通讯作者: 张晓, zhangxiao@seu.edu.cn

DOI：10.12201/bmr.202204.00009

Optimized path design outpatient co-ordination system mechanism for employee medical insurance in Jiangsu Province based on SWOT analysis

• 摘要：目的：了解江苏省职工医保门诊共济机制发展环境，为其优化路径的设计提供依据。 方法：运用 SWOT 分析法探讨江苏省职工医保门诊共济机制运行的优势与劣势，面临的机遇与威胁。 结果：江苏省职工医保门诊共济机制的发展有着财务基础、经办管理、医疗机构、政策导向、现实需求、数字医保背景等多方位的优势与机遇，但面临着法律体系、基金监管、协议管理、参保观念、筹资标准、待遇水平、疫情冲击等层面的劣势与威胁。 结论：建立SWOT矩阵，从四个组合策略维度出发，综合分析相关对策，设计江苏省职工医保门诊共济机制的优化路径。

  关键词： 职工医保; 门诊共济; SWOT分析; 路径设计

   

  Abstract: Objective: To understand the development environment of outpatient co-ordination system mechanism for employee medical insurance in Jiangsu Province, Provide a basis for the design of its optimized path. Methods: SWOT analysis was used to explore the advantages and disadvantages of outpatient co-ordination system mechanism for employee medical insurance in Jiangsu Province, and the opportunities and threats it faces. Results: The development of outpatient co-ordination system mechanism for employee medical insurance in Jiangsu Province has many advantages and opportunities, such as financial basis, handling management, medical institutions, policy orientation, actual demand and digital medical insurance background, but also faced with disadvantages and threats in the aspects of legal system, fund supervision, agreement management, concept of insurance participation, financing standard, treatment levels and epidemic impact. Conclusion: A SWOT matrix was established, starting from four combined strategy dimensions, relevant countermeasures were comprehensively analyzed, and the optimized path of outpatient co-ordination system mechanism for employee medical insurance in Jiangsu Province was designed.

  Key words: basic medical insurance for urban employees; outpatient co-ordination; the SWOT analysis; path design

  提交时间：2022-04-24

  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	2022-01-24	bmr.202204.00009V1	下载

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