The Reference and Enlightenment of APG Grouping and Payment System in the United States for China's Ambulatory Care Payment Reform
Li Jie
Su Dai
Gao Guangying
Abstract：Objective It aims to analyze the grouping methods,payment standard calculation process,and cost settlement rules of ambulatory payment groups(APG)system in the United States.Additionally,it seeks to summarize the technical advantages and implementation key points of APG,providing reference for the ambulatory care payment reform in China.Methods Employing a literature research approach,this study dissects the payment technology and implementation process of APG.A preliminary comparison is made with the practices of APG pilot cities in China.Results The APG 3.18 version catalog comprises 13 types,61 categories,and 666 groups.One APG case can be classified into multiple APG groups,and by applying rules such as consolidation,packaging,and discounting,the final payment amount is calculated.Conclusion The APG payment technology aligns with the characteristics of outpatient health services,offering flexible payment methods and incentivizing healthcare institutions to provide efficient services.This holds significant reference value for the ambulatory care payment reform in China.The key points of APG implementation include improving the quality of outpatient data,localizing grouping and payment rules,establishing a regulatory assessment indicator system,and ensuring alignment with inpatient payments.
Keywords：ambulatory care payment reformambulatory patient groupspayment system
Publication Date：2024-04-05
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 91-96 )