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：

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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.	李克強.不斷深化醫改推動建立符合情惠及全民的醫藥衛生體制.求是, 2011, 22:3-10.
2.	Peabody JW. Policy and healthy-implications for development in Asia. Cambridge:University Press, 1999:184-231.
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4.	嚴娟, 張建軍, 宋朝陽.從分級管理走向管理升級.中國醫療保險, 2011, 65(9):24-26.
5.	胡牧, 劉曉光, 陳仲強.效率醫保:醫院醫保的戰略選擇.中國醫院, 2010, 14(2):10-13.
6.	杜棟, 龐慶華, 現代綜合評價方法與案例精選.北京:清華大學出版社, 2005.
7.	張羅漫, 胡琳.醫院評價指標的篩選方法.中國衛生統計, 1989, 6(3):34-37.
8.	周絢.綜合評價醫院工作提高醫院管理水平.中國衛生統計, 1993, 10(3):32-34.
9.	胡曉, 周典, 吳丹, 等.醫院補償能力評價指標體系初步研究.中國醫院管理, 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.	譚學英.無人機科研項目立項評價方法研究.西北工業大學, 2007.
13.	曲久龍.科技項目評估理論與方法研究.吉林:吉林大學, 2006.
14.	龔志平, 李鋼強, 劉毅, 等.層次分析法中判斷矩陣的調查表問卷設計.中國公共衛生管理, 1995, 11(1):23-25.
15.	常建娥, 蔣太立.層次分析法確定權重的研究.武漢理工大學學報, 2007, 29(1):153-156.
16.	孫紐云, 梁銘會.美國醫療服務績效評價體系的循證研究及對我國的啟示.中國循證醫學雜志, 2012, 12(4):379-382.
17.	夏萍, 莊巖, 盧傳堅, 等.我國醫療質量多維綜合評價方法的循證評價.中國循證醫學雜志, 2011, 11(2):226-230.
18.	李幼平, 喻佳潔, 孫鑫.快速評估方法與流程的探索.中國循證醫學雜志, 2014, 14(5):497-500.
19.	吳丹, 周典, 張勤, 等.醫院管理人員綜合測評指標體系構建.中華醫院管理, 2011, 23(4):423-426.
20.	劉瑞林, 宋喜國.醫院臨床科室成長性評價指標體系與評價方法.衛生經濟研究, 2010, 5(274):44.
21.	陳輝, 王遂民, 孔霞.醫院順應醫療保險制度改革的思考.中國衛生事業管理, 2011, 4(154):215-216.
22.	李瑛, 袁偉, 陳俊國.醫學生人文素質評價指標體系的建立與實證研究.中國社會醫學雜志, 2011, 28(4):238-240.
23.	張磊, 謝祥, 朱佳鑫.高校社會職能服務職能評價體系研究.黑龍江高教研究, 2012, 2(7):51-52.
24.	侯志遠, 孟慶躍, 袁璟, 等.城市社區基本醫療服務提供能力現狀研究.中國衛生經濟, 2010, 29(2):41-43.
25.	陳紅.醫院醫療指標應用及質量控制思考.東南國防醫藥, 2013, 3(15):196-197.

1. 李克強.不斷深化醫改推動建立符合情惠及全民的醫藥衛生體制.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. 嚴娟, 張建軍, 宋朝陽.從分級管理走向管理升級.中國醫療保險, 2011, 65(9):24-26.
5. 胡牧, 劉曉光, 陳仲強.效率醫保:醫院醫保的戰略選擇.中國醫院, 2010, 14(2):10-13.
6. 杜棟, 龐慶華, 現代綜合評價方法與案例精選.北京:清華大學出版社, 2005.
7. 張羅漫, 胡琳.醫院評價指標的篩選方法.中國衛生統計, 1989, 6(3):34-37.
8. 周絢.綜合評價醫院工作提高醫院管理水平.中國衛生統計, 1993, 10(3):32-34.
9. 胡曉, 周典, 吳丹, 等.醫院補償能力評價指標體系初步研究.中國醫院管理, 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. 譚學英.無人機科研項目立項評價方法研究.西北工業大學, 2007.
13. 曲久龍.科技項目評估理論與方法研究.吉林:吉林大學, 2006.
14. 龔志平, 李鋼強, 劉毅, 等.層次分析法中判斷矩陣的調查表問卷設計.中國公共衛生管理, 1995, 11(1):23-25.
15. 常建娥, 蔣太立.層次分析法確定權重的研究.武漢理工大學學報, 2007, 29(1):153-156.
16. 孫紐云, 梁銘會.美國醫療服務績效評價體系的循證研究及對我國的啟示.中國循證醫學雜志, 2012, 12(4):379-382.
17. 夏萍, 莊巖, 盧傳堅, 等.我國醫療質量多維綜合評價方法的循證評價.中國循證醫學雜志, 2011, 11(2):226-230.
18. 李幼平, 喻佳潔, 孫鑫.快速評估方法與流程的探索.中國循證醫學雜志, 2014, 14(5):497-500.
19. 吳丹, 周典, 張勤, 等.醫院管理人員綜合測評指標體系構建.中華醫院管理, 2011, 23(4):423-426.
20. 劉瑞林, 宋喜國.醫院臨床科室成長性評價指標體系與評價方法.衛生經濟研究, 2010, 5(274):44.
21. 陳輝, 王遂民, 孔霞.醫院順應醫療保險制度改革的思考.中國衛生事業管理, 2011, 4(154):215-216.
22. 李瑛, 袁偉, 陳俊國.醫學生人文素質評價指標體系的建立與實證研究.中國社會醫學雜志, 2011, 28(4):238-240.
23. 張磊, 謝祥, 朱佳鑫.高校社會職能服務職能評價體系研究.黑龍江高教研究, 2012, 2(7):51-52.
24. 侯志遠, 孟慶躍, 袁璟, 等.城市社區基本醫療服務提供能力現狀研究.中國衛生經濟, 2010, 29(2):41-43.
25. 陳紅.醫院醫療指標應用及質量控制思考.東南國防醫藥, 2013, 3(15):196-197.

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