加强对门诊费用的管理是医改的一个重要课题。笔者综合项目付费制和费用包干制两种付费制度的优点,设计了“收益定额法”的门诊费用管理模式。其运作方式为:医保基金分别划入统筹和个人帐户;参保人门诊费用只用个人帐户或现金支付;参保人每一结算年度选择一个协定医院定点门诊;医保机构在掌握了当地往年的人均门诊费用后,根据医院的定点人数,给医院核拨一定的人头费, Strengthening the management of outpatient expenses is an important issue in medical reform. The author combines the merits of the two project payment systems and the fee-for-packet system, and designs the out-of-pocket cost management model of the “benefits-quota method.” Its operation mode is: Medicare fund is divided into the overall plan and individual account; the outpatient expenses of the insured person are only paid by personal accounts or cash; the insured person selects one contracted outpatient clinic for each settlement year; the medical insurance organization has mastered the local previous years. After per capita outpatient expenses, according to the number of designated hospitals, a certain amount of personal expenses will be allocated to the hospital.