“结余留用”是县域医共体按人头总额预付的主要激励约束机制，但由于缺乏相关理论和方法指导，实际运行中“结余留用”机制的作用没有得到有效发挥。本项目中“结余”是指基本医保按人头总额预付的原则给县域医共体的预算支付额与实际基金消耗额之间的差值。项目整合多数据库信息及现场调查分析、多值集定性比较分析、利益相关者理论、行为理论，探索价值导向的“结余”设计理念及“结余”形成机制、构建“结余”评估考核体系；基于前述研究，利用门诊、住院费用两部模型构建疾病经济风险测算模型，根据价值导向的“结余”形成机制，并运用数据挖掘技术分析各结余形成路径对疾病经济风险的影响。同时构建县域医共体按人头总额预付结余测算理论模型，利用现场干预验证价值导向下“结余”形成机制有效性及“结余”测量模型科学性，并运用自然实验法验证干预效果。本研究对于完善支付制度设计、推动县域医共体发展、促进价值医疗服务提供具有较高的理论和现实意义。

The utilization of the fund balance retention is the main incentive and restraint mechanism of global capitation prepayment in the County's Healthcare Alliance. However, due to the lack of guidance from relevant theories and methods, the function of this mechanism is not effective for practical operation. In this study, the medical insurance fund balance refers to the difference between the budgetary payment to the county's healthcare alliance and the actual fund consumption according to the principle of the global capitation prepayment. This research combines multi-database information with on-site investigation and analysis, multi-value qualitative comparative analysis, and uses stakeholder theory and behavioral theory to explore the design concept, the formation mechanism and the evaluation system of “medical insurance fund balance”. Based on the above research, the two-part models of outpatient and inpatient expenses are used to construct the disease economic risk adjustment model. According to the formation mechanism of “medical insurance fund balance” oriented in value, the impact of each formation path on disease economic risk is analyzed by Data mining technology. Meanwhile, the theoretical model of the prepaid balance calculation of the county's healthcare alliance is constructed. The field intervention experiment is used to verify the validity and the scientificity of the value-oriented" medical insurance fund balance" formation mechanism and the measurement model. Besides, the natural experiment method will be used to verify the intervention effect. This research has high theoretical and practical significance for improving the design of the payment system, promoting the development of the county's healthcare alliance and promoting the provision of medical services in value.