基于DFSS的医疗保险基金审计质量评价体系设计

Design of a DFSS-based Quality Evaluation System for Medical Insurance Fund Auditing

当前我国医疗保险基金审计质量管理中存在审计力量不足、质量保障机制不健全等问题,进一步提升医疗保险基金审计质量迫在眉睫.六西格玛设计(DFSS)作为一种有效的质量管理方法,强调问题定义、数据驱动的分析、集成的改进方法和稳健性持续改进.运用DFSS的DMADV模型设计一套医疗保险基金审计质量评价体系,在界定阶段界定审计目标与审计需求;在测量阶段运用质量功能展开(QFD)工具确定医疗保险基金审计质量的关键变量并对西格玛水平进行测量;在分析阶段运用5M1E图分析影响医疗保险基金审计质量的原因;在设计阶段根据分析结果从审计制度、审计流程与审计监管三方面进行改进与设计;最后对该评价体系的评价效果进行验证.

The current management of medical insurance fund audit quality in China is plagued by problems such as insufficient audit resources and inadequate quality assurance mechanisms,to further improve the quality of medical insurance fund audit is urgent.DFSS(Design for Six Sigma)is an effective quality management methodology that emphasizes problem definition,data-driven analysis,integrated improvement methods and robust continuous improvement.This study employed the DMADV(Define,Measure,Analyze,Design,and Verify)model of DFSS to design a quality evaluation system for medical insurance auditing.In the definition stage,the audit objectives and requirements were defined.In the measurement stage,the Quality Function Deployment(QFD)tool was utilized to determine key variables that affect the quality of medical insurance fund audits and measure the sigma level.In the analysis stage,the 5M1E(Man,Machine,Material,Method,Measurement,and Environment)chart was employed to analyze the causes that impact the quality of medical insurance fund audits.In the design stage,based on the analysis results,improvements and designs were made from three aspects:audit system,audit process,and audit supervision.Finally,the evaluation effectiveness of this evaluation system was validated.