One of the global challenges is how to effectively restrain the growth of healthcare costs and rationalize the use of healthcare resources. In the global healthcare system reform, payment is expected to be one of the "control handles". This study takes outpatient capitation payment reform as a perspective, classifies the practice and reform trends of capitation payment in some countries, and proposes capitation payment recommendations based on China's national conditions to provide a reference for outpatient medical insurance payment reform in China.
Comparison of Foreign Outpatient Capitation Payment Reform and Implications for China[J]. China Health Insurance. 2023, 0(2): 51-58 https://doi.org/10.19546/j.issn.1674-3830.2023.2.008
中图分类号：
F840.684
C913.7
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参考文献
[1] OBADHA M, CHUMA J, KAZUNGU J, et al.Healthcare purchasing in Kenya: Experiences of health care providers with capitation and fee-for-service provider payment mechanisms[J]. The International journal of health planning and management. 2019, 34(1) : e917-e933. [2] SOOD N, ALPERT A, BARNES K, et al.Effects of Payment Reform in More versus Less Competitive Markets[J]. J Health Econ.2017,51:66-83. [3] TWADDLE A C, EBRARY I.Health Care Reform Around the World[J]. 2002. [4] 中华人民共和国国家标准社会保险术语第4部分:医疗保险[M].北京:中国标准出版社,2015. [5] 丁赛尔. 国外门诊药品费用控制方式概述[J].中国医疗保险. 2011(04):67-69. [6] 英国国民卫生服务体系改革正式生效[J].中国卫生政策研究. 2013,6(04):55. [7] KONTOPANTELIS E, MAMAS M A, VAN MARWIJK H, et al.Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis[J]. BMC medicine.2018,16(1):19. [8] ROLAND M.Linking physicians' pay to the quality of care--a major experiment in the United kingdom[J]. N Engl J Med. 2004,351(14):1448-1454. [9] BMA. Quality and outcomes framework (QOF)[EB/OL].(2021-12-20)[2023-02-20].https://www.bma.org.uk/advice-and-support/gp-practices/funding-and-contracts/quality-and-outcomes-framework-qof. [10] ROLAND M, GUTHRIE B, THOM EDAVID C. Primary medical care in the United kingdom[J]. Journal of the American Board of Family Medicine: JABFM.2012,25 Suppl 1(Suppl.):S6-11. [11] CHEVREUL K, DURAND-ZALESKI I, BAHRAMI S, et al.France Health System Review[R]. Copenhagen: World Health Organization Regional Office for Europe, 2010. [12] MAGALI D, THOMAS B, PAUL D, et al.Gatekeeping and the utilization of physician services in France: Evidence on the Médecin traitant reform[J]. Health policy, 2017,121(6). [13] 冯毅. 基本医疗保险门诊统筹模式研究[D].华中科技大学. 2014. [14] KRONEMAN M, VAN DER ZEE J, GROOT W. Income development of General Practitioners in eight European countries from 1975 to 2005[J]. BMC Health Services Research. 2009 ,9(1). [15] KRONEMAN M, MEEUS P, KRINGOS D S, et al.International developments in revenues and incomes of general practitioners from 2000 to 2010[J]. BMC Health Services Research. 2013,13(1):436. [16] CASSOU M, MOUSQUES J, FRANC C.General practitioners’ income and activity: the impact of multi-professional group practice in France[J]. The European Journal of Health Economics. 2020,21(9). [17] 朱晓丽,代涛,黄菊.若干欧洲国家全科医生支付方式演变及启示[J].医学与哲学(A).2017,38(04):56-59. [18] 顾昕,郭科.从按项目付费到按价值付费:美国老人医疗保险支付制度改革[J].东岳论丛. 2018,39(10):79-87. [19] TOSEEF M U, JENSEN G A, TARRAF W.Medicaid managed care and preventable emergency department visits in the United States[J]. PloS one. 2020,15(10): e0240603-e0240603. [20] PAN K, SILVER S, DAVIS C.Analysis of psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in Medicare Part D in the United States[J]. Trends in psychiatry and psychotherapy.2020,42(1):48-54. [21] Leonard Davis Institute of Health Economics. The Future of Value-Based Payment: A Road Map to2030[EB/OL].(2021-02-17)[2023-02-17].https://ldi.upenn.edu/our-work/research-updates/the-future-of-value-based-payment-a-road-map-to-2030/. [22] PATRICIA S, HILDE B, LUC F, et al.Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience"[J]. BMC Health Services Research.2009,9(1):152. [23] GERKENS S, MERKUR S. Belgium: Health system review[J]. Health systems in transition.2010,12(5):1-266,xxv. [24] GERKENS S, MERKUR S.Belgium: health system review[J]. Health systems in transition.2010,13:1-301. [25] DANHIEUX K, BUFFEL V, REMMEN R, et al.Scale-up of a chronic care model-based programme for type 2 diabetes in Belgium: a mixed-methods study[J]. BMC Health Services Research. 2023;23(1):141. [26] VAN WEEL C, SCHERS H, TIMMERMANS A.Health care in the Netherlands[J]. J Am Board Fam Med.2012,25(Suppl 1):S12-S17. [27] KNOTTNERUS J A, TEN VELDEN G H. Dutch doctors and their patients--effects of health care reform in the Netherlands. N Engl[J] Med.2007,357(24):2424-2426. [28] MARCHILDON G P, BRAMMLIGREENBERG S, DAYAN M, et al.Achieving higher performing primary care through patient registration: A review of twelve high-income countries[J]. Health policy(Amsterdam, Netherlands).2021,125(12):1507-1516. [29] TANGCHAROENSATHIEN V, WITTHAYAPIPOPSAKUL W, PANICHKRIANGKRAI W, et al.Health systems development in Thailand: a solid platform for successful implementation of universal health coverage[J]. Lancet. 2018,391(10126):1205-1223. [30] WATTANAPISIT A, SAENGOW U.Patients' perspectives regarding hospital visits in the universal health coverage system of Thailand: a qualitative study[J]. Asia Pacific family medicine.2018,17(1):9. [31] DAMRONGPLASIT K, MELNICK G.Early results from Thailand's 30 Baht Health Reform: something to smile about[J]. Health affairs(Project Hope).2009,28(3):w457-66. [32] PAEK SEUNG-HUN, MEEMON N, WAN THOMAS T H. Thailand's universal coverage scheme and its impact on health-seeking behavior[J]. SpringerPlus.2016,5(1):1952. [33] BAZYAR M, YAZDI-FEYZABADI V, RASHIDIAN A, et al.The experiences of merging health insurance funds in South Korea, Turkey, Thailand, and Indonesia: a cross-country comparative study[J]. Int J Equity Health. 2021;20(1):66. [34] 刘明瑶. 糖尿病按人头付费支付方式改革对医保费用影响效果分析[D].天津大学,2014. [35] LIMWATTANANON S, TANGCHAROENSATHIEN V, PRAKONGSAI P.Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand[J]. Bull World Health Organ.2007,85(8):600-606. [36] HENNIG-SCHMIDT H, SELTEN R, WIESEN D.How payment systems affect physicians' provision behavior-An experimental investigation[J]. Journal of Health Economics.2011,30(4):637-646. [37] BROSIG-KOCH J, HENNIG-SCHMIDT H, KAIRIES N, et al.How to improve patient care?-An analysis of capitation, fee-for-service, and mixed payment schemes for physicians[R]. Ruhr Economic Papers.2013. [38] 冯毅. 我国门诊统筹“按人头付费”实施现状及改革路径[J].卫生经济研究. 2016(04):45-47. [39] BERTAKIS K D, CALLAHAN E J, AZARI R, et al.Predictors of patient referrals by primary care residents to specialty care clinics[J]. Family medicine.2001,33(3):203-9. [40] AKBARI A, MAYHEW A, AL-ALAWI M A, et al. Interventions to improve outpatient referrals from primary care to secondary care[J]. The Cochrane database of systematic reviews.2008(4), CD005471. [41] ZUIDGEEST M, HENDRIKS M, KOOPMAN L, et al.A comparison of a postal survey and mixed-mode survey using a questionnaire on patients' experiences with breast care[J]. J Med Internet Res.2011,13(3):e68. [42] 曾国华,蒋翠珍,吴雯雯,等.总额预付制对医疗供给行为的作用效应研究述评[J].中国卫生政策研究. 2018,11(09):8-14. [43] ELLIS R P, MCGUIRE T G.Provider behavior under prospective reimbursement: Cost sharing and supply[J]. Journal of Health Economics.1986,5(2):129-151. [44] Leila D, Arash R, Amirhossein T, et al.Payment system of urban family physician programme in the Islamic Republic of Iran: is it appropriate[J]. Eastern mediterranean health journal.2018,24(7):611-617.
