DRG下医疗机构医保基金使用效果评价指标体系构建

Construction of Evaluation Index System for Use Effect of Medical Insurance Fund in Medical Institutions under DRG

在医保支付方式改革的大背景下,为了引导医疗机构进一步提供优质高效的医疗服务,笔者拟构建可以评价DRG下医保基金使用效率且能够运用信息化手段实现实时监管的指标体系,通过文献研究和地方资料搜集,整理出与医保基金评价相关的指标,经过两轮德尔菲专家咨询,构建出包含医疗服务能力、医疗服务质量、资源使用效率和医保监督4个一级指标、20个二级指标的DRG医保基金绩效评价指标体系。医院管理者要实时关注这些指标,提高基金的使用效率,为患者提供优质高效、具有经济效益的医疗服务;医保基金管理者也可以从此入手,对辖区内医疗机构的基金使用情况进行监管和评价,真正使百姓从医改中获益。

In the context of medical insurance payment reform,and in order to guide medical institutions to further provide high-quality and efficient medical services,the authors intend to construct an index system that can evaluate the use efficiency of medical insurance funds under DRG and realize real-time supervision by means of informatization.Through literature research and local data collection,the indicators related to the evaluation of medical insurance fund are sorted out.After two rounds of Delphi expert consultation,the DRG medical insurance fund performance evaluation index system has been established,which includes 4 first-level indexes,involving medical service ability,resource utilization efficiency and medical insurance supervision,and 20 second-level indexes for DRG medical insurance fund performance evaluation index system.Hospital managers should pay attention to these indicators in real time,improve the use efficiency of funds,and provide patients with high-quality,efficient and cost-effective medical services;Medical insurance fund managers can start from this point to supervise and evaluate the use of funds by medical institutions within their jurisdiction so that people can really benefit from medical reform.