基于SFIC协同治理模型的医保基金支付与服务的路径--以重症医学医疗团队研究为例  

Path in collaborative governance of medicare payment and service based on SFIC model:taking the department of critical care medicine as an example

作　　者：齐天 臧学峰 李学伟[1] Qi Tian;Zang Xuefeng;Li Xuewei(School of Economics and Management,Beijing Jiaotong University,Beijing 100044,China;Department of Critical Care Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]北京交通大学经济管理学院,北京100044 [2]首都医科大学附属北京世纪坛医院重症医学科,北京100038

出　　处：《中国中西医结合急救杂志》2022年第1期85-91,共7页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的 探讨政府医保管理部门、医院医保相关部门和医疗专科主诊团队群体在医保基金支付与服务协同治理体系中的实践价值和路径.方法 选择各级政府医保管理部门工作人员、各级医院医保管理相关部门工作人员和重症医学专科主诊团队医护人员群体作为问卷对象.按照SFIC协同治理模型的设计,结合目前医保支付与服务协同治理状况,研究设计了6个单元的操作化量表,最终形成了医保支付与服务协同治理模型验证调研问卷.问卷分别是调研对象的基本情况和根据医保支付与服务协同治理模型内部单元操作化后的测量题目,包括协同环境、初始条件、催化领导、制度设计、协同过程、协同治理效果6个变量21个题项,采用李克特5级评分量表的形式,设立1~5不同等级数值,通过各评分等级的设定量化医保支付与服务协同治理主体的主观感受,使问卷测量具有可行性.通过SPSS 23.0版对问卷数据整理汇总得到统计数据并进行处理,采用探索性因子分析方法运用AMOS 26.0版进行结构方程式指标验证筛选.结果 ① 共发放问卷316份,回收316份问卷,有效问卷308份,有效率97.47%.问卷调查中样本的基本情况和主题内容获得的数据均呈正态分布,能够较为真实地反映目前我国医保支付的基本情况.②6个变量下的21个题项的数据离散程度较低,偏度和峰度的绝对值均小于2和7,满足单变量的正态分布;6个变量的信度值0.827~0.929,稳定性较高,比较变量间简单相关系数(KMO)=0.941>0.6,巴特利(Bartlett)的球形度检验P<0.001,适合进行因子分析.③ 单因素方差分析显示不同主体在初始条件(F=6.758,P=0.001)、催化领导(F=3.903,P=0.021)方面存在显著的差异性.④ 协同环境、初始条件、催化领导和制度设计4个自变量均以中间变量协同过程为部分中介,对因变量协同治理效果产生正向影响.结论 以重症医学医疗团队Objective To explore the practical value and pathways of government health insurance management departments,hospital health insurance-related departments and medical specialty primary care teams in the collaborative governance system of health insurance payment and services.Methods Staff at all levels in departments of govemmental medical insurance management,hospital departments related to medical insurance management and medical staff of medical specialists attending teams in critical care medicine were selected as questionnaire subjects.According to the design of the SFIC collaborative governance model,combined with the current state of collaborative governance of medical insurance payment and services,the study designed a 6-unit operationalized scale,and finally a validation survey questionnaire of the collaborative governance model of medical insurance payment and services was formed.The questionnaires were the investigation and survey of the basic information of the research subjects and the used measurement questions were in accord with those after operationalized in the internal units of the health insurance payment and service collaborative governance model,including the collaborative environment,initial conditions,catalytic leadership,system design,collaborative process,and collaborative governanee effect,all together 6 variables and 21 questions,and 5-grade Likert scale was applied for scoring to differentiate different levels from 1 to 5.Via the setup of the scoring grade,the subjects'subjective perception of the collaborative governance of health insurance payment and services was quantified to make the questionnaire measurement possessing feasibility.The questionnaire data were compiled and summarized by SPSS version 23.0 and Excel to obtain statistical data for processing,and the exploratory factor analysis method was used and AMOS version 26.0 was applied to carry out the validation and screen of structural equation indicators.Results①A total of 316 questionnaires were distributed,316 questionna

关 键 词：医保基金 支付 服务 路径 协同治理 

分 类 号：G63[文化科学—教育学]