医保视角下公立医院评价指标体系构建

Construction of evaluation index system for public hospitals from the perspective of medical insurance

目的构建新医保支付形势下医保部门对公立医院的评价指标体系。方法在文献研究基础上,结合相关政策,根据重要性、可及性、敏感性和简洁性原则,构建原始的指标体系。通过多次小组讨论及两轮专家咨询对指标进行筛选、调整,并利用层次分析法进行权重判断。结果最终确立了一套主题框架由“医疗服务提供、医保服务与管理、医疗改革参与和参保人信任与权益”构成的4个一级指标、12个二级指标、38个三级指标的公立医院评价体系。结论医改背景下会要求公立医院不断完善考核评价体系,应当引导公立医院注重医保服务与管理的同时,考虑患者权益,实现协调发展。

Objective To construct an evaluation index system for public hospitals under the new medical insurance payment situation.Methods On the basis of literature research and relevant policies,the original indicator system was constructed according to the principles of importance,accessibility,sensitivity and simplicity.Through multiple group discussions and two rounds of expert consultation,the indicators were screened and adjusted,and the analytic hierarchy process was used to judge the weights.Results A set of thematic framework consisting of''medical service provision,medical insurance service and management,health care reform participation and the trust and rights of the insured''was established,and the 4 first-level indicators,12 second-level indicators,and 38 third-level indicators were public hospital evaluation system.Conclusion Under the background of medical reform,public hospitals will be required to continuously improve the assessment and evaluation system.Public hospitals should be guided to pay attention to medical insurance services and management,and consider the rights and interests of patients to achieve coordinated development.