我国医保基金协同监管的协同度测量与优化路径研究——基于SFIC模型  

Research on the synergy degree measurement and optimization path of collaborative supervision of medical insurance fund in China:Based on the SFIC framework

作　　者：张敏[1] 吴胤歆[1] ZHANG Min;WU Yin-xin(The School of Health Management,Fujian Medical University,Fuzhou Fujian 350122,China)

机构地区：[1]福建医科大学卫生管理学院,福建福州350122

出　　处：《中国卫生政策研究》2023年第10期41-48,共8页Chinese Journal of Health Policy

基　　金：福建省科技厅创新战略研究项目(2022R0036)。

摘　　要：目的:了解我国医保基金多部门协同监管现状,开发医保领域协同度测量工具,对我国医保基金协同监管相关部门的协同度水平进行测量,为优化医保基金协同监管机制提供参考。方法:基于“协同学”理论和SFIC协同治理模型构建专家深度访谈问卷,开发协同度测量量表,运用“熵权法”确定指标权重,建立协同度测量模型,并以福建省为例进行实证研究。结果:医保基金的安全保障涉及十个相关部门,其中医保、卫生健康、公安、市场监管属于核心部门。协同度测量结果显示,医保部门内部协同度为0.922,处于优质协同水平,其中目标与制度协同最好,人员协同最差。医保与卫生健康、公安、市场监管三个外部部门的协同度分别为0.821、0.848、0.836,处于良好协同水平,且都表现为处理协同最好,信息协同最差。结论和建议:定性研究和定量研究结果相吻合,建议从起始条件、制度设计、催化领导、协同过程四个方面优化协同监管。Objective:The objective of this research is to understand the state of multi-departmental collaborative supervision of medical insurance funds in China,to develop a tool to measure the synergy degree of relevant departments of China s medical insurance fund collaborative supervision,and to offer reference for optimizing the collaborative supervision mechanism of medical insurance funds.Methods:Based on the theory of“synergy”and the SFIC framework,an expert in-depth interview questionnaire is constructed,a synergy evaluation scale is developed,and the“Entropy Weight Method”is employed to assign index weights,a synergy measurement model is established,and empirical research is carried out taking Fujian province as an example.Results:Approximately ten departments are involved in the security of medical insurance funds,with medical insurance department,health care,public security and market supervision being considered core departments.Quantitatively,the internal synergy degree of the medical insurance department scores 0.922,signifying a high level of effective collaboration,among which the coordination between goals and systems is the best and the coordination of personnel is the worst.The coordination degree of the three external departments of medical insurance,health care,public security and market supervision is 0.821,0.848 and 0.836,respectively,which is at a good level of coordination,and all of them are manifested as the best processing coordination and the worst information coordination.Conclusions and Suggestions:Both qualitative and quantitative results are consistent,and it is recommended to optimize collaborative supervision from four aspects:starting conditions,system design,catalytic leadership,and collaborative process.

关 键 词：基金监管 协同监管 综合监管 协同度 SFIC模型 

分 类 号：R197[医药卫生—卫生事业管理]