary medical and health institutions was 0.052 4 and 0.068 3. The contracted services of family doctors had increased the utilization rate of primary medical and health institutions of residents with chronic diseases by 13.84%. The contract services of family doctors had no statistical significance on the utilization rate of primary medical and health institutions of non-chronic residents. The contracted services of family doctors had increased the average utilization rate of elderly residents to primary medical and health institutions by 9.25%. The contracted services of family doctors increased the average utilization rate of non-elderly residents to primary medical and health institutions by 5.98%.

Conclusion

The signing rate of family doctors and the utilization rate of primary medical and health institutions are both good. Contracted family doctors can promote the utilization of primary medical and health institutions by residents, and the contracted service of family doctors is more obvious to the utilization of primary medical and health institutions by people with chronic diseases and the elderly.

Family doctor contract  /  Services in primary medical and health institutions  /  Propensity score matching
韩志鹏, 陈星, 王煜琳, 王广通, 于贞杰, 井淇, 胡善菊, 于颖荣. 家庭医生签约对居民基层医疗卫生机构服务利用的影响研究——基于倾向得分匹配法. 现代预防医学, 2025 , 52 (6) : 1074 -1078 . DOI: 10.20043/j.cnki.MPM.202412192
Zhi-peng HAN, Xing CHEN, Yu-lin WANG, Guang-tong WANG, Zhen-jie YU, Qi JING, Shan-ju HU, Ying-rong YU. Effect of family doctor contract on the service utilization of residents’ primary medical and health institutions: based on propensity score matching method[J]. Modern Preventive Medicine, 2025 , 52 (6) : 1074 -1078 . DOI: 10.20043/j.cnki.MPM.202412192
正文
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2015年，我国出台了《推进分级诊疗制度建设的指导意见》，提出建立“基层首诊、双向转诊、急慢分治、上下联动”的有序就医格局，强调以基层为重点完善分级诊疗服务体系[1]。2016年，《关于推进家庭医生签约服务的指导意见》颁布，推动家庭医生签约服务实施[2]。家庭医生签约服务是促进基层首诊、构建分级诊疗的重要保障[3]。随着医改的推进，家庭医生签约服务对居民基层医疗卫生机构首诊影响的情况受到学者们的关注[4-6]，但在家庭医生签约服务对居民基层医疗卫生机构综合利用方面影响的研究还有所不足，本研究将采用倾向得分匹配法，评估家庭医生签约服务对居民基层医疗卫生机构利用的效应，为推进家庭医生签约服务高质量发展提供参考。
1　资料与方法
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1.1　资料来源
