目前全国很多地方开展了门诊统筹试点,在与定点医疗机构费用结算方面,主要采取按服务项目后付和按人头预付两种方式。眼下,这两种门诊统筹的支付方式还处于探索阶段,存在的主要问题有:(1)居民只能选择1—2家医疗机构签约,不能有效地促进医疗机构竞争。(2)在没有建立全科医生守门人制度前提下,门诊按人头付费可能会导致逆向选 At present, in many parts of the country, out-patient co-ordination pilots have been carried out. In the settlement of fees with designated medical institutions, the two methods are mainly post-payment according to service items and pre-payment by people. Right now, the two outpatient co-ordinated payment methods are still in the exploratory stage, the main problems are: (1) residents can only choose 1-2 medical institutions signed, can not effectively promote the competition of medical institutions. (2) In the absence of a GP system, pay-per-patient may lead to adverse selection