多元协同治理视角下医保基金监管成效及协同监管创新模式研究  

Research on Medical Insurance Fund Supervision Effectiveness and Innovative Model of Collaborative Supervision from the Perspective of Multiple Cooperative Governance

作　　者：覃英华 李嘉程 张鑫 王佳慧 郝艳华[1] 康正[1] 姜胜超 王可欣 郭朋飞 王日珍 吴群红[1] 高力军[1] QIN Ying-hua;LI Jia-cheng;ZHANG Xin(School of Health Management,Harbin Medical University,Harbin,Heilongjiang,150081,China)

机构地区：[1]哈尔滨医科大学卫生管理学院,黑龙江哈尔滨150081

出　　处：《中国医院管理》2021年第11期12-16,共5页Chinese Hospital Management

基　　金：国家社会科学基金重点项目(19AZD013);国家自然科学基金面上项目(72074064);黑龙江省公共健康安全及医改策略高端智库研究项目。

摘　　要：目的探讨目前医疗保障基金监管的工作成效和协同效率,并提出针对性的协同治理策略。方法结合多阶段抽样和目的抽样进行问卷调查,运用Ordinal回归和协同函数进行数据分析。结果61.37%的调查对象认为监管成效较好,成效一般或较不好占38.63%。性别(OR=1.347)、文化程度和工作单位(OR=0.490)、医保基金功能(OR=1.447)、信息共享(OR=0.613)、基金管理规则(OR=1.305)和信息披露制度(OR=1.287)对监管成效评价产生显著性影响;医保体系内部的管理部门(Rx=57.69%)和经办机构(Rx=55.95%)的协同状态良好,而卫生部门、医疗机构、第三方组织和公众等主体仍处于协同探索阶段(Rx<50%)。结论医疗保障基金监管存在协同治理的提升空间,应通过多元主体联动、治理机制触发和治理工具手段协同3大路径推动协同监管创新,实现监管治理功能的有机整合,实现多元主体监管的能动性提升和信息化智能化的创新突破。Objective To explore the effectiveness and synergy efficiency of the current medical insurance fund supervision,and propose a targeted collaborative governance strategy.Methods It combines multi-stage sampling,purposes sampling to conduct questionnaire survey,and uses Ordinal regression and synergy function for data analysis.Results 61.37%of respondents consider the effectiveness of supervision is good,the effectiveness is average or poor accounting for 38.63%.Sexes(OR=1.347),education levels and workplaces(OR=0.490),medical insurance (OR=1.447),information sharing(OR=0.613),fund management rules(OR=1.305)and information disclosure system(OR=1.287)have significant impacts on the evaluation of supervisory effectiveness.The medical insurance department(Rx=57.69%)and the agency(Rx=55.95%)are in a good state of collaboration,while the health department,medical institutions,third-party organizations,and the public are still in the collaborative exploration stage(Rx<50%).Conclusion There is room for improvement of coordinated governance in the supervision of medical security funds.The paths of coordination of multiple entities,triggering of governance mechanisms,and coordination of governance tools should be used to promote collaborative regulatory innovation,realize the organic integration of regulatory governance functions,realize the improvement of the initiative and information of diversified subject supervision,and realize innovative breakthroughs of intelligence.

关 键 词：医疗保障基金 监管 多元协同治理 影响因素 协同效率 

分 类 号：R197.1[医药卫生—卫生事业管理]