基于社会网络分析方法的医保基金监管创新路径研究

Research on Medical Insurance Fund Supervision Path Based on Social Network Analysis Method

目的通过梳理政策文件及文献中提到的医疗保障基金监管的创新路径,为医疗保障基金监管的实施提供参考意见。方法采用文献分析法和社会网络分析法对文献进行整理和分析,并采用TOPSIS法对其结果进行分析。结果政策文件中医疗保障基金监管路径的频次统计排在前3位的为引入社会力量参与监管、推进智能监控和建立信用管理制度;对社会网络分析方法的计算结果进行TOPSIS综合评价,排名前3位的是推进智能监控(C_(i)=1.000)、引入社会力量参与(C_(i)=0.868)和加强医疗保障基金监管队伍建设(C_(i)=0.733)。结论医疗保障基金监管创新可从以下4种路径着手:推进智能监控、加强医疗保障基金监管队伍能力建设、建立信用管理制度和引入社会力量参与。

Objective Combing with the innovative path of the medical insurance fund supervision mentioned in the policy document and the literature,providing references for the implementation of the medical insurance fund supervision.Methods Literature analysis and social network analysis method were adopted for literature finishing and analysis,the TOPSIS comprehensive evaluation method was used to statistically analyze its results.Results In policy documents,the top three of the medical insurance fund supervision paths are introducing social strength to participate in,promoting intelligent monitoring and establishing credit management systems;the result of TOPSIS comprehensive evaluation of the calculation results of social network analysis methods shows that the top three are promoting intelligent monitoring(C_(i)=1.000),introducing social strength to participate(C_(i)=0.868)and strengthening the construction of medical insurance fund supervision team(C_(i)=0.733).Conclusion The medical insurance fund supervision innovation can begin with promoting intelligent monitoring,strengthening the construction of the medical insurance fund supervision team,establishinga credit management system and introducing social strength.