目的: 构建医疗保障监控指标体系,为评估医保智能监控示范点相关政策的落实效果提供参考。方法: 通过专题调研,初步构建医疗保障监控指标体系;采用组合赋权法,邀请医保、医疗、医药等相关领域的5位专家,通过层次分析法和序关系分析法（G1法）进行主观赋权;收集30个医疗保障智能监控示范点各指标的客观数据,通过熵权法和均方差法进行客观赋权;综合主观赋权的权重和客观赋权的权重,计算得到医疗保障监控指标体系各项指标的组合赋权权重,完成医疗保障监控指标体系的建立。根据建立的医疗保障监控指标体系、指标权重,以及各个示范点报告的各指标客观数据,对各个示范点的职工、居民医疗保障监控质量进行综合评分。结果: 通过组合赋权法,最终确定由5个一级指标、17个二级指标以及56个三级指标构建的医疗保障监控指标体系并赋权重。根据本研究建立的医疗保障监控指标体系、各指标权重,以及30个医疗保障智能监控示范点报告的各指标客观数据,评价了30个医疗保障智能监控示范点的医疗保障监控质量。结论: 本研究在医疗保障基金监管领域首次使用组合赋权法构建医疗保障监控指标体系,并获得其中各项指标的具体权重,为医疗保障智能监控示范点城市相关政策的落实效果提供了有效的评价工具,对于建设和完善医保基金监管体系具有积极意义。

Objective: The paper attempts to construct the medical security supervision index system, and to provide a reference for further evaluating the implementation effect of relevant policies of medical security intelligent supervision demonstration sites. Methods: The medical security supervision index system was preliminarily constructed based on special research. Five experts in medical security, medical care, medicine and related fields were invited to conduct subjective empowerment through analytic hierarchy process and order relation analysis (G1) method. The objective data of 30 medical security intelligent supervision demonstration sites were collected and weighted objectively by entropy weight method and mean square error method. The weight of subjective empowerment and the weight of objective empowerment were calculated to obtain the combined weight for each indicator of the medical security supervision index system, therefore to construct the medical security supervision index system. Based on the medical security supervision index system, index weights, and objective data reported by each medical security intelligent supervision demonstration sites, this study comprehensively evaluated the quality of medical security supervision for the Employees' Basic Medical Insurance and the Urban and Rural Residents' Basic Medical Insurance in each site. Results: Based on combination weighting method, the medical security supervision index system was constructed, including 5 primary indicators, 17 secondary indicators and 56 tertiary indicators, and the weight of each indicator. According to the medical security supervision index system established in this study, the weight of each indicator, and the objective data of each indicator reported by 30 medical security intelligent supervision demonstration sites, the quality of medical security supervision in 30 medical security intelligent supervision demonstration sites was evaluated. Conclusion: This study constructed a medical security supervision index system based on the combination weighting method for the first time in the field of medical security fund supervision, and obtained the specific weight of each indicator, which provided an effective tool for evaluating the implementation effect of relevant policies of medical security intelligent supervision demonstration sites, and had positive significance for the construction and improvement of constructing and improving the medical security fund supervision system.