Abstract: Background　Promoting the delivery of contracted family doctor services is an important way to change the traditional delivery pattern of China's primary health services，and an important task for deepening the reform of the pharmaceutical and healthcare system，and a cornerstone of achieving the Healthy China 2030 goals. Reasonable incentive mechanism may significantly ensure that family doctors take initiative at work. However，there are no theoretical analyses of the impact of the current incentive mechanism，especially the changed health insurance reimbursement methods，on practice behaviors of family physicians. Objective　To build up a theoretical framework and a model of family physicians' practice behaviors under the implementation of family doctor system using the principal-agent theory in China. Methods　The principal-agent theory was used to develop a model for analyzing the practice behaviors of family physicians under different health insurance payment methods for family physicians，especially when fee-for-service（FFS） and capitation payments coexist. Results　If the FFS payment system is used，the moral hazard will be inevitable，and family physicians have no incentive to suppress patients' additional needs. If the capitation payment system is used，the total utility or benefit of family physicians will increase，but the utility obtained from patients' health will decrease. The global budget shall be implemented under the premise that the quantity and quality of health services are reasonably designed，otherwise family physicians will have the motivation to treat patients selectively so as to increase their benefits. The income of Chinese family physicians mainly comes from the medical earnings obtained in FFS and the contracted service fee obtained by capitation. Increasing the proportion of contracted service fee can improve the quality of care provided by family physicians. However，the increase in income may not necessarily have a positive effect on the health care quality，since the earnings obtained in FFS account for a large portion of the income. Conclusion　The payment system of family physicians in primary health institutions in China is suggested to be gradually transformed to payment by capitation. At present，family physicians can be encouraged to provide medical services of higher quality by enlarging the proportion of family physicians' contracted service fee in total income.

Key words: Contracted family doctor services, Physician agency theory, Payment mechanism, Incentive

摘要： 背景　推进家庭医生签约服务是转变中国基层医疗卫生服务模式的重要举措，是深化医药卫生体制改革的重要任务，也是实现“健康中国2030”战略的基石。合理的激励机制是家庭医生发挥自身能动性的重要保证因素，但是目前家庭医生的激励机制，尤其是医疗保险补偿方式的转变，对其行为的影响尚缺乏相关理论分析。目的　以医生代理理论为支撑，构建符合中国国情的家庭医生行为理论分析框架和模型。方法　以医生代理理论为基础，构建家庭医生在不同医保支付方式下，尤其是按项目付费和按人头付费并存的情况下医生行为分析模型。结果　按项目付费时，道德风险不可避免，医生没有任何动机来抑制患者因道德风险而产生的额外需求；按人头付费后家庭医生的总利润会提高，但是从患者健康中得到的效用值会下降；推行总额预付的前提是设计合理的医疗服务数量和质量，否则家庭医生就会有选择患者的动机。中国家庭医生的收入主要来源于按项目付费方式的医疗收入和按人头签约得到的服务费，提高签约服务费占收入比例可以提高家庭医生的服务质量，但是由于收入中占较大比例的是按项目付费获得的收入，收入的增加不一定能够对患者的质量提供正向影响。结论　中国的基层医疗卫生机构家庭医生的支付方式应该逐步转变为按人头付费，目前可以通过逐步提高家庭医生签约服务费占收入比例的方式，激励家庭医生提供更高质量的医疗服务。

关键词: 家庭医生签约服务, 医生代理理论, 支付方式, 激励