A medical insurance fund operation performance evaluation system under the DRG payment mode reform
BackgroundAn evaluation system for comprehensively measuring medical insurance fund operational performance under China’s Diagnosis Related Groups (DRG) payment reform holds critical theoretical and practical significance, especially for enhancing the efficiency of medical insurance fund utilization...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1549575/full |
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| author | Zijian Wang Zijian Wang Zijian Wang Weifu Chang Weifu Chang Aijing Luo Aijing Luo Aijing Luo |
| author_facet | Zijian Wang Zijian Wang Zijian Wang Weifu Chang Weifu Chang Aijing Luo Aijing Luo Aijing Luo |
| author_sort | Zijian Wang |
| collection | DOAJ |
| description | BackgroundAn evaluation system for comprehensively measuring medical insurance fund operational performance under China’s Diagnosis Related Groups (DRG) payment reform holds critical theoretical and practical significance, especially for enhancing the efficiency of medical insurance fund utilization and the quality of healthcare services. However, few studies undertake performance evaluations of medical insurance funds under DRG payments, especially those incorporating the Analytic Hierarchy Process (AHP)-Entropy Weight Method (EWM)- Fuzzy Comprehensive Evaluation (FCE) method model.MethodsThis study utilizes operational data from medical insurance funds across eight cities in S Province, China, from 2020 to 2022. It develops an innovative performance evaluation system for medical insurance funds utilizing the AHP-EWM-FCE evaluation method. Finally, it explores the key influencing factors by applying the Tobit regression model.ResultsAs the reform of DRG payment methods has advanced, the operational performance scores related to the management, fundraising, utilization, and satisfaction of DRG medical insurance funds have consistently improved. Notably, the comprehensive indexes of QD and JN cities exhibit significant comparative advantages, resulting in higher performance evaluation scores for their medical insurance funds. Additionally, the performance scores assessed by the proposed evaluation system align closely with actual operational outcomes. Regression analysis further indicates that medical service capability is the key determinant influencing the operational performance of medical insurance funds.ConclusionThis study develops a novel evaluation system for measuring medical insurance funds’ operational performance. The insights can help proactively foster the high-quality development of these funds, and modernization of the medical insurance governance system and governance capabilities; stimulate the fund’s productivity; and enhance the health and wellbeing of people. |
| format | Article |
| id | doaj-art-5fd85224a674453385a9397c8bb486c9 |
| institution | Kabale University |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj-art-5fd85224a674453385a9397c8bb486c92025-02-10T13:18:39ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-02-011310.3389/fpubh.2025.15495751549575A medical insurance fund operation performance evaluation system under the DRG payment mode reformZijian Wang0Zijian Wang1Zijian Wang2Weifu Chang3Weifu Chang4Aijing Luo5Aijing Luo6Aijing Luo7The Second Xiangya Hospital of Central South University, Changsha, ChinaSchool of Public Administration, Central South University, Changsha, ChinaKey Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, ChinaKey Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, ChinaThe Third Xiangya Hospital of Central South University, Changsha, ChinaThe Second Xiangya Hospital of Central South University, Changsha, ChinaKey Laboratory of Medical Information Research (Central South University), College of Hunan Province, Changsha, ChinaClinical Research Center For Cardiovascular Intelligent Healthcare in Hunan Province, Changsha, ChinaBackgroundAn evaluation system for comprehensively measuring medical insurance fund operational performance under China’s Diagnosis Related Groups (DRG) payment reform holds critical theoretical and practical significance, especially for enhancing the efficiency of medical insurance fund utilization and the quality of healthcare services. However, few studies undertake performance evaluations of medical insurance funds under DRG payments, especially those incorporating the Analytic Hierarchy Process (AHP)-Entropy Weight Method (EWM)- Fuzzy Comprehensive Evaluation (FCE) method model.MethodsThis study utilizes operational data from medical insurance funds across eight cities in S Province, China, from 2020 to 2022. It develops an innovative performance evaluation system for medical insurance funds utilizing the AHP-EWM-FCE evaluation method. Finally, it explores the key influencing factors by applying the Tobit regression model.ResultsAs the reform of DRG payment methods has advanced, the operational performance scores related to the management, fundraising, utilization, and satisfaction of DRG medical insurance funds have consistently improved. Notably, the comprehensive indexes of QD and JN cities exhibit significant comparative advantages, resulting in higher performance evaluation scores for their medical insurance funds. Additionally, the performance scores assessed by the proposed evaluation system align closely with actual operational outcomes. Regression analysis further indicates that medical service capability is the key determinant influencing the operational performance of medical insurance funds.ConclusionThis study develops a novel evaluation system for measuring medical insurance funds’ operational performance. The insights can help proactively foster the high-quality development of these funds, and modernization of the medical insurance governance system and governance capabilities; stimulate the fund’s productivity; and enhance the health and wellbeing of people.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1549575/fullmedical insurance fundsAHP-EWM-FCE methodologyperformance evaluationDRG payment reformTobit regression model |
| spellingShingle | Zijian Wang Zijian Wang Zijian Wang Weifu Chang Weifu Chang Aijing Luo Aijing Luo Aijing Luo A medical insurance fund operation performance evaluation system under the DRG payment mode reform Frontiers in Public Health medical insurance funds AHP-EWM-FCE methodology performance evaluation DRG payment reform Tobit regression model |
| title | A medical insurance fund operation performance evaluation system under the DRG payment mode reform |
| title_full | A medical insurance fund operation performance evaluation system under the DRG payment mode reform |
| title_fullStr | A medical insurance fund operation performance evaluation system under the DRG payment mode reform |
| title_full_unstemmed | A medical insurance fund operation performance evaluation system under the DRG payment mode reform |
| title_short | A medical insurance fund operation performance evaluation system under the DRG payment mode reform |
| title_sort | medical insurance fund operation performance evaluation system under the drg payment mode reform |
| topic | medical insurance funds AHP-EWM-FCE methodology performance evaluation DRG payment reform Tobit regression model |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1549575/full |
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