[1]朱晓丽,王玙珩,王 斌,等.价值支付视角下门诊按人头付费的理论内涵和改革建议[J].卫生经济研究,2024,41(07):31-35,40.
　ZHU Xiaoli,WANG Yuheng,WANG Bin,et al.Theoretical Implications and Reform Proposals for Outpatient Capitation Payment from the Perspective of Value-based Payment[J].Journal Press of Health Economics Research,2024,41(07):31-35,40.
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价值支付视角下门诊按人头付费的理论内涵和改革建议
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
41
期数:
2024年07期
页码:
31-35,40
栏目:
医疗保障
出版日期:
2024-07-03

文章信息/Info

Title:
Theoretical Implications and Reform Proposals for Outpatient Capitation Payment from the Perspective of Value-based Payment
作者:
朱晓丽1; 王玙珩1; 王 斌2; 代 涛1
1.中国医学科学院医学信息研究所，卫生政策与管理研究中心，北京 100020
2.德州市中医院，山东 德州 253000
Author(s):
ZHU Xiaoli;  WANG Yuheng;  WANG Bin;  DAI Tao
Institute of Medical Information, Center for Health Policy and Management, Chinese Academy of Medical Science, Beijing 100020, China
关键词:
价值支付; 医保门诊统筹; 按人头付费; 激励机制
Keywords:
value-based payment;  outpatient coordination in medical insurance;  capitation payment;  incentive mechanism
分类号:
R197.1
文献标志码:
A
摘要:
按人头付费是医保门诊统筹改革的核心任务之一。价值支付视角下按人头付费应具有控制医疗成本、提升服务质量、改善患者健康结果的价值目标，其核心要素包括：以整合型医疗卫生服务组织和基层家庭医生签约团队为供方主体，为特定疾病人群或签约人群提供连续性医疗服务；支付标的为固定时间范围内发生的医疗费用总额，通过合理设定人头基础费率和风险调整因子，建立以质量和健康结果为核心的绩效支付和结余分享、风险分担机制等，建立起支付方、供方、患者三方价值均衡且相容的激励约束机制。
Abstract:
Capitation payment is one of the core tasks in the reform of outpatient coordination in medical insurance in China. From the perspective of value-based payment, capitation payment should have the value objectives of controlling medical costs, enhancing service quality, and improving patient health outcomes. The core elements of capitation payment include the following: integrated healthcare service organizations and primary care family physician contracted teams should be the main providers to provide continuous healthcare services for specific disease populations or contracted populations; When the payment target is the total amount of medical expenses incurred within a fixed time frame, the mechanisms of performance payment, balance sharing, and risk sharing centered on quality and health outcomes should be established by reasonably setting capitation basic rate and risk adjustment factor; a balanced, compatible incentive and constraint mechanism should be has established among the payer, supplier, and patient.

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更新日期/Last Update: 2024-07-03