Objective: The paper attempts to explore the reform process, practical characteristics, and implementation outcomes of capitation payment models for chronic disease management under an integrated service orientation, and to provide references for policy improvement. Methods: Policy text analysis, case study, and comparative analysis were conducted. Based on policy documents, published literature, and research team survey data, four cases were selected for comparison: Suixi County (Anhui Province, China), Tianjin City (China), Singapore’s Healthier SG, and the US Medicare APCM. Results: Chronic disease capitation payment in China has expanded from outpatient chronic disease coverage to outpatient special/chronic diseases, general outpatient pooling, total budget for county-level medical alliances, and family doctor contracting, showing a trend from a single payment tool toward a collaborative governance mechanism. More effective models generally feature payment refinement, service integration, health outcome orientation, and digital intelligence empowerment. Through mechanisms such as accountability binding, risk calibration, and performance feedback loops, they drive chronic disease management from passive treatment to proactive health management, achieving multiple goals of cost management, quality improvement, and health enhancement. Conclusion: Capitation payment is not only an important tool for medical insurance method payment reform but also a key institutional lever for promoting chronic disease management and integrated service system development. Future efforts should strengthen collaboration between healthcare security administrations and health commissions, improve risk adjustment, performance assessment, and benefit distribution mechanisms, and enhance digital intelligence technology support.
Key words
chronic disease management /
capitation payment /
medical insurance payment method /
integrated healthcare
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