基于综合指数法的医院医疗保险住院管理绩效指标评价体系的构建

Construction of Performance Indicator Evaluation System of Hospital Medical Insurance Management Based on Comprehensive Index Method

目的构建一套适宜医院医保住院管理的绩效指标评价体系,对医保住院管理效果给予科学的、量化的评价,以便更好地进行医保管理。方法采用专家咨询法将2018年数据与2017年同期数据进行对照,建立指标体系并确定各指标值及权重,采用综合指数法对医保住院管理指标进行计算。结果确定的指标体系包括:指标类型4类,指标内容7项,并通过指标赋值及权重计算出22个医疗科室医保住院管理评价分数,其中最好成绩为8.4分,最低成绩为2.9分。结论该绩效指标评价体系能够量化科室医保管理水平,并能够找出医保住院管理中存在的薄弱环节,从而有针对性的给予改进。

Objective To construct a set of performance index evaluation system suitable for hospitalization management of hospital health care, and to give scientific and quantitative evaluation to the effect of hospitalization management, so that the hospital can better manage health insurance.Methods The data of 2018 and the same period of 2017 are compared by Delphi method, and the index system is established and the values and weights of each index are determined.Computation of Medical Insurance Inpatient Management Indicators by Comprehensive Index Method.Results The final index system includes four categories of indicators, seven items of indicators, and the scores of medical insurance inpatient management in 22 medical departments are calculated through the assignment and weight of indicators. The best score is 8.4 points, and the lowest score is 2.9 points.Conclusions The performance index evaluation system can quantify the medical insurance management level of the department and can find out the weak link existing in medical insurance hospitalization management, so as to give targeted improvement.