会计学院知识库

党的二十大报告中指出，“人民健康是民族昌盛和国家强盛的重要标志。把保障人民健康放在优先发展的战略位置，完善人民健康促进政策。”医疗保险基金不仅是医保制度发展的“基石”，更是人民群众的“救命钱”。十八大以来，审计署始终将医保基金审计作为工作重点，但我国目前尚未形成一套科学、完整、统一的医保基金绩效审计评价指标体系。加强医保基金绩效审计，有助于推动医疗健康事业的高质量发展。在此背景之下，本文通过构建医保基金绩效审计评价指标体系，以达到提高医保基金绩效审计工作效率的目的。不仅有助于丰富医保基金绩效审计评价的理论研究内容，也能为各地区构建医保基金绩效审计评价指标体系提供参考和启发。

本文运用案例研究法，在梳理了大量国内外文献的基础上，首先整理了甘肃省“十三五”期间医疗保险基金的制度执行情况，然后以甘肃省2020年医疗保险基金绩效审计为案例，全面论述了当前甘肃省医疗保险基金绩效审计概况，发现现阶段甘肃省医保基金绩效审计评价方面存在评价指标体系不完善、评价标准尚未统一、部分评价指标选取缺乏灵活性、评价基础数据提取率低的问题。针对以上问题，本文利用层次分析法，以“顶层设计”原则为导向，根据医保基金的资金运转流程，从医疗保险基金的筹集、使用、管理、监督四个阶段着手，结合“5E”绩效审计理论及前人的研究成果，构建了甘肃省医疗保险基金绩效审计评价指标体系。随后将该评价指标体系实际运用于甘肃省医疗保险基金绩效审计评价中，在收集相关领域的专家意见之后，采用模糊综合评价法对甘肃省医疗保险基金的实际运行情况进行得分计算，并得出结论：甘肃省医疗保险基金整体运行情况良好，能够起到保障全省人民健康、提高人民群众获得感的作用。该评价结果也与甘肃省医保基金的实际运行情况相符，证明了本文所构建的评价指标体系具有一定可行性。最后，本文提出了推行甘肃省医保基金绩效审计评价指标体系的保障措施，以期通过构建医保基金绩效审计评价指标体系，更好的反映出甘肃省医保基金的运行情况，进一步提高甘肃省医保基金的使用效能，为甘肃省人民健康提供更好的经济保障。

As stated in the Report of the Party's 20th National Congress, "The health of the people is an important symbol of the prosperity of the nation and the prosperity of the country. We will make ensuring people's health a strategic priority and improve policies to promote people's health." The medical insurance fund is not only the "cornerstone" of the development of the medical insurance system, but also the "life-saving money" of the people. Since the 18th National Congress of the CPC, the National Audit Office has been focusing on the audit of medical insurance funds. However, a scientific, complete and unified evaluation index system of medical insurance fund performance audit has not been formed yet. Strengthening the performance audit of medical insurance funds is conducive to promoting the high-quality development of medical and health undertakings. Under this background, this paper establishes the evaluation index system of medical insurance fund performance audit to improve the efficiency of medical insurance fund performance audit. It not only helps to enrich the theoretical research content of medical insurance fund performance audit evaluation, but also provides reference and inspiration for each region to construct the evaluation index system of medical insurance fund performance audit.

This paper uses the case study method, on the basis of combing a large number of domestic and foreign literature, firstly sorts out the implementation of the medical insurance fund system in Gansu Province during the 13th Five-Year Plan period, and then takes the performance audit of the medical insurance fund in 2020 as a case to comprehensively discuss the current performance audit of the medical insurance fund in Gansu Province. It is found that the evaluation index system is not perfect, the evaluation standard is not unified, the selection of some evaluation indexes is not flexible, and the extraction rate of basic evaluation data is low. To solve the above problems, this paper uses analytic hierarchy process (AHP), guided by the principle of "top-level design", according to the fund operation process of medical insurance fund, starts from the four stages of raising, using, managing and supervising medical insurance fund, and combines the "5E" performance audit theory and previous research results to build the performance audit evaluation index system of medical insurance fund in Gansu Province. Then, the evaluation index system was actually applied in the performance audit evaluation of medical insurance fund in Gansu province. After collecting the expert opinions in related fields, the fuzzy comprehensive evaluation method was adopted to calculate the score of the actual operation of medical insurance fund in Gansu Province, and the conclusion was drawn: The medical insurance fund of Gansu Province runs well, which can protect the health of the whole province and improve the people's sense of gain. The evaluation results are also consistent with the actual operation of the medical insurance fund in Gansu Province, which proves that the evaluation index system constructed in this paper has certain feasibility. Finally, this paper puts forward the safeguard measures to implement the performance audit evaluation index system of Gansu medical insurance fund, in order to better reflect the operation of Gansu medical insurance fund, further improve the use efficiency of Gansu medical insurance fund, and provide better economic security for the health of Gansu people by constructing the performance audit evaluation index system of Gansu medical insurance fund.