Establish Evaluation Systems of Medical Service Capability Related to Total Payment Control of Medical Insurance_Chinese Journal of Evidence-Based Medicine

Authors：

 LIJia-jin ¹ , FENGHai-huan ¹ , LITian-jun ¹ ,  WENYan-qiu ¹ ,  SUNLin ²

1. Office of Medical Insurance, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Office of Outpatient, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

WENYan-qiu, Email: 331221241@qq.com; SUNLin, Email: 1245227915@qq.com

Keywords：

Total payment control of medical insurance; Medical service capability; Analytic hierarchy process; Evaluation system

DOI：

10.7507/1672-2531.20140227

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore effective evaluation tools as well as systems of medical service capability related to total payment control of medical insurance. Methods Combining references and using the Delphi method, the evaluation indicators of total payment control of medical insurance were screened and identified. Then, based on analytic hierarchy process, a weight questionnaire was designed and weighted coefficients of all-level indicators were also calculated. Results We proposed a mathematical model to evaluate medical service capability related to total payment control of medical insurance using three types of primary evaluation indicators and seventeen types of secondary evaluation indicators with their weighted coefficients. Conclusion The establishment of the evaluation systems of medical service capability in medical institutions could objectively reflect medical service capability to some extent, and provide references on total payment control of medical insurance for medical insurance agencies.

Citation： LIJia-jin, FENGHai-huan, LITian-jun, WENYan-qiu, SUNLin. Establish Evaluation Systems of Medical Service Capability Related to Total Payment Control of Medical Insurance. Chinese Journal of Evidence-Based Medicine, 2014, 14(12): 1413-1417. doi: 10.7507/1672-2531.20140227 Copy

1.	李克强.不断深化医改推动建立符合情惠及全民的医药卫生体制.求是, 2011, 22:3-10.
2.	Peabody JW. Policy and healthy-implications for development in Asia. Cambridge:University Press, 1999:184-231.
3.	Frenk J. Reinventing primary health care:the need for systems integration. Lancet, 2009, 374(9684):170-173.
4.	严娟, 张建军, 宋朝阳.从分级管理走向管理升级.中国医疗保险, 2011, 65(9):24-26.
5.	胡牧, 刘晓光, 陈仲强.效率医保:医院医保的战略选择.中国医院, 2010, 14(2):10-13.
6.	杜栋, 庞庆华, 现代综合评价方法与案例精选.北京:清华大学出版社, 2005.
7.	张罗漫, 胡琳.医院评价指标的筛选方法.中国卫生统计, 1989, 6(3):34-37.
8.	周绚.综合评价医院工作提高医院管理水平.中国卫生统计, 1993, 10(3):32-34.
9.	胡晓, 周典, 吴丹, 等.医院补偿能力评价指标体系初步研究.中国医院管理, 2012, 32(3):15-17.
10.	Chen CT. Extensions of the TOPSIS for group decision-making under fuzzy environment. Fuzzy Set and Systems, 2000, 114(1):1-9.
11.	Chang TH, Wang TC. Using the fuzzy multi-criteria decision making approach for measuring the possibility of successful knowledge management. Information Sciences, 2009, 179(4):355-370.
12.	谭学英.无人机科研项目立项评价方法研究.西北工业大学, 2007.
13.	曲久龙.科技项目评估理论与方法研究.吉林:吉林大学, 2006.
14.	龚志平, 李钢强, 刘毅, 等.层次分析法中判断矩阵的调查表问卷设计.中国公共卫生管理, 1995, 11(1):23-25.
15.	常建娥, 蒋太立.层次分析法确定权重的研究.武汉理工大学学报, 2007, 29(1):153-156.
16.	孙纽云, 梁铭会.美国医疗服务绩效评价体系的循证研究及对我国的启示.中国循证医学杂志, 2012, 12(4):379-382.
17.	夏萍, 庄岩, 卢传坚, 等.我国医疗质量多维综合评价方法的循证评价.中国循证医学杂志, 2011, 11(2):226-230.
18.	李幼平, 喻佳洁, 孙鑫.快速评估方法与流程的探索.中国循证医学杂志, 2014, 14(5):497-500.
19.	吴丹, 周典, 张勤, 等.医院管理人员综合测评指标体系构建.中华医院管理, 2011, 23(4):423-426.
20.	刘瑞林, 宋喜国.医院临床科室成长性评价指标体系与评价方法.卫生经济研究, 2010, 5(274):44.
21.	陈辉, 王遂民, 孔霞.医院顺应医疗保险制度改革的思考.中国卫生事业管理, 2011, 4(154):215-216.
22.	李瑛, 袁伟, 陈俊国.医学生人文素质评价指标体系的建立与实证研究.中国社会医学杂志, 2011, 28(4):238-240.
23.	张磊, 谢祥, 朱佳鑫.高校社会职能服务职能评价体系研究.黑龙江高教研究, 2012, 2(7):51-52.
24.	侯志远, 孟庆跃, 袁璟, 等.城市社区基本医疗服务提供能力现状研究.中国卫生经济, 2010, 29(2):41-43.
25.	陈红.医院医疗指标应用及质量控制思考.东南国防医药, 2013, 3(15):196-197.

