Based on the experience of local outpatient payment method reform in China, the paper systematically compares the relevant policies in various regions, mainly analyzes the problems and challenges in the reform, and provides policy recommendations for improving the reform. The research shows that pilot regions in China have formed a diversified composite payment mechanism for outpatient services, including four types of payment methods under total budget: fee-for-service, capitation, value-based payment, and APG (Ambulatory Payment Group). However, there are still external challenges, including the aging population and worsening chronic disease trends, cross-region medical treatment and imbalance in the supply and demand of medical services, as well as conflicts between coordinated development and regulation of medical insurance, medical services, and pharmaceuticals and multi-party management. Internal institutional issues include the risks of extensive total budget management, the difficulties of refined management in diversified composite payments, and the difficulties in the integrated management of outpatient mutual aid reform policies. In the next phase, we should continue to innovate the concept of outpatient payment method reform based on the fundamental ideas of "people first" "health-centered" and "service-oriented" .Then the reform should combine the main functions of family doctors and capitation payment under total budget, leveraging the institutional advantages of new payment methods in refined management, and continuously optimize the reform measures of outpatient payment methods. Finally, the reform should adapt to the changes in current diagnosis and treatment models, incentivize medical institutions to provide high-quality medical services, reduce the burden of outpatient care on patients, guide the rational allocation of resources and promote the construction of a new orderly medical treatment and diagnosis system, comprehensively understanding the evolution trend of outpatient payment method reform.
Key words
outpatient payment method /
fee-for-service /
capitation /
APG
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