在DRG支付方式改革下,医疗保险基金运营绩效评估系统
Zijian Wang1,2,3, Weifu Chang3,4, Aijing Luo1,3,5
1The Second Xiangya Hospital of Central South University, Changsha, China.
中国的医疗保险基金在诊断相关组 (DRG) 支付改革下表现有所改善. 医疗服务能力是运营成功的关键,强调需要有效的评估系统.
科学领域:
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
- 医疗保健管理的管理
背景情况:
- 中国的诊断相关集团 (DRG) 支付改革需要医疗保险基金的强有力的评估系统.
- 现有的研究缺乏综合性绩效评估,整合了先进的方法,如AHP-EWM-FCE,用于DRG基金.
研究的目的:
- 根据DRG支付改革,开发和应用医疗保险基金的创新绩效评估系统.
- 确定影响这些基金运营业绩的关键因素.
主要方法:
- 利用了中国S省8个城市的运营数据 (2020-2022年).
- 开发了一种使用分析层次过程 (AHP) - 重法 (EWM) - 模糊综合评估 (FCE) 模型的绩效评估系统.
- 采用托比特回归分析来探索影响因素.
主要成果:
- 管理,筹款,利用和满意度的运营绩效得分在DRG改革后持续改善.
- QD和JN城市表现出卓越的绩效指标.
- 评估系统的得分与实际的运营成果密切相关.
- 医疗服务能力成为基金业绩的主要决定因素.
结论:
- 开发的AHP-EWM-FCE系统为评估医疗保险基金绩效提供了一种新的方法.
- 调查结果支持医疗保险治理的现代化和基金生产率.
- 提高基金业绩有助于改善公众健康和福祉.
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