医疗保险门诊按人头付费实施效果研究的系统综述  

Systematic Review of Implementation Effect of Medical Insurance Outpatient Capitation Payment

作　　者：程熙 陈文[1] 张璐莹[1] CHENG Xi(School of Public Health,Fudan University,Shanghai,200032,China)

机构地区：[1]复旦大学公共卫生学院,上海200032

出　　处：《医学与社会》2024年第12期112-116,共5页Medicine and Society

基　　金：国家社会科学基金资助重大项目,编号为20ZDA072;国家自然科学基金资助项目,编号为72374049。

摘　　要：目的:对医疗保险门诊按人头付费的实施效果研究进行系统综述,为未来相关的理论研究和实践的开展提供参考。方法:检索PubMed、Web of Science、万方数据、中国知网数据库,按照文献纳入和排除标准,纳入2013-2023年医疗保险门诊按人头付费实施效果相关的文献,对所得文献资料进行系统描述。结果:初步检索得到文献1588篇,经过筛选后纳入12篇文献。研究表明医疗保险门诊按人头付费在改善卫生服务利用、控制医疗费用等方面均能取得一定的效果。按人头付费与按绩效付费相结合比单一的支付方式更能产生有效的激励机制。结论:总体来看,医疗保险门诊按人头付费有助于改善卫生服务利用和控制医疗费用。未来的研究可以使用证据等级较高的研究设计追踪评价短期和长期的实施效果,为门诊按人头付费方式改革提供更有力的证据支持。Objective:To systematically review the research of implementation effect of medical insurance outpatient capitation payment,aiming to provide reference for future theoretical research and practical exploration.Methods:PubMed,Web of Science,Wanfang Data,and China National Knowledge Infrastructure were searched.In accordance with the inclusion and exclusion criteria for literature selection,literatures related to the effects of medical insurance outpatient capitation payment from 2013 to 2023 were included.The literature data obtained were systematically described.Results:A preliminary search yielded 1588 articles,of which 12 articles were included after screening.The studies indicated that outpatient capitation payment in medical insurance had achieved certain effects in improving healthcare service utilization and controlling medical expenses.A combination of capitation and pay-for-performance produced more effective incentives than a single payment.Conclusion:Overall,medical insurance outpatient capitation payment contributes to improving healthcare service utilization and controlling medical expenses.Future studies could use a study design with a higher evidence level to track and evaluate short-and long-term effects,thereby furnishing robust evidence to substantiate outpatient capitation reform.

关 键 词：医疗保险 按人头付费 门诊 实施效果 

分 类 号：R-05[医药卫生] R197.1