Since August 2022, Shengzhou City of Zhejiang Province has been carrying out the reform of outpatient payment mode in medical insurance, gradually carrying out the reform of capitation by implementing the total budget, updating the calculation standard of capitation fee, improving the incentive and constraint mechanism and other measures, so as to encourage primary health care institutions to provide appropriate basic medical services, reduce primary medical expenses, and promote the sustainable development of medical insurance fund.

To analyze the influence mechanism of capitation for outpatient services in basic medical insurance on medical expenses in Shengzhou City, Zhejiang Province, and to provide reference for improving the relevant payment system.

Using "capitation" and "medical costs" as both English and Chinese search terms, databases such as CNKI, Wanfang, PubMed and Web of Science were searched for relevant literature on capitation from 2000-01-01 to 2022-07-31, as well as the policy documents, government reports and news reports related to the implementation of capitation from April to July 2022. Personal interviews were conducted with representatives of capitation payment policy makers and implementers in Shengzhou City from September to December 2022 (n=13) . A qualitative analysis of capitation reform policy on medical expenses under the total outpatient budget in Shengzhou City, Zhejiang Province was performed by using system dynamics approach.

The policies of the current round of medical insurance payment reform in Shengzhou were plotted as a cause graph with five feedback loops obtained, showing that the implementation of the total capitation budget policy can motivate primary health care institutions to provide standardized medical services for residents, promote an increase in the contracting rate in primary care, thus controling medical expenses; a scientific capitation fee standard can motivate primary health care institutions to autonomously control and reduce costs; increasing the reimbursement ratio of medical insurance can effectively reduce the medical burden of patients; improving the performance appraisal system is conducive to the continuous improvement of service capabilities of primary health care institutions; strengthening the construction of information sharing mechanisms can achieve data sharing and exchange, and comprehensively improve the health of residents.

The implementation of capitation reform in conjunction with multiple policy measures can improve the contracting and consultation rates in primary care institutions, broaden the sources of medical insurance fund, ensure the sustainability of medical insurance fund, improve the medical service and capabilities of primary care institutions, improve the health status of residents, and significantly improve the prevention and treatment effect of chronic diseases.

浙江省嵊州市自2022年8月起开展医疗保险门诊支付方式改革，通过实施总额预算、更新人头费测算标准、改进激励约束机制等政策逐步开展按人头付费改革，激励基层医疗卫生机构提供适宜的基本医疗服务，降低基层医疗费用支出，促进医疗保险基金的可持续发展。

分析浙江省嵊州市基本医疗保险门诊按人头付费政策对基层医疗卫生机构费用的影响机制，为完善相关支付制度提供参考。

于2022年4—7月，以"capitation""medical costs"等为英文检索词，以"按人头付费""医疗费用"等为中文检索词，检索2000-01-01—2022-07-31 PubMed、Web of Science、中国知网、万方数据知识服务平台等数据库中与按人头付费相关的文献，同时梳理嵊州市实行按人头付费相关的政策文件、政府报告及新闻报道等；于2022年9—12月，对嵊州市按人头付费政策制定与实施者代表进行个人访谈（n=13）。采用系统动力学方法对浙江省嵊州市门诊总额预算下按人头付费改革政策对费用的影响机制进行定性分析。

将嵊州市本轮医疗保险支付方式改革的政策绘制成因果关系图，得到5条反馈回路。结果显示：按人头总额预算政策的实行能激励基层医疗卫生机构为居民提供规范的医疗服务，促进提高基层签约率，从而控制医疗费用支出；科学的人头费用标准能够激励基层医疗卫生机构自主控制医疗费用；提高医疗保险报销比例，可以切实减轻患者就医负担；完善绩效考核制度，有利于持续提升基层医疗卫生机构服务能力；加强信息共享机制的建设，实现数据共享互通，能整体性地提高居民的健康水平。

实施按人头付费改革配合多项政策措施，能够提高基层签约率和就诊率，拓宽医疗保险基金来源，保证医疗保险基金的可持续性，提高基层医疗卫生机构的医疗水平和服务能力，改善居民健康状况，最终有利于改善慢性病的防治效果。