我国基本医疗保险门诊统筹按人头付费方案分析

Evaluation of the outpatients risk pooling of capitation payment under basic medical insurance in China

收集各地有关按人头付费改革的政策文件，采用文献分析法，依照世界银行提供的分析框架，从服务包定义、人头费标准核算、定点机构确定、财务制度设计、服务监控等方面进行比较分析。发现各地虽对按人头付费有所探索，但大部分方案设计不够全面，科学合理的人头费标准测算方法和动态调整机制尚有待完善。建议对按人头费付费方案进行系统设计，以趋利避害。

An analysis is made according to policy documents of localities on capitation payment, and by means of literature review and the analysis framework of the World Bank,this paper reviewed studied the following：definition of service package,per capita rate,designated institutions,design of financial regulations,and service supervision.Given the attempts made at localities,most of the schemes are incomplete in design,and defective in capitation measurement methods and dynamic adjustment mechanisms.The authors recommend a systematic design of the capitation payment scheme for better outcomes.