十年新医改取得了巨大成就，但当前仍面临诸多挑战。人口老龄化、疾病谱 变化等因素导致医疗服务需求逐年增加，加之经济增速放缓等现象，医保基金收 支平衡压力不断增大。此外，就诊人数长期集中在较高等级医院，医疗资源配置 结构性失衡。卫生费用控制、分级诊疗制度等都依赖于有待完善的基层医疗服务 体系，而全民覆盖的基本医保如何在以家庭医生制度为抓手的基层医疗体系建设 中发挥基础性、引导性作用，具有重要的探讨价值。本文旨在探究我国家庭医生 及其医保治理政策运行现状、剖析家庭医生制度现存问题、了解专科医生从事家 庭医生工作意愿和居民需求意愿，以期从医保治理角度提出有关政策建议。 本研究将宏观政策分析和微观意愿调查相结合。在完善的文献综述基础上， 首先总结国际上典型国家的家庭医生制度及其医保治理的经验做法，了解先进成 果并比较得出我国现存问题；接着梳理我国家庭医生及其医保治理的有关政策文 本，并提炼出典型城市的有益经验，然后运用霍恩-米特政策执行系统模型对我国 家庭医生及其医保治理有关政策的执行情况加以剖析；最后通过问卷调查法开展 实证研究，通过描述性分析、卡方检验、多元线性回归、交叉表分析、供需曲线 分析等方式探究专科医生担任家庭医生的供给意愿和居民购买服务的需求意愿。 研究结果方面，国际比较研究体现出我国家庭医生数量严重短缺，转诊制度 和支付机制等有待完善。政策分析显示，试点工作取得积极成效，但政策目标制 定应注重循证，以医生人力供给和医保支付等为代表的政策资源配置尚不充分、 不均衡，且政策执行过程中的合作与互动还需加强。供需意愿调查表明，专科医 生从事家庭医生工作的意愿较强，愿意参与或考虑参与的共占 77%；医生意愿的 影响因素包括月收入水平、转诊合理性评价、地区分级诊疗认可度和胜任力自评 （P<0.05）；医生期望薪酬存在最低预期，约为 12 万元/年；居民最重视的服务项 目是慢病管理和公卫服务；居民支付意愿与门诊个人支出水平相近，且各类保险 居民的支付意愿中位数均为 1000 元/年；人均签约费的供需均衡价格为 550 元/年。 总之，为了进一步优化医保对于家庭医生制度的治理，政府应健全由医保牵 头的多方给付机制，促进家庭医生服务由后付制向预付制转变；制定合理的薪酬 支付标准，改善家庭医生执业环境，引导专科医生从事家庭医生工作；加快建立 医保治理实体性机制，有效落实相关政策精神。

The new medical reform in the past decade has made great achievements, but it still faces many challenges. Factors such as aging populations and changes in the disease spectrum have led to an increase in the demand for medical services year by year, coupled with a slowdown in economic growth and other phenomena, the pressure on the balance of payments of medical insurance funds is increasing. In addition, the number of doctors has been concentrated in higher-level hospitals for a long time, and the medical resources allocation is structurally unbalanced. The control of health expenses and the implementation of the graded diagnosis and treatment system all depend on the primary medical service system to be improved. How can the basic medical insurance covered by the whole people play a fundamental and guiding role in the construction of the primary medical system based on the family doctor system? Important discussion value. This article aims to explore the current status of the operation of family doctors and their medical insurance governance policies in China, analyze the existing problems of the family doctor system, understand the willingness of specialist doctors to work as family doctors, and the needs of residents, in order to put forward relevant policy recommendations from the perspective of medical insurance governance. This study combines macro-policy analysis and micro-will survey. On the basis of a comprehensive literature review, first sum up the international family doctor system and the experience of medical insurance governance in typical countries, understand the advanced results and compare the existing problems in China; then comb the relevant policy texts of our family doctors and their medical insurance governance , And extract the beneficial experience of typical cities, and then use the Horn-Meter policy execution system model to analyze the implementation of relevant policies of family doctors and their medical insurance governance in China; Finally, empirical research is carried out through questionnaire survey and descriptive analysis , Chi-square test, multiple linear regression, cross-tab analysis, supply-demand curve analysis and other methods to explore the willingness of specialists to serve as family doctors and residents‘ willingness to purchase services. In terms of research results, international comparative research shows that there is a serious shortage of family doctors in China, and the referral system and payment mechanism need to be improved. Policy analysis shows that the pilot work has achieved positive results, but policy objectives should be based on evidence-based, and the allocation of policy resources represented by doctor manpower and medical insurance payment is not sufficient and uneven, and cooperation and interaction between policy implementers need to be strengthened. A survey of supply and demand willingness shows that specialist doctors have a strong willingness to work as family doctors, and 77% of them are willing to participate or consider participating; the influencing factors of doctors‘ willingness include monthly income level, rationality evaluation of referrals, regional level diagnosis and treatment approval and competence Self-assessment （P＜0.05）; doctors expect a minimum salary of about 120000 yuan per year; residents‘ most important service items are chronic disease management and public health services; residents‘ willingness to pay is similar to the outpatient personal expenditure level, and The median willingness to pay for various types of insurance residents is 1000 yuan per year; the equilibrium supply and demand price of the contract fee per capita is 550 yuan per year. Generally speaking, in order to strengthen the medical insurance‘s governance of the family doctor system, the government should improve the diversified payment mechanism led by medical insurance to promote the transformation of the family doctor service from the post-payment system to the pre-payment system; formulate reasonable salary payment standards, improve family doctor practice environment, then guide specialists to engage in family doctor work; accelerate the establishment of a substantive mechanism for medical insurance governance and effectively implement the spirit of relevant policies.