基于Delphi法的完善全民医保制度要素设计专家意见分析

Analysis of the Expert Opinion on the Complementing the Universal Health Insurance System Based on Delphi Method

目的：探讨我国全民医保制度优化设计相关意见。方法通过文献分析和专家咨询设计调查问卷。采用德尔菲专家法、专家定性访谈进行意见收集，并利用EpiData录入数据并使用SPSS软件进行分析。结果：两轮专家咨询中整体协调系数均较低。分别为0．10和0．40。在第一轮中各项要素的变异系数均较高在22．00％～45．00％之间，在将访谈内容及第一轮调查结果进行反馈后。第二轮变异系数均下降至27．40％以下。结论：专家对全民医保制度要素重要性及可行性的评估结果显示专家对于全民医保制度设计的态度及意见的一致性较差，这在一定程度上是受自身工作内容及个人阅历影响，同时也是对于我国目前医保体制存在问题的一种反映。专家对将现有医保制度进行整合及管理达成了共识，但对于具体由哪一部门主管仍存在争议；统筹层次要逐步提升至国家级统筹；同时专家认为福利包和支付方式的设计需要专业人士进行更为精确地测算和设计。

Objective： To explore the relevant advice about optimization design of China＇s universal health insurance. Methods： With literature review and expert consulting, Delphi method and specialist qualitative interview were conducted to collect opinion. Ep- iData was applied to input data and SPSS Software was used to perform the analysis. Results： The overall coordination coefficient of the two rounds of expert consuhation were relatively low（0.10 and 0.40）. The coefficient of variation of elements were higher in 22.00% -45.00% in the first round. After the feedback of interview content and first round interview result, the coefficient of variation de- creased under 27.40%. Conclusion： The assessment results of the importance and feasibility of the national health care system ele- ments showed that the consistency of the expert opinion on designing universal medical insurance system was poor, which was caused by the work and personal experience and the reflection of the existing problems in medical insurance system of China. Experts achieved consensus on the integration and management of medical insurance system. But there was still dispute on which department should control. Pooling hierarc, hy should promote national pooling level gradually; meanwhile, experts believed welfare package and payment design needed to be mnre accurate calculation and design by the professionals.