基于PMC指数模型的基本医疗保险付费总额预算政策评价研究

Research on the evaluation of basic medical insurance total payment budget policy based on the PMC index model

目的:为基本医疗保险付费总额预算政策的完善及优化提供参考。方法:建立PMC指数模型对37项政策进行评价,结合PMC曲面图探讨现有政策的优势与不足。结果:37项政策中有6项被评为优秀政策,28项被评为良好政策,3项为合格政策;在一级变量基本原则(X2)、协商机制(X6)、结算办法(X7)、考核与监管(X8)得分较高,分别为0.95、0.80、0.82、0.96;在适用范围(X3)和预算管理(X4)得分较低,分别为0.54和0.44。结论:目前基本医疗保险付费总额预算政策有待健全,可从预算指标总额细化、拓展适用范围及探索其他付费方式等方面考虑。

Objective:To provide a reference for the improvement and optimization of the basic medical insurance total payment budget policy.Methods:A PMC index model was developed to evaluate the 37 policies,and the strengths and weaknesses of the existing policies were explored in conjunction with PMC surface plots.Results:Six of the 37 policies were rated as excellent policies,28 as good policies,and three as qualified policies;the scores were higher in the basic principles of the primary variables(X2),consultation mechanism(X6),settlement methods(X7),and assessment and supervision(X8),with 0.95,0.80,0.82,and 0.96,respectively;the scores were lower in the scope of application(X3)and budget management(X4),with The scores are 0.54 and 0.44 respectively.Conclusion:At present,the total budget policy of basic medical insurance payments needs to be improved,which can be considered in terms of refining the total budget index,expanding the scope of application,and exploring other payment methods.