目的: 分析江苏省张家港市“服务人头点值法”支付方式改革的实施效果,为完善按疾病诊断相关分组（DRG）支付框架下多元复合支付机制提供决策参考。方法: 在总结“服务人头点值法”作用机制的基础上,基于内外圈利益相关者理论,构建“控成本、保质量、提效率”三维评估框架,使用2021—2024年医保决算数据,采用定量评估方法,对“服务人头点值法”支付方式改革的实施效果进行评估。结果: 张家港市医疗总费用年均增长率控制在6.08%,医保基金运行效率提高,次均门诊费用显著下降,住院率与31天再入院率明显降低,医疗服务质量与效率均有提高。结论: “服务人头点值法”支付方式改革对张家港市在控制医疗费用不合理增长、保障医疗服务质量、提升医保基金使用效率方面成效显著。今后需进一步探索点值形成的相关指标,进一步精细化点值的激励机制,以提高点值的科学性。

Objective: By analyzing the implementation effect of the "Service Number Point Value Method" payment method reform in Zhangjiagang City of Jiangsu Province, the paper provides decision-making reference for improving the diversified and compound payment mechanism under the DRG payment framework. Method: Based on the summary of the underlying mechanism of the "service number point value method" and the theory of internal and external circle stakeholders, a three-dimensional assessment framework of "controlling costs, ensuring quality, and improving efficiency" was constructed. Using medical insurance final settlement data from 2021 to 2024, a quantitative assessment method was adopted to evaluate the implementation effect of the "service number point value method" payment method reform. Result: The average annual growth rate of total medical expenses of Zhangjiagang City was controlled at 6.08%. The operational efficiency of medical insurance funds has been improved. The average outpatient cost per visit decreased significantly. The hospitalization rate and the 31-day readmission rate have significantly decreased, and both the quality and efficiency of medical services have improved. Conclusion: The "service number point value method" payment method reform has achieved remarkable results in Zhangjiagang City in controlling the irrational growth of medical expenses, ensuring the quality of medical services, and improving the efficiency of medical insurance fund utilization. In the future, it is necessary to further explore the relevant indicators for the formation of point value and further refine the incentive mechanism of point value to enhance the scientific nature of point value.