Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents
Year: 2025
Type: article
Abstract: The scientific design of performance indicators for the use of medical insurance funds contributes to the dynamic development of China's medical insurance management from extensive to refined, from rigid to dynamic, and from procedural fairness to substantive fairness. This study conducted a literature review on the local legislative or policy norms regarding medical insurance performance indicators in 86 cities in China, analyzed the current status and existing problems in the design of medical insurance performance indicators in China, and finally proposed suggestions for future improvement paths. Research has found that in China, the basic framework for medical insurance performance has been established in various regions, including indicator objects, indicator content, assessment methods, and result application. However, there are still many imperfections in the design of China's medical insurance performance indicators, such as the lack of regional differences and an obvious "one size fits all" phenomenon, a lack of scientificity in the design of indicators, a single assessment subject, a lack of diversity in participation, and an imbalance in the reward and punishment mechanism. The core contradiction lies in the imbalance between "cost control targets" and "medical service laws" and "patient health needs." This study helps provide a macro-level overall understanding of the design of current Chinese medical insurance performance indicators.
Authors: Liang Zhang, Honghong Li
Institution: Shanxi University
Language: English
Subfield: Finance
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4411839844