Research on Construction of Medical Insurance Fund Supervision Index System under CHS-DRG Payment
- VernacularTitle:CHS-DRG付费下医保基金监管指标体系构建研究
- Author:
Yang LI
1
;
Zhe WANG
;
Linghan SHAN
;
Yuan MA
;
Wen CHE
;
Chao LIANG
;
Zijun LIANG
;
Lijun CUI
;
Liang WANG
Author Information
1. 哈尔滨医科大学附属第一医院 黑龙江 哈尔滨 150001
- Publication Type:Journal Article
- Keywords:
China Healthcare Security Diagnosis Related Groups payment;
medical insurance fund supervision;
index system;
Delphi method
- From:
Chinese Hospital Management
2025;45(10):65-68
- CountryChina
- Language:Chinese
-
Abstract:
Objective To screen out the indexes of medical insurance fund under China Healthcare Security Diagno-sis Related Groups(CHS-DRG)payment based on Delphi method and improve the efficiency of medical insurance fund supervision.Methods Using the Delphi method,32 experts in the medical insurance field were selected and 2 rounds of expert questionnaires were conducted to design an evaluation scale for the monitoring indicators of medi-cal insurance funds under CHS-DRG payment.The consultation results were evaluated from three aspects of motiva-tion,authority,and coordination.Results A medical insurance fund supervision index system based on three dimen-sions of medical insurance fund use quality,efficiency and safety supervision is constructed,including 3 first-level indicators,7 second-level indicators and 44 third-level indicators.Results The construction ofmedical insurance fund supervision index system under CHS-DRG payment should respect the actual clinical diagnosis and treatment,strengthen the intelligent supervision method,and timely intervene in medical insurance fund management risks.
