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

Corresponding author: Guo Yu, graceguo@ruc.edu.cn

DOI: 10.12201/bmr.202604.00060

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  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

  Submit time: 9 April 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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  1	2026-02-25	10.12201/bmr.202604.00060V1	Download

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