基本医疗保险参保者受益感评价指标体系构建研究

Research on Construction of Evaluation Index System for Benefit Feeling of Basic Medical Insurance Participants

目的:构建覆盖医保利用全流程的基本医疗保险参保者受益感评价指标体系,为基本医疗保险参保者受益感评估提供科学依据。方法:通过文献研究和小组讨论初步构建评价指标体系,采用德尔菲法进行两轮专家咨询,并运用层次分析法确定各指标权重。结果:两轮专家问卷回收率均为100%,专家的权威系数为0.7986,最终构建了以经济负担感、便利感、公平感、规范感、效用感、知晓感、认同感为主体框架的基本医疗保险参保者受益感评价指标体系,包括7个一级指标、22个二级指标和36个三级指标。结论:本研究所选专家的积极性和权威性较高,指标权重的计算结果合理。基本医疗保险参保者受益感评价框架应从医保利用所涉及到的各个环节建立,真正地关注政策目标人群的实际受益感受。

Objective: To construct an evaluation index system covering the whole process of basic medical insurance utilization, so as to provide a scientific basis for evaluating the benefit feeling of basic medical insurance participants. Methods: The evaluation index system was initially constructed through literature research and group discussion, two rounds of expert consultation were conducted using the Delphi method, and weights of each index were determined using analytic hierarchy process. Results: The return rate of the expert questionnaires in both rounds was 100% and the authority coefficient of the experts was 0.7986. The final evaluation index system of the benefit feeling of basic medical insurance participants with the main framework of sense of financial burden, sense of convenience, sense of fairness, sense of normality, sense of utility, sense of knowledge and sense of identity was constructed, which included 7 primary indicators, 22 secondary indicators and 36 tertiary indicators. Conclusion: The experts selected for this study are highly motivated and authoritative, the degree of coordination is good, and the calculation results of indicator weights are reasonable. The framework for evaluating the benefit feeling of basic medical insurance participants should be established from all aspects involved in the utilization of medical insurance, and truly focus on the actual benefit feeling of the policy target population.