Construction of performance evaluation index system for outpatient capitation based on value-based payment
10.3760/cma.j.cn111325-20230428-00342
- VernacularTitle:基于价值支付理念的门诊按人头付费绩效评价指标体系构建
- Author:
Hang XU
1
;
Xiaojing MA
;
Meng JIA
Author Information
1. 中国医学科学院医学信息研究所，北京 100020
- Keywords:
Outpatient;
Capitation;
Performance evaluation;
Value-based payment;
Indicator system;
Delphi
- From:
Chinese Journal of Hospital Administration
2023;39(10):763-768
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To construct a performance evaluation index system of outpatient capitation under basic medical insurance in China based on the concept of value-based payment, so as to provide reference for the medical insurance departments to evaluate the performance of outpatient capitation.Methods:From January to February 2023, the initial index system was constructed based on literature research and expert discussion. Twenty experts were invited for 2 rounds of Delphi consultation and the index system was revised and improved, and the weight value of the index was determined by using analytic hierarchy process.Results:Seventeen experts completed the consultation. The final performance evaluation index system of outpatient capitation included 4 first-level indicators, 9 second-level indicators and 20 third-level indicators. In the first-level indicators, the weights of service delivery, medical costs, quality of care, and health outcomes were 0.234, 0.262, 0.262 and 0.242, respectively. The second-level indicators mainly included basic medical services, cost control, fund operation, quality of chronic disease management, etc. The index system not only included medical quality and cost control indicators, but also included several value-based indicators such as health outcomes and patient satisfaction.Conclusions:A performance evaluation index system for outpatient capitation has been successfully constructed, which simultaneously assesses the process and results of capitation, and can provide theoretical reference for the medical insurance departments to carry out performance evaluation.
