健康发展与政策研究2024，Vol.27Issue(2)：175-181,7.DOI:10.12458/HDPR.202404025
内控风险视角下医保监管系统规范公立医院医疗行为的有效性研究
Study on the effectiveness of medical insurance supervision system in regulating medical behavior in public hospitals from the perspective of internal control risk
摘要
Abstract
Objective To construct the evaluation model of the supervision system of medical insurance and evaluate the effectiveness of the medical insurance supervision system in regulating the medical behavior in public hospitals.Method A"Five-in-one"evaluation model based on grounded theory was established and a public hospital group A was used as a pilot to comprehensively evaluate the application effect of the medical insurance supervision system.Results The"Five-in-one"evaluation model with a clinical diagnosis and treatment standard pool as the core was showed to be suitable for health care supervision system evaluation,and effective health supervision system helps to improve medical staff's comprehension of health care policy,and their satisfaction.Further,this model is of great sig-nificance to regulate the medical behavior of public hospitals and effectively protect from internal operational risks.Conclusion The whole-process evaluation of the effectiveness of the medical insurance supervision system effectively improves the hospital governance capacity and the level of medical insurance management,and consequently ensures the quality of medical treatment and the safety of medical insurance fund.关键词
内控风险/医保监管/医疗行为Key words
internal control of risk/medical insurance supervision/medical behavior分类
医药卫生引用本文复制引用
王磊,王力男,周尚成..内控风险视角下医保监管系统规范公立医院医疗行为的有效性研究[J].健康发展与政策研究,2024,27(2):175-181,7.基金项目
国家自然科学基金(81973979) （81973979）
