门诊按人头付费方式改革的实践探索  

Practice of Reform for Outpatient Payment by Capitation

作　　者：赵宁 高广颖 吴妮娜[1,2,3] 李进[1,2] 杨佳 ZHAO Ning;GAO Guangying;WU Nina;LI Jin;YANG Jia(School of PubEc Health,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学公共卫生学院,北京100069 [2]首都卫生管理与政策研究基地,北京100069 [3]首都医科大学国家医疗保障研究院,北京100069

出　　处：《卫生经济研究》2023年第1期29-33,共5页

摘　　要：归纳总结了我国部分地区门诊按人头付费实践的特点,在此基础上提出了优化路径:渐进式建立居民自由就医机制,探索与家庭医生签约服务联动的门诊按人头付费方式,实施基于风险调整的人头费总额设定机制,采用按人头付费为主的复合支付方式,实现医保支付和医疗服务向以“健康”为中心转变。This study summarized the characteristics of outpatient payment by capitation in some areas.It is recommended to gradually establish medical mechanism voted by residents’feet.We proposed to explore a new outpatient payment capitation way linked with family doctor contracting service.In addition,it is suggested to implement a total setting mechanism for capitation fee based on the risk adjustment,and adopt the compound payment method,so as to realized health-oriented medical insurance payment and medical services.

关 键 词：医疗保险 按人头付费 支付方式改革 门诊 

分 类 号：F840.684[经济管理—保险]