Research On The Medical Security Agency Assessment Index System For Unannounced Inspection Of Medical Security Fund In Gansu Province

Objectives:Establish an assessment index system for medical security agencies involved in the unannounced inspection of Gansu Province medical security fund,in order to comprehensively,scientifically,and reasonably assess medical security agencies(hereinafter referred to as medical security agencies)during the unannounced inspection process of Gansu medical security fund,maintain the safety of the medical security fund,optimize the unannounced inspection mechanism of Gansu Province medical security fund,and provide theoretical support for similar work in other regions.Methods:1.Through data analysis and semi-structured interviews,grasp the goals,key points,and existing problems of assessing medical security agencies during the unannounced inspection process of medical security funds(hereinafter referred to as "medical security agency unannounced inspection"),and form a pool of assessment indicators and structural framework for medical security agencies in Gansu Province medical security fund unannounced inspection;Conduct multiple group discussions to construct the first draft of the assessment indicator system.2.The Delphi method was used to conduct two rounds of correspondence with experts in Gansu Province medical security and related fields to modify,optimize and determine the final draft of the assessment index system for medical security agencies in Gansu Province medical security fund unannounced inspection;Using the Analytic Hierarchy Process(AHP)to conduct a third round of correspondence with experts,collect their opinions on indicator weights,and use the SPSSAU online statistical analysis platform to test the consistency of expert assignment to clarify indicator weights.3.Using empirical survey method,design a survey questionnaire based on the established assessment index system,simulate the unannounced inspection scenario of medical security funds,select municipal medical security agencies in Gansu Province to conduct empirical surveys,reflect the performance of rights and responsibilities of medical security agencies and the existing safety risks of medical security funds based on the survey results,and conduct reliability and validity tests on the assessment index system.Results:1.Construction of the first draft of the assessment index system for medical security agenciesThrough reviewing domestic and foreign literature and relevant policies issued by medical security and other departments in China,a semi-structured interview was conducted with 11 experts in the field of medical security in Gansu Province(5 people),Hunan Province(2 people),Liaoning Province(2 people),and Jiangsu Province(2people).It was found that there is a lack of comprehensive inspection content and standards for conducting unannounced inspections in medical security agencies,including agreement management of designated medical institutions,recognition of outpatient treatment for chronic and special diseases A pool of assessment indicators for remote medical settlement,manual sporadic reimbursement,improvement and implementation of internal control systems,financial system of medical security funds,expense review system,supervision of medical security funds,public satisfaction,and handling of petition work,as well as a structural framework that includes basic service operation standards and quality,institutional work management control,and service effectiveness.Based on the above results,a group discussion will be conducted to construct a preliminary draft of the evaluation index system for medical security agencies in Gansu Province medical security fund unannounced inspection,including three primary indicators: basic services,deep management,and final effectiveness.There will be eight secondary indicators,including basic service facilities,basic service specifications,fund security management,overall work management,information management,staff management,publicity effectiveness,and service evaluation,as well as 41 tertiary indicators.2.Final draft of the assessment indicator system for medical security agencies and determination of indicator weightsA total of 18 experts from Gansu Province were consulted by Delphi method method and analytic hierarchy process,respectively from medical security(14),administrative management(2)and clinical medicine(2)and other professional fields.In the two rounds of expert correspondence conducted by Delphi method method,the positive coefficient of experts is 100%,the expert authority coefficient is 0.861 and0.846 respectively,and the Kendall’s W coordination coefficient of indicators is 0.308 and 0.321 respectively.The final draft of the evaluation index system for medical security agencies involved in the unannounced inspection of Gansu Medical security Fund includes 3 first level indicators,8 second level indicators,and 37 third level indicators.The third round of correspondence adopts the Analytic Hierarchy Process to determine the weight of indicators.The first level indicators include basic service(0.486),deep management(0.351),and final effect(0.164).The second level indicators include basic service conditions(0.307),basic service specifications(0.179),fund security management(0.177),overall work management(0.076),information management(0.063),staff management(0.035),publicity effect(0.069),and service evaluation(0.095),The importance of indicators at all three levels is consistent.3.Empirical investigation on the evaluation index system of medical security agenciesAn empirical survey was conducted on 5 municipal level medical security agencies in Gansu Province.The survey data showed that their weighted total scores were Agency A(23.20),Agency B(22.21),Agency C(25.25),Agency D(24.19),and Agency E(25.76).Based on the number of questions,an in-depth discussion was conducted using Agency A as an example.In addition,this study also conducted reliability and validity tests on the evaluation indicator system based on the evaluation score data of five medical security agencies.In terms of reliability,the overall evaluation index system and each level indicator θ The coefficients are all>0.7,with good reliability.In terms of validity,the evaluation index system of medical security agencies for the unannounced inspection of Gansu Medical security Fund is based on the relevant medical security policies issued by the relevant departments at the national,provincial and municipal levels,supplemented by domestic and foreign literature review,qualitative research and other methods,through two rounds of Delphi method method experts’ correspondence,fully soliciting the suggestions of experts in medical security,administrative management,clinical medicine and other fields,and with the help of analytic hierarchy process,Through the third round of inquiry,the weight of the evaluation indicators was determined,and it was believed that the content validity of the evaluation indicator system was high.Conclusions:1.This study constructed an assessment index system for medical security agencies involved in unannounced inspection of Gansu Province Medical security Fund,including 3 first level indicators,8 second level indicators,and 37 third level indicators.The experts participating in the inquiry have rich experience,good representativeness,and a high level of enthusiasm,authority,and coordination among the experts.2.The medical security agencies included in the empirical survey meet the standards,simulate the unannounced inspection scenario of the medical security fund,and apply the constructed assessment index system to better reflect the current status of institutional rights and responsibilities and the existing safety risks of the medical security fund.The empirical survey results,through reliability and effectiveness tests,believe that the assessment index system obtained in this study is scientific,reasonable,and standardized,which can serve to improve the unannounced inspection mechanism of the medical security fund in Gansu Province,Effectively assessing medical security agencies and maintaining the safety of medical security funds during the unannounced inspection process of medical security funds provides theoretical support,and can also provide reference basis for similar work in other regions.