The SWOT Analysis Of China’s Healthcare Security Fund Supervision

Objective: To understand the environmental factors including the internal strengths,weaknesses,external opportunities and threats of existing in the supervision of China’s healthcare security fund,analyze the strategies of healthcare security fund supervision during the "14th Five-Year Plan" period and put forward policy recommendations.Methods: This study took the internal and external environmental factors of China’s healthcare security fund supervision as the research object.The initial PEST-SWOT environmental factor indicators were determined through literature reviews.The Delphi method was used to modify the initial indicators.A total of two rounds of questionnaires were collected,aiming to combine with expert opinions,perfect and revise the indicators,and summarize the indicators of China’s healthcare security fund regulatory environmental factors by the PEST-SWOT model.The Epidata 3.1 software was used to record the questionnaire data.Double entry to ensure the quality of data record.After verification,the data was imported into SPSS 22.0 software for data analysis,and the cut-off method was used to calculate various factors for inclusion and exclusion criteria.The weighted statistical method was used to calculate the weights of four types of factors: strengths,weaknesses,opportunities,and threats according to the importance of experts on the importance of indicators.The SO,WO,ST,and WT strategic choices were selected based on the expert advice.Results: 1.The indicator system framework and indicator candidate store of PEST-SWOT environmental factors were determined initially through literature review,including four firstlevel indicators and 21 second-level indicators of internal strengths,internal weaknesses,external opportunities,and external threats.2.In the first round,25 related experts in the fields of healthcare security fund were consulted,of which 21 participated in the consultation.In the second round,21 experts were sent letters of inquiry.The recovery rate and valid recovery rate are both 100%.The expert authority coefficient is 0.726.The p value of the significance test of the overall coordination coefficient of the indicators of the two rounds of expert consultations was <0.05.3.After distributing and recalling two rounds of expert consultation questionnaires,according to the selection criteria of the indicators and combining with expert opinions,there were 4 secondary indicators which had delete,with 1 secondary indicator adding and 2 secondary indicators modifying.The final China’s healthcare security fund Supervise framework of the PEST-SWOT environmental factors has been identified,including four first-level indicators and 18 second-level indicators.The specific indicators are as followed: The strengths of China’s healthcare security fund supervision:(1)The National Healthcare Security Bureau was established and a fund supervision department was established to ensure the smooth implementation of fund supervision work from the system;(2)China’s healthcare security agency has accumulated some practical experience;(3)The diversified development of social supervision bodies such as public opinion media and third-party supervision agencies;(4)There have been many effective supervision methods such as restricting access,reporting complaints,audit and punishment,and information disclosure,etc..;(5)Special actions to combat fraud and the development of "two pilots and one demonstration" are implementing.The weakness of China’s healthcare security fund supervision:(1)Relevant departments lack full-time supervision team or institution,as well as lacking professional personnel;(2)Relevant departments of healthcare security,health administration,public security lack coordination,and have unclear powers and responsibilities,as well as no effective linkage mechanism;(3)The level of intelligent monitoring and intelligence is low,and the standards are not uniform across regions,and it is difficult to promote such new regulatory technologies in grass-roots and remote areas;(4)The lack of relevant laws and regulations,and the regulations on the supervision of healthcare security funds have not yet been issued which means the construction of the legal system lags behind.The opportunities of China’s healthcare security fund supervision:(1)The Party and state leaders attach great importance to healthcare security fund and make important instructions many times;(2)As an integral part of the social governance system and governance capacity modernization,they can follow the trend;(3)The construction of the social credit system continues to advance;(4)Other countries have rich practical experience in the aspects of healthcare security legislation,management system,healthcare security anti-fraud and medical service quality supervision,etc.,which can be used for reference;(5)The rapid development of modern information technology,such as face recognition and video surveillance can be applied to fund supervision methods.The threats of China’s healthcare security fund regulatory:(1)Inadequate government investment in compensation has brought operating pressure to hospitals,forcing hospitals to operate in violation of regulations;(2)Industry self-regulation standards have not yet been formed;(3)Incomplete clinical pathways and low transparency;(4)Some residents lack the awareness of safeguarding the healthcare security fund,or are easily used by designated medical institutions and criminal gangs because of their low education level.4.Use the weighted statistical method in Delphi method to calculate the weight of each factor.The ranking of the first-level index weights is: Weakness(4.631)> Strengths(4.581)> Opportunity(4.429)> Threat(4.060).According to the SWOT strategy selection method,a combination of WO and SO is adopted.Conclusion: This study constructed the PEST-SWOT environmental factor framework of China’s healthcare security fund supervision,including four first-level indicators of S,W,O,and T,and 18 second-level indicators.According to the weight of the indicators,it is clear that the strategy of combining WO and SO should be adopted.The relevant departments should perfect the co-governance mechanism,strengthen legislative norms,build professional teams,improve intelligent monitoring,and develop credit supervision.