目的: 从医保管理视角分析四川省基本医保支付方式改革绩效考核指标特征,为探索构建科学的医保支付绩效考核机制提供参考。方法: 收集四川省12个市州医保局印发的DRG/DIP年度考核评分表,运用词频分析、UCINET社会网络分析及熵权法,对指标的分布特征、中心度关系与权重结果进行综合分析。结果: 分析发现,CMI值、时间消耗指数、费用消耗指数、医保结算清单填报率等指标在考核体系中出现频率高,中心度大,熵值高,熵权值低,具有核心通用性;不同市州在指标数量、结构和权重设置上存在差异,反映出医保支付方式改革政策导向的地区差异。结论: DRG/DIP绩效考核体系应契合医保支付方式改革目标,在统一标准与地区差异间寻求平衡,构建以省级统筹为方向,以基础性指标为核心、差异化指标为补充的绩效评价体系,考核结果可与医保清算和政策资源配置挂钩,通过横向比较形成标杆效应,并兼顾纵向分析,避免“鞭打快牛”。绩效考核体系需优选可量化的客观指标,根据改革进程持续优化,形成科学、灵活、可持续的考核体系。

Objective: The paper analyzes the characteristics of the basic medical insurance payment system reform performance assessment indicators in Sichuan Province from the perspective of medical insurance management, to provide evidence for exploring and establishing a scientific performance evaluation mechanism for medical insurance payment system. Methods: DRG/DIP annual assessment tables from 12 municipal healthcare security administrations of Sichuan Province were analyzed using word frequency analysis, UCINET social network analysis, and the entropy weight method to assess indicator distribution, centrality, and weighting. Results: Indicators such as CMI, time and cost consumption indices, and settlement accuracy appeared frequently with high centrality and entropy, reflecting their core generality. Differences across regions in indicator quantity, structure, and weighting revealed local variations in policy orientation. Conclusion: The DRG/DIP performance evaluation system should align with payment reform goals, balance unified standards with regional flexibility, and establish a provincial-level coordinated framework, with core foundational indicators supplemented by differentiated indicators. By linking evaluation results with fund settlement and policy allocation, it can create a benchmarking effect through horizontal comparisons while also incorporating vertical analysis to avoid the pitfall of penalizing the high-performing units. The performance evaluation system should prioritize quantifiable and objective indicators, undergo continuous optimization aligned with the reform progress, and ultimately evolve into a scientific, flexible, and sustainable framework.