关键词: 按人头总额预付制, 冠心病, 卫生服务利用, 医疗费用, 政策评估

Abstract: Objective　To explore the impact of the capitation prepayment system on medical service utilization and medical costs of patients with coronary heart disease, and to provide a reference for decision making to deepen the health insurance payment reform.Methods　Descriptive statistics were performed on data related to service utilization of patients with coronary heart disease in the sample regions from 2015-2019, and the changes in patient service utilization and healthcare costs after the implementation of the capitation prepayment reform were analyzed based on the propensity score matching method.Results　In the first year of reform implementation, the number of visits per capita in the pilot group was 0.21 less than in the control group (P<0.05), the number of visits per capita at county-level medical institutions was 0.06 less than in the control group (P<0.05), and the cost of visits per capita reduced by CNY 8.50 compared with the control group (P<0.05). The number of hospital visits per capita in the pilot group in the second year of reform implementation was 0.20 less than that in the control group (P<0.05), and the drug cost of hospitalization per capita reduced by CNY 62.56, compared with the control group (P<0.05).Conclusion　The capitation prepayment system effectively promotes prevention gate-shifting, directs patients with chronic diseases to increase the utilization of primary health care institutions, and effectively controls the rise of medical costs.

Key words: capitation prepayment, coronary heart disease, health service utilization, medical costs, policy evaluation