研究采用分层随机抽样法，从山东省随机抽取两个地市，在每个地市随机抽取 3个区/县，在每个区/县中随机抽取 3个街道/乡镇、在每个街道/乡镇中随机抽取 3个社区/村庄，在每个社区/村庄中随机抽取30~40 户家庭，从选定家庭中随机选择一个大于等于15岁的个人进行问卷调查。本次调查共回收问卷2 952份，其中有效问卷份2 854份，有效率为96.6%。本研究已通过山东第二医科大学（原潍坊医学院）医学伦理委员会审查（编号：2023YX081），并已获得所有调查者的知情同意。
1.2　倾向得分匹配法
倾向得分匹配法是一种反事实推断的分析方法，根据处理组的特征，找出与处理组特征尽可能类似的控制组进行匹配，从而消除非处理因素的干扰，起到解决选择性偏差和内生性问题的作用。签约家庭医生的居民作为处理组，未签约的作为控制组，利用logit模型计算匹配倾向分值，将控制组的个体按照最邻近匹配、半径匹配和核匹配的方法与处理组中的个体进行匹配，得到家庭医生签约对居民基层医疗卫生机构利用影响的平均处理效应(Average treatment effect for the treated，ATT)。基层医疗卫生机构利用为因变量，是被调查居民自调查日前一个月内的基层医疗卫生机构利用情况。此外，慢性病人群和老年人群是家庭医生签约服务的重点人群，与非慢性病人群和非老年人群相比身体健康状况差异较大，在签约家庭医生后对基层医疗卫生机构服务利用会存在一定差异，因此本研究分别对居民慢性病情况和老年情况做异质性分析，将60岁及以上居民列为老年人群。
1.3　统计分析
研究使用Stata 18软件进行统计学分析，一般资料以频数、百分比等描述。家庭医生签约服务与居民基层医疗卫生机构利用之间的关系采用logit模型和倾向得分匹配法进行分析。
2　结果
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2.1　调查对象基本情况
调查对象中女性有1 232人（43.2%），男性有1 622人（56.8%）。65岁以上的居民1 223人（42.9%），慢性病患者934人（32.7%），新发病患者276人（9.7%），医疗保险参保者2 794人（97.9%），签约居民2 163人（75.8%）。（见表1）
调查居民共2 854人，其中利用过基层医疗卫生机构服务的1 863人，利用率为65.28%。
2.2　基层医疗卫生机构利用的影响因素分析
以居民是否利用基层医疗卫生机构服务(赋值:利用=1，不利用=0)为因变量，性别、年龄、文化程度、婚姻状况、居住区域、人口类别、家庭人均年收入、是否患慢性病、是否患新发病、是否签约家庭医生等为自变量，进行二元多因素logistic回归分析。分析结果显示，在居民基层医疗卫生机构服务利用上，文化程度、居住区域、人口类别、家庭人均年收入、是否患慢性病、是否患新发病、是否签约家庭医生具有统计学意义（P<0.05)。大专及以上（OR=0.473；95%CI=0.251~0.891）、城市（OR=0.282；95%CI=0.204~0.391）、20 000~33 332元家庭人均年收入组（OR=0.671；95%CI=0.489~0.920）的居民利用基层医疗卫生服务的积极性更低(OR<1)。常驻（OR=2.042；95%CI=1.155~3.610）、患慢性病（OR=4.946；95%CI=4.017~6.090）、患新发病（OR=17.091；95%CI=11.384~25.661）、签约家庭医生（OR=1.402；95%CI=1.045~1.882）的居民利用基层医疗卫生服务的积极性更高(OR>1)。（见表2）
2.3　样本匹配平衡性检验
为保证匹配效果的质量，研究对签约组和未签约组之间的平衡性进行检验。以最近邻匹配来解释匹配效果，匹配后各变量的标准化偏差越小说明匹配效果越好。图1显示，匹配后各变量的标准化偏差都得到了减少，大部分变量的标准化偏差值在10%以下，说明家庭医生签约组和未签约组的样本差异得到了较好地消除，满足平衡性假设，匹配效果好。
2.4　家庭医生签约对基层医疗卫生机构服务利用的平均处理效应估计结果
分析结果显示，在最邻近匹配方法下，家庭医生签约对居民基层医疗卫生机构利用无统计学意义，而在半径匹配和核匹配方法下，家庭医生签约对居民基层医疗卫生机构利用有统计学意义。在半径匹配和核匹配两种方法下，ATT结果分别为0.052 4和0.068 3，即签约家庭医生的居民对基层医疗卫生机构服务的利用概率分别提高5.24%和6.83%。(见表3)
2.5　异质性分析
对患有慢性病人群和未患有慢性病人群进行异质性分析，在最近邻匹配方法下，家庭医生签约对患有慢性病居民的基层医疗卫生机构服务利用有统计学意义，ATT结果为0.138 4，即签约家庭医生对患有慢性病居民的基层医疗卫生机构服务的利用概率提高了13.84%。而在半径匹配和核匹配方法下，家庭医生签约对患有慢性病居民的基层医疗卫生机构服务利用无统计学意义。同时，三种匹配方法下，家庭医生签约对未患有慢性病居民的基层医疗卫生机构服务利用均无统计学意义。
