Analysis of the Payment Combination Policy of APG Points Method in Outpatient Departments of Jinhua City

China Health Insurance ›› 2024, Vol. 0 ›› Issue (10) : 68-77.

China Health Insurance ›› 2024, Vol. 0 ›› Issue (10) : 68-77. DOI: 10.19546/j.issn.1674-3830.2024.10.010
Management Platform

Analysis of the Payment Combination Policy of APG Points Method in Outpatient Departments of Jinhua City

Author information +
History +

Abstract

Objective: The paper explores how to establish an effective payment mechanism for medical insurance outpatient service by analyzing the payment combination policy of APG points in Jinhua City. Methods: On the basis of summarizing the principle of APG, the policy performance evaluation framework is constructed based on the three values of service accessibility, quality and safety, and efficiency and payment. The data of Jinhua municipal medical insurance fund expenditure and outpatient payment from 2019 to 2023 are used, and the methods of quantitative evaluation are applied to evaluate the effect of the outpatient combination payment policy of "APG points plus capitation package" in Jinhua City. Results: The growth rate of medical expenses and medical insurance fund was about 7%, and there was a balance of employees’ medical insurance and residents’ medical insurance, including the total budget balance of outpatient APG. The proportion of medical treatment in different places is relatively low. The service capacity and operational efficiency of Level-I medical institutions are increasing. The balance rate of APG patients increased, the structure of outpatient expenses was gradually optimized, the quality of medical services was stable, and there was no complementary effect between outpatient and inpatient coordination. Conclusion: Jinhua City separated contracted service and uncontracted service groups, and embedded disease risk weighting and group budget into the former, which improved the scientific and fair allocation of medical insurance funds, consolidated the foundation of medical insurance performance assessment, promoted the quality and efficiency of outpatient services, stimulated the enthusiasm of primary medical institutions, and became a part of the medical insurance payment systematic project of Jinhua City. In the future, it is necessary to further explore the rational docking and intelligent operation of inpatient DRG and outpatient APG, so as to improve the scientific grouping and reduce the operating cost.

Key words

outpatient group score APG / capitation weighted grouping budget / systematic project,medical insurance payment method

Cite this article

Download Citations
Analysis of the Payment Combination Policy of APG Points Method in Outpatient Departments of Jinhua City[J]. China Health Insurance. 2024, 0(10): 68-77 https://doi.org/10.19546/j.issn.1674-3830.2024.10.010

References

[1] 吴伟旋,向前.三种病例组合系统的比较研究[J].卫生经济研究,2017(09):21-24.
[2] GOLDFIELD N, AVERILL R, EISENHAN DLER J, et al.Ambulatory Patient Groups, Version 3.0——a classification system for payment of ambulatory visits[J]. Journal of ambulatory care management, 2008, 31(1): 2-16.
[3] 刘星辰,杨燕绥,李超凡.美国门诊病例分组预付制的经验及对我国的启示[J].中国卫生政策研究,2021,14(07):48-54.
[4] 张玉海,徐勇勇.国外门诊病人的病例组合研究及有关问题[J].中华医院管理杂志,2000(12):56-57.
[5] 张玉海. 医院门诊病人病例组合方法的研究[D].西安:第四军医大学,2001.
[6] SHAEFFER C.Ambulatory payment classifications[J]. Journal of emergency nursing, 2000, 26(1): 20-23.

Accesses

Citation

Detail

Sections
Recommended

/