通讯作者: 周良荣, 1443361448@qq.com

DOI：10.12201/bmr.202110.00003

Construction of credit evaluation index system for designated hospitals of medical insurance based on regulatory demand -- Taking zhangjiajie experimental study as an example

• 摘要：诚信是医疗保险正常运行的基础，定点医院信用是医保基金监管的关键之一。如何科学评价医保定点医院的信用，建立其信用评价指标体系、方法，引导医院和医务人员正确、合理、合法提供医疗服务，减少医保基金流失，实现医、保、患共赢，乃是当今亟需研究的重要问题。本文在《医疗保障基金监管信用评价指标操作手册（定点医疗机构/A类）》基础上，通过整合、增补、调整权重等，构建了利益相关者普遍认可的定点医院信用评价指标体系和评价方法，并在张家界市进行小试和中试。实验基础上进一步修改和完善的指标体系和评价方法，以期为医保定点医院监管决策提供参考，为其他地区试点乃至推广提供借鉴。

  关键词： 信用评价; 定点医院; 医疗保险; 基金监管

   

  Abstract: Good faith is the basis of normal operation of medical insurance, and the credit of designated hospitals is one of the keys to the supervision of medical insurance fund. How to scientifically evaluate the credit of designated hospitals for medical insurance, establish their credit evaluation index system and methods, guide hospitals and medical staff to provide medical services correctly, reasonably and legally, reduce the loss of medical insurance funds, and achieve a win-win situation among doctors, insurance and patients is an important issue that needs to be studied. Based on the national manual, this paper establishes the credit evaluation index system and evaluation method of designated hospitals universally recognized by stakeholders through integration, supplement and weight adjustment, and carries out small and pilot tests in Zhangjiajie city. On the basis of the experiment, the index system and evaluation method are further modified and improved, in order to provide reference for the supervision and decision-making of designated hospitals for medical insurance, and for the pilot and promotion of other regions.

  Key words: Credit evaluation; Designated hospitals; Medical insurance; Fund regulation

  提交时间：2022-03-07

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2021-10-20	bmr.202110.00003V1	下载

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