定点医疗机构医疗保险信用等级评价指标体系架构的研究

发布时间：2018-03-10 01:01

本文选题：指标体系架构　切入点：德尔菲法　出处：《山西医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：研究目的本研究的目的希望建立起一套能够适用于我国医院发展现状的、便于实际应用的定点医疗机构医疗保险信用等级评价指标体系。具体制定出评价指标、指标权重,最终构建定点医疗机构信用等级评价指标体系。为实现定点医院医疗保险信用等级评价提供科学、规范、适用的标准化指标体系。研究方法 1.文献研究法通过大量阅读国内外相关文献资料,了解国内外医保诚信现状及存在的普遍问题及信用等级评价指标体系建立的有关研究,并进行归纳总结。 2.现场调研法通过对现行医保信用评价办法进行调研,发现并收集实际评价过程中存在的不足。收集用于建立定点医疗机构医保信用等级评价体系的初步指标,形成初步的评价指标尺。 3.专家咨询法本研究共进行两轮专家咨询,第一轮专家咨询的主要目的是筛选指标,第二轮专家咨询的主要目的是确定评价指标。 4.层次分析法(AHP法) 应用层次分析法结合专家咨询问卷计算评价指标的权重,从而形成最终的评价指标架构。研究结果 1.确定了以基础管理、结算管理、医疗管理、质量管理、信息管理5大类指标为结构,并且具有层次性的评价指标,包括5个一级指标、22个二级指标和74个三级指标。经过两轮专家咨询结果显示：专家对指标赋值的集中趋势明显,协调系数趋于增大,这表明专家对指标认同度不断增大,指标筛选是合理的。 2.确定了各级指标权重值。应用层次分析法结合专家咨询法构建判断矩阵,采用了层次分析法yaahp0.5.3软件对专家咨询结果进行指标权重计算。各级指标满足一致性要求,得出一级指标的权重赋值分别为0.2125、0.1739、0.2563、0.2189、0.1384,三级指标的权重见附录4。 3.对所选专家基本信息进行分析,结果显示专家有较高的权威性,积极性也很高。两轮专家咨询的总体协调系数分别为0.264、0.326,协调系数卡方检验P值均小于0.01,第二轮协调系数高于第一轮,结果可取。 4.计算克朗巴哈系数信度系数α得出α值处于0.35—0.7之间,说明评价指标体系具有较好的信度。研究结论应用层次分析法建立了较为完整的定点医疗机构医疗保险信用等级评价指标体系架构,分为五个维度：基础管理、结算管理、医疗管理、质量管理、信息管理。其中一级指标权重从高到低依次为：医疗管理0.2563、质量管理0.2189、基础管理0.2125、结算管理0.1739、信息管理0.1384。
[Abstract]:Research purpose. The purpose of this study is to establish an evaluation index system of medical insurance credit grade for designated medical institutions, which is suitable for the development of hospitals in our country and is convenient for practical application. Finally, it constructs the credit rating evaluation index system of designated medical institutions, which provides a scientific, standardized and applicable standardized index system for realizing the evaluation of medical insurance credit rating of designated hospitals. Research method. 1. Literature research. Through reading a large number of domestic and foreign related literature materials, understand the domestic and foreign health insurance credibility status quo and existing common problems and credit rating evaluation index system related research, and sum up. 2. Field research. Through the investigation and investigation of the current methods of medical insurance credit evaluation, this paper finds out and collects the shortcomings in the actual evaluation process, collects the preliminary indexes used to establish the evaluation system of the medical insurance credit grade of the medical institutions, and forms a preliminary evaluation index scale. 3. Expert advice. In this study, two rounds of expert consultation were conducted. The main purpose of the first round of expert consultation was to select indicators, and the main purpose of the second round of expert consultation was to determine the evaluation index. 4. Analytic hierarchy process (AHP). The weight of evaluation index is calculated by AHP and expert consultation questionnaire, and the final evaluation index structure is formed. Research results. 1. Five categories of indicators, namely, basic management, settlement management, medical management, quality management and information management, are defined as the structure and the evaluation indexes are hierarchical. The results of two rounds of expert consultation show that the concentration trend of experts' assignment of indicators is obvious, and the coordination coefficient tends to increase, which indicates that the degree of experts' identity to the indicators is increasing. Index screening is reasonable. 2. The weight value of indexes at all levels is determined. The judgment matrix is constructed by using AHP combined with expert consultation method, and the index weight of expert consultation results is calculated by using AHP yaahp0.5.3 software. The indexes at all levels meet the requirements of consistency. The weight assignment of the first class index is 0.2125 / 0.1739 / 0.2563 / 0.2189 / 0.1384 respectively, and the weight of the third grade index is shown in Appendix 4. 3. The analysis of the basic information of the selected experts shows that the experts have a high degree of authority, The overall coordination coefficient of the two rounds of expert consultation is 0.264 0. 326, the coordination coefficient of the chi-square test P value is less than 0.01, the second round coordination coefficient is higher than the first round, the result is desirable. 4. The reliability coefficient 伪 of kronbaha coefficient is between 0.35-0.7, which indicates that the evaluation index system has good reliability. Research conclusion. The evaluation index system of medical insurance credit grade of designated medical institutions is established by using AHP, which can be divided into five dimensions: basic management, settlement management, medical management, quality management. Information management. One of the index weight from high to low is: medical management 0.2563, quality management 0.2189, basic management 0.2125, settlement management 0.1739, information management 0.1384.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：F842.684

【参考文献】