ArticleFrontiers in public health2025
A medical insurance fund operation performance evaluation system under the DRG payment mode reform.
Article in Frontiers in public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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7 citing papers in PubMed.
- Temporal Patterns in Hospital Performance Indicators in the Chilean Public Hospital System: A Longitudinal Analysis Using Dimensionless Coefficients.Healthcare (Basel, Switzerland) · 2026Article
- Financing Regimes and Case-Mix Complexity in Psychiatric Hospitals Beyond the Pandemic Shock-Insights from a Regional European Healthcare System.Healthcare (Basel, Switzerland) · 2026Article
- Impacts of medical insurance payment reform (DRG) on public medical institutions: evidence from pilot cities in China.BMC health services research · 2026Article
- A sequential mixed-methods study to develop and validate the nursing infection control effectiveness index (NICEI).BMC nursing · 2026Article
- Spatiotemporal evolution and spatial benefit analysis of the coupling coordination of China's three medical systems.Frontiers in public health · 2026Article
- Article
- Adaptability research on lean management under medical insurance payment reform: threshold effect of DRG/DIP reform intensity and operational efficiency of traditional Chinese medicine hospitals.Frontiers in public health · 2025Article
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3 authors.
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Abstract
Background: An 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. Methods: This 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. Results: As 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. Conclusion: This 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.
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