论文部分内容阅读
目的:提高天津市医保质量,为医保机构完善医疗保险制度提供科学依据。方法:采用专家咨询的方法对医保运行情况进行调查,并采用层次分析模型确定评价指标及其权重。结果:建立了一套由3个一级指标、9个二级指标、47个三级指标的连接医保机构、医疗机构和患者三方的医保质量评价指标体系,发现患者个人负担率、患者自费率、基金结余情况、药品费用、统筹基金支付情况是影响天津市医保质量的关键指标。结论:构建合理的医保质量评价指标体系是必要的,同时提高天津市医保质量需要制定和完善一系列医保政策。
Objective: To improve the quality of medical insurance in Tianjin and provide a scientific basis for the medical insurance institutions to perfect the medical insurance system. Methods: The expert consultation method was used to investigate the health insurance operation and the AHP was used to determine the evaluation index and its weight. Results: A set of evaluation index system of medical insurance quality was established which consisted of three first-level indicators, nine second-level indicators and 47 third-level indicators connected with the medical insurance agencies, medical institutions and patients. It was found that the individual burden rate of patients and patients at their own expense Rate, the fund balance, drug costs, co-ordinate fund payment is the key indicators affecting the quality of Tianjin medical insurance. Conclusion: It is necessary to construct a reasonable evaluation index system of medical insurance quality. At the same time, it is necessary to formulate and perfect a series of health insurance policies to improve the quality of medical insurance in Tianjin.