The idea of overall payment per head for medical insurance clinics is that the outpatient expenses settled by medical insurance centers and hospitals are multiplied by the approved per capita outpatient expenses.

The Ministry of Finance, the Ministry of Human Resources and Social Security and the National Health and Family Planning Commission jointly issued the Opinions on Strengthening the Budget Management of the Basic Medical Insurance Fund and Giving Full Play to the Role of the Medical Insurance Fund in Controlling Fees, clearly proposing to implement the reform of the payment mode of the basic medical insurance, comprehensively implement the combination of various ways such as the total budget, pay by head for outpatient service, pay by diseases, pay by groups related to disease diagnosis (DRGs) and pay by bed day, so as to adapt to the characteristics of different people, diseases and medical services, and gradually reduce the compound payment mode according to projects.

Outpatient co-ordination and head-to-head settlement are carried out by combining monthly prepayment and year-end settlement.

Settlement formula:

Monthly outpatient co-ordination fund should be paid in advance = (per capita amount of annual outpatient co-ordination fund of contracted medical institutions/12)× number of contracted persons in the current month 10.

The actual prepayment amount of monthly outpatient co-ordination fund = the prepayment amount of monthly outpatient co-ordination fund ×95%. Among them, 5% is deducted as the assessment fund and paid according to the assessment results in the annual assessment.

Total amount of year-end liquidation = total amount of outpatient co-ordination fund that contracted medical institutions should prepay in the current year-actual medical expenses paid by contracted medical institutions in the current year. Among them, the total annual prepayment fund is equal to the sum of the prepayment amount of the monthly outpatient co-ordination fund.

At the time of year-end liquidation, if the fixed utilization rate of outpatient contracted medical institutions does not exceed 70%, it will be settled according to the actual settlement method of the project, and all the remaining funds will be used as the fixed funds for the next year.