基于史密斯政策执行模型的黑龙江省异地就医问题治理成效及其影响因素甄别

Analysis of the Governance Effectiveness of Cross Regional Medical Treatment in Heilongjiang Province and Its Influencing Factors Based on Smith's Policy Implementation Model

目的:明晰黑龙江省异地就医问题治理成效,为完善异地就医直接结算政策提供参考。方法:基于史密斯政策执行模型,对黑龙江省参与医疗保障相关的工作人员进行问卷调查,分析探究异地就医问题治理成效及驱动因素。结果:40%的调查对象认为黑龙江省异地就医治理成效不好。参保地医保经办机构的异地就医备案流程便捷(OR=1.519),备案信息管理规范(OR=1.563),异地就医治理成效将可能更好。此外,医保、财政等利益相关方参与异地就医问题治理所需的业务协同机制完善(OR=2.317)、协同所需的配套措施充足(OR=1.372)、医保信息系统建设完善(OR=2.193)也是治理效能有效发挥的促进因素。结论:优化备案信息管理、加强异地就医业务协同制度机制建设、优化异地信息系统是异地就医治理效能发挥的有力举措。

Objective To clarify the effect of management of cross-location medical treatment in Heilongjiang Province,and provide reference for improving the policy of direct settlement of cross-location medical treatment.Methods Based on the Smith Policy Implementation Model,a questionnaire survey was conducted among the staffs involved in medical insurance in Heilongjiang Province,and the effect of management of cross-location medical treatment and the driving factors were analyzed.Results 40%of the survey respondents believed that the governance of cross-location medical treatment in Heilongjiang Province was ineffective.The effectiveness of cross-location medical treatment governance is likely to be better with a convenient filing process(OR=1.519)and standardized management of filing information(OR=1.563)by the medical insurance agencies in the insured places.In addition,the improved operational coordination mechanism(OR=2.317),adequate supporting measures(OR=1.372),and improved health insurance information system(OR=2.193)required by the participation of stakeholders such as health insurance and finance in the management of cross-location medical treatment are also factors that contribute to the effec-tiveness of governance.Conclusion Optimizing the management of filing information,strengthening the construction of institutional mechanisms for cross-location medical care business collaboration,and improving cross-location information systems are power-ful measures for the effective performance of cross-location medical care governance.