不确定信息环境下的医保基金绩效评价模型

Performance Evaluation Model of Medical Insurance Funds in Uncertain Information Environment

从医疗保险基金运转流程视角,建立医保基金筹集、使用、管理3个维度的绩效评价指标体系;利用证据冲突系数和证据相似度改进D-S理论,使其准确度量证据间冲突程度和有效合成冲突证据;将改进D-S理论和灰色关联分析有效集成,建立医保基金绩效评价模型,实现医保基金绩效评价信息的不确定性度量与融合。以山东省烟台市为例进行实证研究,研究表明,该模型能够解决评价指标筛选、指标组合权重求解及多源绩效评价信息合成等问题,降低了证据的不确定度,绩效评价结果很好地反映了统筹地区医保基金运行状况。

This study constructs the performance evaluation index system of medical insurance funds from the perspective of the medical insurance fund operation process.The index system can be divided into three dimensions,fund raising,fund utilization and fund management.Besides,the improved D-S evidence theory is proposed based on conflict coefficient and similarity of evidence to measure the conflict degree of evidence accurately and to combine highly conflictive evidence effectively. This study develops a performance evaluation model of medical insurance funds based on improved D-S evidence theory and grey relational analysis to measure the uncertainty of medical insurance fund information and to combine the information.Yantai is set as an example to verify the proposed model. The results show that this model can solve the problems of evaluation indexes screening,index combination weights determination and multi-source evaluation information fusion.The evaluate results reflect actual conditions of medical insurance funds performance of pooling regions.