基于整体性治理理论的医保基金监管效果及影响因素研究

Study on the Supervision Effect and Influencing Factors of the Medical Insurance Fund Based on the Holistic Governance Theory

目的对医疗保障基金监管效果进行综合评价,找出影响因素,为进一步提升医疗保障基金监管效果提供参考。方法对黑龙江省医疗保障经办部门人群展开问卷调查,采用秩和检验及二分类logistic回归分析探究医疗保障基金监管效果及影响因素。结果调查收集医保从业人员问卷1322份,总体效果评价上,超过67%的人群认为医疗保障基金监管效果较好。除医疗保障治理相关概念和知识的了解度(OR=0.283)负向影响医疗保障基金监管效果外,医疗保障信息化建设程度、邀请各利益主体协商的参与度、各利益主体协商效果、运用治理理论指导重大医疗保障问题治理实践行动的能力、部门参与医疗保障重大改革的磋商机制完善程度均对医疗保障基金监管效果具有正向影响。结论提高各利益主体对治理理念的了解程度,加强医疗保障信息化建设,提升整体性治理策略中医疗保障基金监管治理的协调能力和整合能力。

Objective It comprehensively evaluated the supervision effect of medical insurance funds,findd out influencing factors on it and provided a reference for further improving the supervision effect of medical insurance funds.Methods A questionnaire survey was conducted on the population in the medical insurance department of Heilongjiang Province.The rank-sum test and multi-factor logistic regression analysis were explored the regulatory effect and influencing factors of medical insurance funds.Results It collected a total of 1322 questionnaires from medical insurance practitioners.In terms of the overall effect evaluation.More than 67%of the population believed that the supervision effect of medical insurance funds was good.The degree of understanding of concepts and knowledge related to medical insurance governance(OR=0.283)had a negative impact on the supervision effect of medical insurance funds.In addition,the degree of medical insurance informatization construction,the participation of all stakeholders invited for consultation,the consultation effect of all stakeholders,the ability to use governance theories to guide the governance practices of major medical insurance issues,and the perfection of the consultation mechanism of departments participating in the major medical insurance reform both have an essential impact on the supervision effect of medical insurance funds.Conclusion It needed to improve the understanding of governance concepts among stakeholders,strengthen the informatization construction of medical insurance as holistic governance means,improve the coordination and integration ability of the supervision and governance of medical insurance funds in the overall governance strategy.