统筹区医保基金绩效管理和评价体系构建研究初探

The Preliminary Study On The Establishment Of Performance Management And Evaluation System Of The Coordinated Region

《中共中央国务院关于深化医疗保障制度改革的意见》提出完善创新基金监管方式,实施基金运行全过程绩效管理,建立医保基金绩效评价体系。目前,我国的统筹区医保基金绩效管理和评价工作尚处起步阶段,需建立相关制度法规和评价指标体系。本文首先分析了社会医保基金的绩效内涵和绩效目标,并结合国内外经验提出医保基金绩效管理和评价的制度设计原则与内容,在构建医保基金绩效评价指标体系的同时,采用主成分分析法得到医保基金绩效的主要影响因素和权重;最后对下一步开展统筹区医保基金绩效管理和评价工作做了展望。

In the Opinions On Deepening The Reform Of Healthcare Security System,it is proposed to improve and innovate the supervision mode of medical insurance fund,implement the whole process performance management of fund operation,and establish the performance evaluation system of medical insurance fund.Currently,performance management and evaluation work of medical insurance of coordinated regions is still at the beginning stage,and the construction of the related constitutions and the evaluation system needs to be established.To begin with,this article analyzes the performance implication and performance goal of medical insurance.We propose the principles and contents of the constitutions for performance evaluation and management combined with domestic and foreign experience.While constructing the performance evaluation index system of medical insurance fund,the main infl uencing factors and weights of medical insurance fund performance are obtained by principal component analysis.Finally,the future development of medical insurance fund performance management and evaluation is prospected.