中国卫生事业管理2025，Vol.42Issue(5)：531-537,7.
我国医保基金监管政策的量化评价
Quantitative Evaluation of Regulatory Policies for China's Medical Insurance Fund Based on PMC Index Model A-nalysis
摘要
Abstract
Objective To analyze the evolution trend and changing characteristics of China's medical insurance fund supervi-sion policies before and after the establishment of the National Healthcare Security Administration,and quantitatively evaluate the special policies for medical insurance fund supervision under the background of the continuous deepening of the new healthcare re-form.Methods Based on text mining,a PMC index model was constructed using the relevant research results of Chinese policy en-vironment and domestic scholars.The 14 policy texts selected from which were quantitatively evaluated and analyzed.Results The average PMC index of 14 special policies was 6.25,with 5 policies rated as excellent,8 policies rated as good,and 1 policy rated as passing.There was no bad or perfect policies,reflecting the overall good quality of China's medical insurance fund regulatory policies.In terms of the mean values of each primary indicator,the overall policy scores were relatively high in terms of policy e-valuation,policy content,and policy areas.Conclusion With the establishment of the National Medical Insurance Bureau and the continuous deepening of healthcare reform,China has significantly enhanced its policy formulation and design for medical insur-ance fund supervision.However,challenges still remain,including limited policy content,inadequate incentive and constraint mechanisms,insufficient interdepartmental coordination,and unimproved talent team development.Therefore,it is recommended to enhance policy trend forecasting and macro-level guidance to better understand the evolving policy environment,shift in mind-set to establish a multi-tiered incentive and restraint framework,perfect the supervision system for medical insurance funds,clar-ify the rights and responsibilities of all stakeholders,increase investment in supervision human resources and intensify talent team development.关键词
医保基金监管/量化评价/政策评估/文本挖掘/PMC指数模型Key words
supervision of medical insurance funds/quantitative evaluation/policy evaluation/text mining/PMC index model分类
医药卫生引用本文复制引用
汤子健,黎犇,李青,陈建钦..我国医保基金监管政策的量化评价[J].中国卫生事业管理,2025,42(5):531-537,7.基金项目
国家社科基金年度项目一般项目"城乡基层社会治理共同体建设的经验、规律与机制设计研究"(20BGL239) （20BGL239）
广西高校人文社科重点研究基地健康与经济社会发展究中心课题"广西医保基金监管运行效率评价及提升策略研究"(2024RWB10) （2024RWB10）
