大数据价值链视角下紧密型县域医共体医保总额测算指标体系构建研究  

Construction of the index system for calculating the total amount of medical insurance in a compact county medical community from the perspective of big data value chain

作　　者：苏岱 胡莹 SU Dai;HU Ying(School of Public Health,Capital Medical University,Beijing 100069,China;不详)

机构地区：[1]首都医科大学公共卫生学院,北京100069

出　　处：《中国农村卫生事业管理》2025年第3期170-176,共7页Chinese Rural Health Service Administration

基　　金：国家自然科学基金青年科学基金项目(72304194);北京市教育委员会科研计划项目(KM202310025026)。

摘　　要：目的构建大数据价值链视角下紧密型县域医共体医保总额测算指标体系。方法基于协同治理理论和卫生服务利用行为理论模型,结合文献研究筛选风险因素,开展两轮专家咨询,构建紧密型县域医共体医保总额测算指标体系。结果最终建立包含3个一级指标、13个二级指标、50个三级指标的紧密型县域医共体医保总额测算指标体系。其中,一级指标中政策因素的权重值显著高于个体因素和区域因素。二级指标中服务需求及利用权重排在前列,三级指标中就诊费用权重最大。结论指标体系中政策因素占据主体地位,重视政策因素的主体地位,发挥政府的主导作用,完善医保管理机制,提升医共体内部资源配置的公平性和效率。Objective To construct an indicator system for calculating the total amount of medical insurance for a compact county medical community from the perspective of big data value chain.Methods The collaborative governance theory and the theoretical model of health service utilization behavior were integrated,and risk factors were screened based on literature research.Two rounds of expert consultation were conducted to construct an indicator system for calculating the total amount of medical insurance for a compact county medical community.Results This study finally established an indicator system which consisted of 3 first-level indicators,13 secondlevel indicators,and 50 third-level indicators.Among them,policy factors in the first-level indicators had the largest weight value compared with individual factors and regional factors.The weight of service demand and utilization ranked first in the second-level indicators,and the weight of medical expenses in the third-level indicators was the largest.Conclusions Policy factors occupy a dominant position in the indicator system.We should attach importance to the dominant position of policy factors,give play to the leading role of the government,improve the medical insurance management mechanism,and enhance the fairness and efficiency of resource allocation within the medical community.

关 键 词：大数据价值链 协同治理 紧密型县域医共体 总额测算 风险调整 指标体系 

分 类 号：R19[医药卫生—卫生事业管理]