医保信息监管工具问题瓶颈、影响因素及策略研究

Research on Bottlenecks,Influencing Factors and Innovation Strategies of Medical Insurance Information Supervision Tools

目的调查分析医疗保障信息监管工具的建设情况及存在的问题瓶颈,探讨影响医疗保障信息监管工具的多维因素及创新策略。方法对黑龙江省医疗保障相关人员进行问卷抽样调查,采用χ2检验以及多因素logistic回归分析探究医疗保障信息监管工具的影响因素。结果调查收集有效问卷1320份。结果显示,51.6%认为具有较完备的医疗保障信息监管工具,但仍在标准化、智能监管以及人才储备上存在问题瓶颈。医疗保障信用体系建设(OR=3.953)是影响信息监管工具建设程度评价的关键因素、医疗保障基金信息化监管手段(OR=1.608)、信息标准化接口与信息共享(OR=1.499)、信息化人才建设(OR=1.326)对信息监管工具的建设程度有重要影响。结论信息化是医疗保障基金监管的核心技术工具,围绕诚信监管与智能监管有效探索信息监管工具在医疗保障基金监管中的积极作用,提高多主体在医疗保障基金监管的协同监管能力、组织协调能力、精准监管能力以及信息化技术应用能力。

Objective Investigate and analyze the construction situation of medical security information supervision tools and existing bottlenecks,and explore the multi-dimensional factors and innovative strategies that affect medical security information supervision tools.Methods A questionnaire sample survey is conducted on medical insurance-related personnel in Heilongjiang Province,and the influencing factors of medical insurance information supervision tools are explored using the 2 test and multi-factor logistic regression analysis.Results The survey collected 1320 valid questionnaires.The results showed that 51.6%believed that they have relatively complete medical security information supervision tools,but there are still bottlenecks in standardization,intelligent supervision and talent reserve.The construction of the medical insurance credit system(OR=3.953)is a key factor that affects the evaluation of the construction of information supervision tools,medical insurance fund information fund supervision methods(OR=1.608),information standardization interface and information sharing(OR=1.499),information talent construction(OR=1.326)has an important impact on the construction of information supervision tools.Conclusion Informatization is the core technical tool for medical insurance fund supervision.Focusing on integrity supervision and intelligent supervision,which will effectively explore the positive role of information supervision tools in medical insurance fund supervision,and improve the coordination,organization and coordination,precision supervision capabilities,and the ability to apply information technology of multiple entities in the supervision of medical insurance funds.