基于AHP的医院医保管理评价模型的建立

Establishment of Hospital Medical Insurance Management Evaluation Model Based on AHP

目的 完成医保患者各种支付的精细化管理,让医院各专科合理诊疗和提高医疗服务质量,进而达到平衡医保基金的支出。方法 通过计分模型和层次分析法(analytic hierarchy process, AHP),以医院医保管理评价为问题背景,详细描述了应用AHP解决综合排名问题的计算方法及结果比较。结果 AHP使用综合处理的方法依据决策者的两两比较矩阵计算标准的优先级wi和决策方案的优先级rij,更接近医院医保管理实际情况。结论 采用AHP方法完成医院医保管理评价,让医院医保管理更加精细化,使得评价更公平,有效促进了医院对于各临床专科在医保方面的管理水平。

Objective To complete the refined management of various payments for medical insurance patients, to allow the hospitals to conduct reasonable diagnosis and treatment and improve the quality of medical services, so as to achieve a balanced medical insurance fund expenditure. Methods Through the scoring model and the Analytic Hierarchy Process, with the evaluation of hospital medical insurance management as the problem background, the calculation method and result comparison of applying AHP to solve the comprehensive ranking problem are described in detail. Results AHP uses a comprehensive processing method to calculate the priority wi of the standard and the priority rij of the decision plan based on the pairwise comparison information of the decision maker, which is closer to the actual situation of hospital medical insurance management. Conclusion The AHP method is used to complete the evaluation of hospital medical insurance management, which makes the hospital medical insurance management more refined, makes the evaluation fairer, and effectively promotes the hospital’s medical insurance management level for each clinical specialty.