Исследование процесса контроля медицинской помощи медицинской организации в рамках программы обязательного медицинского страхования

Abstract

The article deals with the research of the process of medical organization service control in the scope of compulsory health insurance program using methods of system analysis, such as IDEF0 and activity diagrams. For estimation of medical expert’s agreement, Cohen’s kappa was used. As a result, aformal model of the analyzed process and subprocesses with determined inputs, outputs, elements of managementand executives was presented. It was concluded that it is necessary to develop an intellectual information system for estimating clinical records concerning getting financial resources for clinical service.