Construction of credit evaluation index system for designated hospitals of medical insurance based on regulatory demand -- Taking zhangjiajie experimental study as an example

Corresponding author: zhouliangrong, 1443361448@qq.com

DOI: 10.12201/bmr.202110.00003

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  Abstract: Good faith is the basis of normal operation of medical insurance, and the credit of designated hospitals is one of the keys to the supervision of medical insurance fund. How to scientifically evaluate the credit of designated hospitals for medical insurance, establish their credit evaluation index system and methods, guide hospitals and medical staff to provide medical services correctly, reasonably and legally, reduce the loss of medical insurance funds, and achieve a win-win situation among doctors, insurance and patients is an important issue that needs to be studied. Based on the national manual, this paper establishes the credit evaluation index system and evaluation method of designated hospitals universally recognized by stakeholders through integration, supplement and weight adjustment, and carries out small and pilot tests in Zhangjiajie city. On the basis of the experiment, the index system and evaluation method are further modified and improved, in order to provide reference for the supervision and decision-making of designated hospitals for medical insurance, and for the pilot and promotion of other regions.

  Key words: Credit evaluation; Designated hospitals; Medical insurance; Fund regulation

  Submit time: 7 March 2022

  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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