ArticleBMC health services research2025
What goals does China's medical insurance fund supervision aim to achieve? A quantitative analysis based on national-level policies.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe goals of medical insurance fund supervision will influence the selection of supervisory methods and their effectiveness. This study aims to identify the multiple goals of China's medical insurance fund supervision and to examine the hierarchy and proximity among these goals.
methods133 national-level policies related to the goals of medical insurance fund supervision in China were selected. Frequency ranking and social network analysis were used to explore the hierarchical relationships among these goals. The Ochiai coefficient in the similarity matrix was used to assess the proximity. Clustering analysis was performed via the generation of a dendrogram, while multidimensional scaling was applied to validate the clustering results.
resultsFund security was the most frequently cited goal (11.01%) among the 84 goals, followed by ending insurance fraud (8.55%) and protecting the rights and interests of citizens (6.38%). Efficiency and economy-related goals, such as fund security and intelligence, were prioritized over public-oriented goals like social participation and justice. The correlation coefficients among the goals ranged from 0.000 to 0.602, with the strongest association observed between fairness and justice (r = 0.602).
conclusionsThe supervision of China's medical insurance fund involves diverse goals that are interrelated and centered on the core objectives of ensuring fund security, combating medical insurance fraud, and safeguarding citizens' rights and interests. They can be distilled into five categories: fairness, citizenship, efficiency, administration, and social welfare. These findings can provide empirical evidence for the governance of goal conflicts in medical insurance fund supervision and the construction of an assessment framework for supervisory efforts.
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