Analysis of the Payment Combination Policy of APG Points Method in Outpatient Departments of Jinhua City
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.
万方数据
维普
