目的: 调查医保从业人员的教育和专业背景等情况,分析医保从业人员对医保支付方式的知晓水平和影响因素,为提高医保从业人员的专业能力提出对策和建议。方法: 选取不同地区医保从业人员,于2021年进行线上问卷调查并收集数据,主要包括人口学特征、医保支付方式知晓情况、工作投入情况。采用SPSS23.0统计软件进行秩和检验、Spearman相关性分析和无序多分类Logistic回归分析。结果: 共回收有效问卷280份,调查对象中40岁以下的医保从业人员占比55.7%,68.6%的医保从业人员有本科及以上学历,65.4%有10年及以上工作经验,7.9%是保险类专业背景,44.3%是医护类专业背景。Logistic回归分析结果显示,影响医保从业人员对医保支付方式知晓情况的因素有工作年限、职称、工作机构、所在地区。结论: 加强医保从业人员的培训和继续教育力度,加快建立职称晋升制度,建设专业医保人才队伍,促进医保支付方式改革高效运行。

Objective: The paper investigates the education and professional background of health insurance workforces, analyzes the awareness and influencing factors of health insurance workforces on the health insurance payment reform policy, and puts forward suggestions for improving the management ability of health insurance workforces. Methods: In 2021, practitioners from different regions of the medical insurance sector were selected to conduct an online questionnaire survey and collect data, mainly including demographic characteristics, knowledge of medical insurance payment methods, and work commitment. SPSS23.0 statistical software was used for rank sum test, Spearman correlation analysis and disordered multinomial logistic regression analysis. Results: A total of 280 valid questionnaires were submitted. Results: Among the respondents, 55.7% were under the age of 40, 68.6% had a bachelor's degree or above, 65.4% had 10 years' work experience, 7.9% had a professional background in insurance, and 44.3% had a medical and nursing background. The results of logistic regression analysis show that the factors affecting medical insurance practitioners' knowledge of medical insurance payment methods include the working years, the job title, the work organization, and the region. Conclusion: The training and continuing education of health insurance workforces should be strengthened, a professional title promotion system should be established, a professional medical insurance talent team should be built, and the efficient operation of the reform of medical insurance payment methods should be promoted.