The per capita payment for medical insurance outpatient services means that the outpatient fees settled between the medical insurance center and the hospital are multiplied by the approved average outpatient fee per person.

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 Basic Medical Insurance Funds and Playing the Role of Medical Insurance Funds in Cost Control," which clearly proposed the implementation of the reform of basic medical insurance payment methods and the comprehensive implementation of the basic medical insurance payment method based on the total amount.

Based on the budget, outpatient payment is based on capitation, and inpatient payment is based on disease type, diagnosis-related groupings (DRGs), bed-day payment and other methods. It is a composite payment method that adapts to different groups of people, different diseases and medical service characteristics, and gradually

Reduce fee-based payments and cover all medical institutions and medical services with payment reform.

Outpatient services are settled on a per capita basis through a combination of monthly prepayment and year-end settlement.

Settlement formula: Monthly outpatient overall fund prepayment amount = (annual outpatient overall fund per capita quota of the contracted medical institution/12) × number of contracted persons on the 10th of the month.

The actual prepayment amount of the monthly outpatient co-ordination fund = the prepayment amount of the monthly outpatient co-ordination fund × 95%.

5% will be deducted as assessment fee, which will be paid based on the assessment results during the annual assessment.

The total amount of year-end liquidation = the total annual prepaid outpatient coordination fund of the contracted medical institution - the annual actual medical expense advance amount of the contracted medical institution.

Among them, the total annual prepayment fund is equal to the sum of the prepayment amounts of the monthly outpatient co-ordination funds.

During the year-end liquidation, if the quota usage rate of the outpatient coordination contracted medical institution does not exceed 70%, it will be settled according to the project settlement method, and all remaining funds will be used as pre-allocated quota funds for the next year.