目的:探索适宜我国区域医疗服务体系改革的混合预付支付模式,并论证其效果。方法:借鉴国内外医疗集团支付模式,设计以“按疾病测算+集团打包预付+单病种付费+绩效管理”为核心的集团总额预付制,并通过准实验的政策干预对照试验,利用差分模型,论证该支付方式在控费和改善服务协作方面的效果。结果:从4个乡镇中筛选符合病种纳入标准的住院报销样本共38 980条,以及两级住院病历共194份,发现相对对照组,实验组每人每5个月平均住院率下降0.08%,三级医院住院服务风险比下降0.16%,服务连续性上升了33.80%。集团总额预付制有助于降低住院结构、促进医疗协作,但实际效果因基层首诊和双向转诊制度未能很好执行受到一定影响。结论:建议未来医联体改革应以激励医疗协作、改善服务质量为目标,以分级诊疗和信息共享为基础,在循证基础上配合实施适宜的混合预付模式。 Objective: To explore a hybrid prepaid payment model suitable for the reform of regional medical service system in China and demonstrate its effectiveness. Methods: Using the payment model of domestic and international medical groups as reference, we designed the group prepay system with the core of “disease estimation + group prepayment + single disease payment + performance management”, and adopted the quasi-experiment policy intervention intervention The difference model demonstrates the effectiveness of the payment method in controlling fees and improving service collaboration. Results: A total of 38,980 hospitalized reimbursement samples were collected from 4 townships, and 194 hospital records of two levels were collected. The average hospitalization rate of every 5 months in the experimental group was 0.08% lower than that of the control group , Tertiary hospital inpatient service risk decreased by 0.16%, service continuity increased by 33.80%. The group prepayment system helps to reduce the hospitalization structure and promote medical cooperation, but the actual effect is affected to some extent due to the failure of primary referral and the two-way referral system to be implemented well. Conclusion: It is suggested that the future medical reform should be based on the evidence-based implementation of the appropriate hybrid prepaid mode based on the evidence-based diagnosis and treatment and information sharing, with the objective of encouraging medical cooperation and improving service quality.