Research on Construction of Medical Insurance Fund Supervision Index System under CHS-DRG Payment
Li Yang
Wang Zhe
Shan Linghan
Ma Yuan
Che Wen
Liang Chao
Liang Zijun
Cui Lijun
Wang Liang
Abstract：Objective To screen out the indexes of medical insurance fund under China Healthcare Security Diagno-sis Related Groups(CHS-DRG)payment based on Delphi method and improve the efficiency of medical insurance fund supervision.Methods Using the Delphi method,32 experts in the medical insurance field were selected and 2 rounds of expert questionnaires were conducted to design an evaluation scale for the monitoring indicators of medi-cal insurance funds under CHS-DRG payment.The consultation results were evaluated from three aspects of motiva-tion,authority,and coordination.Results A medical insurance fund supervision index system based on three dimen-sions of medical insurance fund use quality,efficiency and safety supervision is constructed,including 3 first-level indicators,7 second-level indicators and 44 third-level indicators.Results The construction ofmedical insurance fund supervision index system under CHS-DRG payment should respect the actual clinical diagnosis and treatment,strengthen the intelligent supervision method,and timely intervene in medical insurance fund management risks.
Keywords：China Healthcare Security Diagnosis Related Groups paymentmedical insurance fund supervisionindex systemDelphi method
Publication Date：2025-10-05
Online Publishing Date：2025-10-21(First online date of this platform, not the publication date of the document)
Pages：4( 65-68 )