通讯作者: 郭瑜, graceguo@ruc.edu.cn

DOI：10.12201/bmr.202604.00060

Research on the Construction of Performance Evaluation Indicator System for Medical Insurance Funds

• 摘要：目的：构建科学合理的医保基金绩效评价指标体系，为提升基金使用效益和监管水平提供理论支撑。方法：系统梳理全国164份医疗保险基金绩效评价报告及相关政策文件，形成初始指标池；运用德尔菲法邀请22位专家开展两轮专家咨询，筛选确认指标；采用层次分析法构建判断矩阵，确定各级指标权重。结果：构建了包含4项一级指标、12项二级指标和30项三级指标的医保基金绩效评价指标体系。专家积极系数均大于95%，权威程度系数为0.9615，协调系数W分别为0.206和0.221，差异具有统计学意义。各判断矩阵一致性比率CR均小于0.1。结论：本研究构建的指标体系覆盖医保基金运行全周期，显著强化了产出与结果导向，可为优化医保预算分配、强化基金风险防控及推动“三医协同”提供精准的决策依据与实践工具。

  关键词： 医疗保险基金; 绩效评价; 指标体系; 德尔菲法; 层次分析法

   

  Abstract: Objective:?To construct a scientific and rational performance evaluation indicator system for medical insurance funds, providing theoretical support for improving fund utilization efficiency and regulatory standards. Methods:?An initial indicator pool was formed by systematically reviewing 164 national medical insurance fund performance evaluation reports and related policy documents. The Delphi method was utilized to conduct two rounds of expert consultations with 22 experts to screen and confirm the indicators. The Analytic Hierarchy Process was applied to construct judgment matrices, determine the weights of indicators at all levels, and perform consistency tests. Results:?A?medical insurance fund performance evaluation indicator system?was constructed, comprising 4 first-level, 12 second-level, and 30 third-level indicators. The expert enthusiasm coefficients were all greater than 95%, the authority coefficient was 0.9615, and Kendalls W coefficients were 0.206 and 0.221 respectively, with statistically significant differences. The consistency ratios (CR) of all judgment matrices were less than 0.1. Conclusion:?The indicator system constructed in this study covers the entire lifecycle of medical insurance fund operations and significantly strengthens the orientation towards outputs and outcomes. It offers precise decision-making basis and practical tools for optimizing medical insurance budget allocation, reinforcing fund risk prevention and control, and promoting the “tri-medical coordination”.

  Key words: Medical insurance fund; Performance evaluation; Indicator system; Delphi method; Analytic Hierarchy Process

  提交时间：2026-04-09

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2026-02-25	10.12201/bmr.202604.00060V1	下载

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