通讯作者: 朱平华, zhupinghua@gxmu.edu.cn

DOI：10.12201/bmr.202510.00010

Research on the Influencing Factors of Capacity Enhancement of Medical insurance handling personnel in Public Hospitals-Based on the DEMATEL-ISM-MICMAC Hybrid Method

• 摘要：目的：解析影响公立医院医保管理人员能力提升的关键因素、层级结构及内在作用路径，为加强医院医保管理人才队伍建设提供理论依据和实践参考。方法：通过文献分析、政策解读与访谈结果三方互证的方式，构建公立医院医保管理人员能力提升影响因素指标体系，采用DEMATEL-ISM-MICMAC相结合的混合方法，对影响因素进行关系界定、层级划分及驱动力-依赖性分析。结果：影响公立医院医保经办人员能力提升的关键因素共有12个，通过ISM模型可将各影响因素划分为表层因素、中间层因素、深层因素和本质层因素4个层级，借助MICMAC分析可归类为“低驱动力-低依赖性”的自发因素群、“高驱动力-低依赖性”的独立因素群及“低驱动力-高依赖性”的依赖因素群。结论：政策解读与知识储备是能力提升的根本驱动因素；职业伦理与职责是能力体系的的深层支撑因素；医保基金监管能力是关键结果与绩效体现。

  关键词： 公立医院；医保管理人员；能力提升；决策实验室分析法（DEMATEL）；解释结构模型（ISM）；交叉影响矩阵相乘法模型（MICMAC）; ; ; ; ; 

   

  Abstract: Objective: To analyze the key factors, hierarchical structure and internal action paths that affect the ability improvement of medical insurance management personnel in public hospitals, and to provide theoretical basis and practical reference for strengthening the construction of medical insurance management talent teams in hospitals. Methods: Through the mutual verification of literature analysis, policy interpretation and interview results, an index system of influencing factors for the ability improvement of medical insurance management personnel in public hospitals was constructed. A hybrid method combining DEMATEL-ISM-MICMAC was adopted to define the relationships, divide the levels and conduct driving force - dependence analysis of the influencing factors. Results: There are a total of 12 key factors influencing the ability improvement of medical insurance management personnel in public hospitals. Through the ISM model, these influencing factors can be classified into four levels: surface factors, intermediate factors, deep factors, and essential factors. With the help of MICMAC analysis, it can be classified into the spontaneous factor group of low driving force - low dependence, the independent factor group of high driving force - low dependence and the dependent factor group of low driving force - high dependence. Conclusion: Policy interpretation and knowledge reserve are the fundamental driving factors for ability improvement; Professional ethics and responsibilities are the deep-seated supporting factors of the ability system. The regulatory capacity of medical insurance funds is a key outcome and performance manifestation.

  Key words: Public hospitals; Medical insurancemanagement personnel; Ability improvement; Decision Laboratory Analysis (DEMATEL); Explain the Structural Model (ISM); Cross-influence Matrix Multiplication Model (MICMAC).

  提交时间：2025-10-09

  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	2025-09-04	bmr.202510.00010V1	下载

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