东莞门诊费用按人头付费方式的探索与实践

Discussion and Application of Per Capita Payment in Dongguan

按人头付费通过调节医疗保险基金流向,促进基层医疗机构从注重疾病治疗向健康保障、疾病预防转变,改变参保人就医行为,引导卫生资源合理配置。本文简要介绍东莞现行的社区门诊结算方式和按人头付费方式上的改革历程,从首诊制、总额确定方法、付费管理办法、年终清算激励机制四方面进行回顾,了解东莞在这些关键点上的做法、遇到的问题,以及解决问题的思考和探索。

Per capita payment promotes basic medical institutions changing from emphasizing on disease treatment to the health care and disease prevention by adjusting the medical insurance fund flows. It also changes the insured medical behavior and guides the rational allocation of health resources. This paper introduces the current settlement methods for community outpatients of Dongguan, shows the reform process of per capita payment. It reviews the experience in four aspects such as first contact care at community health services centers, the total payment determination method, payment management, year-end settlement inspiration mechanisms, to help understanding the practice, problems, and solution methods in these key points in Dongguan.