Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents

Liang Zhang; Honghong Li

doi:doi:10.11648/j.ajhr.20251303.17

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Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents

Liang Zhang^*, Honghong Li

Published in American Journal of Health Research (Volume 13, Issue 3)

Received: 21 April 2025 Accepted: 3 June 2025 Published: 11 June 2025

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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.

Published in	American Journal of Health Research (Volume 13, Issue 3)
DOI	10.11648/j.ajhr.20251303.17
Page(s)	178-185
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

China's Medical Insurance Fund, Achievements, Performance Indicators, Examination of Normative Documents

References

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[8]	Zhang Zaisheng, Xu Aihao (2015). Construction and Application of Evaluation Index System for Medical Insurance System —Taking Urban-Rural Resident Medical Insurance System of Tianjin as an Example. Chinese Public Administration, 2015, (1): 99-103. https://doi.org/10.3782/j.issn.1006-0863.2015.01.18
[9]	Wanbin, Hu Dayang, Zhang Wei, etc (2020). Study on the Operation Performance of Medical Insurance Funds in Jiangsu under the Medical and Drug Insurance Policy Reform. Chinese Health Economics, 2020, 39(4): 36-39. https://doi.org/10.7664/CHE20200410
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[14]	Li Weine, Fan Jinyuan (2013). Establishment of Internal Performance Evaluation Indicators for Retail Drugstore in Haikou City. China Pharmacy, 2013, 24(21): 2014-2016. https://doi.org/10.6039/j.issn.1001-0408.2013.21.33
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APA Style

Zhang, L., Li, H. (2025). Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents. American Journal of Health Research, 13(3), 178-185. https://doi.org/10.11648/j.ajhr.20251303.17

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ACS Style

Zhang, L.; Li, H. Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents. Am. J. Health Res. 2025, 13(3), 178-185. doi: 10.11648/j.ajhr.20251303.17

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AMA Style

Zhang L, Li H. Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents. Am J Health Res. 2025;13(3):178-185. doi: 10.11648/j.ajhr.20251303.17

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@article{10.11648/j.ajhr.20251303.17,
  author = {Liang Zhang and Honghong Li},
  title = {Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents
},
  journal = {American Journal of Health Research},
  volume = {13},
  number = {3},
  pages = {178-185},
  doi = {10.11648/j.ajhr.20251303.17},
  url = {https://doi.org/10.11648/j.ajhr.20251303.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20251303.17},
  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.
},
 year = {2025}
}

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TY  - JOUR
T1  - Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents

AU  - Liang Zhang
AU  - Honghong Li
Y1  - 2025/06/11
PY  - 2025
N1  - https://doi.org/10.11648/j.ajhr.20251303.17
DO  - 10.11648/j.ajhr.20251303.17
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 178
EP  - 185
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20251303.17
AB  - 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.

VL  - 13
IS  - 3
ER  -

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Author Information

Liang Zhang

School of Law, Shanxi University, Taiyuan, China

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Honghong Li

Shanxi Jinlai Law Firm, Taiyuan, China

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Plain Text BibTeX RIS

APA Style

Zhang, L., Li, H. (2025). Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents. American Journal of Health Research, 13(3), 178-185. https://doi.org/10.11648/j.ajhr.20251303.17

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ACS Style

Zhang, L.; Li, H. Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents. Am. J. Health Res. 2025, 13(3), 178-185. doi: 10.11648/j.ajhr.20251303.17

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AMA Style

Zhang L, Li H. Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents. Am J Health Res. 2025;13(3):178-185. doi: 10.11648/j.ajhr.20251303.17

Copy | Download

@article{10.11648/j.ajhr.20251303.17,
  author = {Liang Zhang and Honghong Li},
  title = {Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents
},
  journal = {American Journal of Health Research},
  volume = {13},
  number = {3},
  pages = {178-185},
  doi = {10.11648/j.ajhr.20251303.17},
  url = {https://doi.org/10.11648/j.ajhr.20251303.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20251303.17},
  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.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Research on Performance Management Indicators for the Use of China's Local Basic Medical Insurance Funds — A Study Conducted on 86 Normative Documents

AU  - Liang Zhang
AU  - Honghong Li
Y1  - 2025/06/11
PY  - 2025
N1  - https://doi.org/10.11648/j.ajhr.20251303.17
DO  - 10.11648/j.ajhr.20251303.17
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 178
EP  - 185
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20251303.17
AB  - 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.

VL  - 13
IS  - 3
ER  -

Copy | Download