对老年人群和非老年人群进行异质性分析，在最近邻匹配方法和核匹配下，家庭医生签约对老年人群的基层医疗卫生机构服务利用有统计学意义，ATT结果分别为0.110 5和0.079 9，平均ATT为0.092 5，即签约家庭医生对老年人群的基层医疗卫生机构服务利用率提高了11.05%和7.99%，平均提高9.52%。而在半径匹配下，家庭医生签约对老年人群的基层医疗卫生机构服务利用无统计学意义。同时，在三种匹配方法下，家庭医生签约对非老年人群的基层医疗卫生机构服务利用均有统计学意义，ATT结果分别为0.072 8、0.057 6和0.049 0，平均ATT为0.059 8，即签约家庭医生对非老年人群的基层医疗卫生机构服务利用率提高了7.28%、5.76%和4.90%，平均提高5.98%。（见表4）
3　讨论与建议
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研究发现，家庭医生签约率为75.8%，对比2022年发布的《关于推进家庭医生签约服务高质量发展的指导意见》中提到的“到2035年家庭医生签约服务覆盖率达到75%以上”的政策目标[7]，本研究家庭医生签约率结果表现良好，说明样本地区家庭医生签约工作取得了较好的成效。同时，基层医疗卫生机构服务利用率为65.28%，相对于“在分级诊疗背景下，确保基层就诊率提高到65%以上”的目标[8]而言，结果表现良好，说明样本地区基层医疗卫生机构服务的居民利用情况较好。
在核匹配和半径匹配两种匹配方法下，签约家庭医生居民对基层医疗卫生机构服务的利用概率分别提高5.24%、6.83%，证明家庭医生签约可以促进居民对基层医疗卫生机构服务的利用。孙华君、吴瑶琴等人的研究中也表明了签约家庭医生能提高居民的基层就诊率[9-10]，本研究结果与其结论相似。
异质性分析结果发现，家庭医生签约对患有慢性病居民的基层医疗卫生机构服务利用促进情况更为明显，而对未患有慢性病居民的基层医疗卫生机构服务利用没有显著影响。姜晓利等人也发现了“患慢性病的签约家庭医生居民的基层首诊性评分高于未患慢性病的签约居民”[4]，说明患有慢性病签约居民比普通签约居民对基层医疗卫生机构服务的接受度更高。原因可能与未患有慢性病的居民相比，患有慢性病居民因接受慢性病管理服务，与家庭医生的见面交流时间增多，有利于建立起互信的情感关系[11]，从而使得患有慢性病的人群更易接受家庭医生的就医指导。同时，异质性分析结果还发现，家庭医生签约服务对老年人群基层医疗卫生机构服务利用率平均提高9.52%，而对于非老年人群基层医疗卫生机构服务利用率平均提高5.98%，家庭医生签约对老年人群基层医疗卫生机构服务利用的促进情况更为明显。巫蓉、朱亚等人研究中也发现60岁及以上老年居民在接受以家庭医生为核心的基层首诊以及选择基层医疗机构进行首诊方面均显著好于60岁以下居民[12]。原因可能是老年人群相对于非老年人群更容易生病，利用家庭医生服务的次数更多，对家庭医生信任感更强，从而更容易接受家庭医生的就医指导。
以上研究结论启示，还应采取措施进一步完善家庭医生签约服务，发展整合型基层医疗卫生服务体系，推动家庭医生签约服务与基层医疗卫生服务协同发展。整合型医疗卫生服务体系的首要任务是提升基层医疗卫生机构的服务能力和质量[13]，有助于提高居民对基层医疗卫生机构服务的满意度，进而提高居民对家庭医生的信任度。同时发展强制基层首诊的就医流程[14]，强化家庭医生与就医服务的绑定程度，提高家庭医生的就医话语权，进而提高家庭医生签约覆盖率。此外还要发展家庭医生与基层医疗卫生机构合作的定制化医疗卫生服务项目，满足不同人群的医疗卫生服务需求[15]，提高家庭医生签约服务对不同人群基层医疗卫生机构服务利用的促进作用。
基金
收起
  • 国家自然科学基金(72374156)
  • 山东省2023年全省公共卫生体系建设研究课题(GWY202363)
  • 2023 年度研究生科研创新基金项目(2023YJSCX032)
  • 山东省自然科学基金(ZR2019MG028)
文献
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2025年第52卷第6期
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doi: 10.20043/j.cnki.MPM.202412192
  • 接收时间：2024-12-11
  • 首发时间：2026-03-18
  • 出版时间：2025-03-25
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  • 收稿日期：2024-12-11
基金
国家自然科学基金(72374156)
山东省2023年全省公共卫生体系建设研究课题(GWY202363)
2023 年度研究生科研创新基金项目(2023YJSCX032)
山东省自然科学基金(ZR2019MG028)
作者信息
    1．山东第二医科大学管理学院，山东　潍坊　261053
    2．山东第二医科大学护理学院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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