1. 李克强.不断深化医改推动建立符合情惠及全民的医药卫生体制.求是, 2011, 22:3-10.
2. Peabody JW. Policy and healthy-implications for development in Asia. Cambridge:University Press, 1999:184-231.
3. Frenk J. Reinventing primary health care:the need for systems integration. Lancet, 2009, 374(9684):170-173.
4. 严娟, 张建军, 宋朝阳.从分级管理走向管理升级.中国医疗保险, 2011, 65(9):24-26.
5. 胡牧, 刘晓光, 陈仲强.效率医保:医院医保的战略选择.中国医院, 2010, 14(2):10-13.
6. 杜栋, 庞庆华, 现代综合评价方法与案例精选.北京:清华大学出版社, 2005.
7. 张罗漫, 胡琳.医院评价指标的筛选方法.中国卫生统计, 1989, 6(3):34-37.
8. 周绚.综合评价医院工作提高医院管理水平.中国卫生统计, 1993, 10(3):32-34.
9. 胡晓, 周典, 吴丹, 等.医院补偿能力评价指标体系初步研究.中国医院管理, 2012, 32(3):15-17.
10. Chen CT. Extensions of the TOPSIS for group decision-making under fuzzy environment. Fuzzy Set and Systems, 2000, 114(1):1-9.
11. Chang TH, Wang TC. Using the fuzzy multi-criteria decision making approach for measuring the possibility of successful knowledge management. Information Sciences, 2009, 179(4):355-370.
12. 谭学英.无人机科研项目立项评价方法研究.西北工业大学, 2007.
13. 曲久龙.科技项目评估理论与方法研究.吉林:吉林大学, 2006.
14. 龚志平, 李钢强, 刘毅, 等.层次分析法中判断矩阵的调查表问卷设计.中国公共卫生管理, 1995, 11(1):23-25.
15. 常建娥, 蒋太立.层次分析法确定权重的研究.武汉理工大学学报, 2007, 29(1):153-156.
16. 孙纽云, 梁铭会.美国医疗服务绩效评价体系的循证研究及对我国的启示.中国循证医学杂志, 2012, 12(4):379-382.
17. 夏萍, 庄岩, 卢传坚, 等.我国医疗质量多维综合评价方法的循证评价.中国循证医学杂志, 2011, 11(2):226-230.
18. 李幼平, 喻佳洁, 孙鑫.快速评估方法与流程的探索.中国循证医学杂志, 2014, 14(5):497-500.
19. 吴丹, 周典, 张勤, 等.医院管理人员综合测评指标体系构建.中华医院管理, 2011, 23(4):423-426.
20. 刘瑞林, 宋喜国.医院临床科室成长性评价指标体系与评价方法.卫生经济研究, 2010, 5(274):44.
21. 陈辉, 王遂民, 孔霞.医院顺应医疗保险制度改革的思考.中国卫生事业管理, 2011, 4(154):215-216.
22. 李瑛, 袁伟, 陈俊国.医学生人文素质评价指标体系的建立与实证研究.中国社会医学杂志, 2011, 28(4):238-240.
23. 张磊, 谢祥, 朱佳鑫.高校社会职能服务职能评价体系研究.黑龙江高教研究, 2012, 2(7):51-52.
24. 侯志远, 孟庆跃, 袁璟, 等.城市社区基本医疗服务提供能力现状研究.中国卫生经济, 2010, 29(2):41-43.
25. 陈红.医院医疗指标应用及质量控制思考.东南国防医药, 2013, 3(15):196-197.

Next Article
Association between Expression of Osteopontin and Chinese Population with Hepatocellular Carcinoma and Its Clinical Pathological Characteristics: A Meta-Analysis

Chinese Journal of Evidence-Based Medicine

Establish Evaluation Systems of Medical Service Capability Related to Total Payment Control of Medical Insurance

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content