医保医师信用评价指标体系的构建  

Construction of credit evaluation index system for medical insurance physicians

作　　者：苏承音 苏学峰 张云霞[2] 孟彦辰[1] SU Chengyin;SU Xuefeng;ZHANG Yunxia;MENG Yanchen(Department of Health Law,School of Medical Humanities,Capital Medical University,Beijing 100069,China;Linfen People′s Hospital)

机构地区：[1]首都医科大学医学人文学院卫生法学教研室,北京100069 [2]临汾市人民医院

出　　处：《山西医科大学学报》2024年第4期494-499,共6页Journal of Shanxi Medical University

基　　金：首都医科大学国家医疗保障研究院开放性课题(YB2020B07)。

摘　　要：目的通过建立医保医师信用评价指标体系,指导医保医师维护医保基金安全,进而持续推进社会信用体系建设向纵深发展。方法使用内容分析法和德尔菲法构建指标体系,利用层次分析法确定指标权重。结果专家咨询的积极系数为100%,权威系数为0.77,第一轮肯德尔和谐系数为0.772,第二轮肯德尔和谐系数为0.922(P<0.001)。筛选出一级指标3个(医疗服务行为、践约情况、伦理道德与社会评价),二级指标9个(如不合理治疗等),三级指标23个(如无指征住院等)。结论基于德尔菲法筛选出的医保医师信用评价指标较为精炼,可为后续研究提供参考。Objective To establish a credit evaluation index system for medical insurance physicians for maintaining the safety of the medical insurance fund and pushing forward the construction of the social credit system to a deeper and deeper development.Methods The indicator system was constructed using content analysis and the Delphi method,and the weights of the indicators were determined using hierarchical analysis.Results The positive coefficient of expert consultation was 100%,the authority coefficient was 0.77,the Kendall harmony coefficient in the first round was 0.772 and the second round Kendall harmony coefficient was 0.922(P<0.001).Three primary indicator(medical service behaviour,practice,ethics and social evaluation),nine secondary indicators(e.g.irrational treatment,etc.),and 23 tertiary indicators(e.g.hospitalisation without indication,etc.)were successfully screened.Conclusion The credit evaluation indexes of health insurance physicians screened based on the Delphi method are more concise,which can provide reference for the subsequent research.

关 键 词：医疗保险 医保医师 医保基金监管 信用体系 信用评价 指标体系 德尔菲法 层次分析法 

分 类 号：R197[医药卫生—卫生事业管理]