通讯作者: 吴胤歆, wuyinxin@fjmu.edu.cn

DOI：10.12201/bmr.202311.00006

Research on the Measurement and Optimization Path of Coordination Degree in Collaborative Supervision of China’s Medical Insurance Fund—Based on the SFIC Framework

• 摘要：目的：本研究旨在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，并以福建省为例对医保基金协同监管体系中核心部门的协同度水平进行实证研究。结果：定性研究发现，医保基金的安全保障涉及十个相关部门，其中医保、卫健、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。医保与卫健、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：定性研究和定量研究结果相吻合，文章基于SFIC模型从起始条件、制度设计、催化领导、协同过程四个方面提出协同监管优化建议。

  关键词： 基金监管；协同监管；综合监管；协同度；SFIC模型; ; ; ; 

   

  Abstract: Abstract Objective：The objective of this research is to assess the state of multi-departmental collaborative oversight of medical insurance funds in China. To that end, we develop a specialized measurement tool, quantify the efficacy of inter-departmental synergy, and offer actionable insights for national policy. Methods: Utilizing the SFIC framework, we design a comprehensive interview blueprint, create a synergy evaluation scale ,and establish a measurement model. The “Entropy Weight Method” is employed to assign index weights. Fujian Province serves as the case study for assessing the levels of synergy among core departments involved in the oversight. Results: Qualitative findings indicate that approximately ten departments play a role in ensuring the security of medical insurance funds, with four considered as core departments. Quantitatively, the synergy score for the medical insurance department stands at 0.922, signifying a high level of effective collaboration, outperforming three other external departments. Conclusion: Both qualitative and quantitative results are aligned. Informed by the SFIC framework, this study proposes optimization strategies for enhancing collaborative oversight. Recommendations are categorized under four key areas: initial conditions, system architecture, catalytic leadership, and cooperative processes.

  Key words: Financial Supervision of Funds; Collaborative Supervision; Holistic Supervision; Degree of Interdepartmental Collaboration; SFIC Framework

  提交时间：2023-11-20

  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	2023-07-22	bmr.202311.00006V1	下载

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