Based on agile governance theory, this study explores the challenges and optimization paths in hospital medical insurance management. With the frequent adjustments of medical insurance policies, the expanding scale of insured patients, and the growing demand for digitalization, traditional medical insurance management models have become inadequate. Agile governance theory which emphasizes flexibility, adaptability, and people-centric principles offers a new perspective for hospital medical insurance management. This paper proposes optimization paths through value-driven leadership, organizational restructuring, and enhanced environmental adaptability to advance the agile transformation of hospital medical insurance management. Taking the application of agile governance in a hospital in Wuhan City of Hubei Province as a case study, it elaborates on practical measures for implementing this theory in medical insurance management. Specifically, the redesign of high-frequency workflows—such as the application, filing, and approval processes for separately reimbursable medications and prescription circulation—demonstrates the practical application of agile governance in medical insurance management. The findings suggest that agile governance is a significant method to improve management efficiency and service quality, providing innovative insights for healthcare security reform. Future efforts should further refine agile governance mechanisms to meet the evolving demands of the healthcare security sector.
Key words
agile governance /
medical insurance management in hospital /
digital-intelligent transformation /
policy adaptation /
service optimization
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