A Study on methods of risk-adjusted capitation fee of risk pooling for outpatient services in basic medical insurance:A case study of Shenzhen City
10.3969/j.issn.1674-2982.2017.09.005
- VernacularTitle:基于风险调整的基本医疗保险门诊统筹按人头付费标准测算研究 ——以深圳市为例
- Author:
Lihuan AI
;
Ronghai WU
;
Li XIAO
;
Zhiguo ZHANG
- Keywords:
Basic medical insurance;
Risk pooling of outpatient services;
Capitation;
Risk adjustment
- From:
Chinese Journal of Health Policy
2017;10(9):39-45
- CountryChina
- Language:Chinese
-
Abstract:
Objective: The main objective of the present study is to develop the risk-adjusted capitation pay-ment standards to compensate health service providers. Methods:Descriptive statistical analysis was conducted to an-alyze the insured's enrollment and visit conditions, and the two-part model was conducted to obtain the appropriate compensation standard using data retrieved from information system of social health insurance for the period of 2014 to 2015 in Shenzhen City. Results:The estimated value of total expenditure per insured person per month is 6. 17 yuan. Age,sex,insurance level and with or without chronic disease or catastrophic disease were elicited as risk adjustors. The whole number insured people were divided into 52 groups by this four risk-adjustment factors whereby the rele-vant payment standards for each group was calculated. Conclusions:By adjusting capitation fee on the grounds of risk of disease and expected expense of medical services of the insured, the capitation payment standards can be calculat-ed virtually. This method will promote the process of capitation payment system reform and also lay a solid foundation for further research.
