目的：（1）通过定性与定量研究方法，建立基本医疗保险参保人就医权益评价指标。（2）通过实证研究，探究门诊和住院参保人就医权益现况。（3）探讨一般人口学因素和使能资源对门诊就医权益的影响。（4）探讨一般人口学因素和使能资源对住院就医权益的影响。（5）比较分析门诊和住院就医权益差异。方法：（1）应用文献分析法回顾和整理国内外患者测评工具，结合医保具体需求，通过归纳法和演绎法开发评价指标；（2）应用专家评价法收集专家意见，计算评价指标内容效度，修改指标条目，研制调查问卷；（3）应用问卷调查法开展调查，通过统计学方法进行信效度检验；（4）采用EXCEL2016和SPSS 29，采用描述性统计、独立样本t检验和二元逻辑回归等方法，描述门诊和住院就医权益现况，进行差异分析和影响因素分析。结果：（1）评价指标建立。依据量表开发一般步骤，建立了门诊和住院两套参保人就医权益评价指标和调查问卷，问卷包括基本信息项和就医权益评价评标。（2）信效度。门诊总量表Cronbachα系数0.910，各分量表Cronbachα系数范围为0.794~0.941；各分量表与总体的相关系数＞0.4。住院总量表Cronbachα系数0.916，各分量表Cronbachα系数范围为0.715~0.949，各分量表与总量表的相关系数＞0.4；内容效度和结构效度良好。（3）得分情况。门诊方面，总得分3.97±0.618、“服务感受和结果”得分4.22±0.648、“服务过程和可及性”得分3.53±0.913、“知情权和申诉权“得分3.88±0.873。住院方面，总得分4.24±0.618、“服务感受和结果”得分4.52±0.582、“服务过程和可及性”得分3.78±0.967、 “知情权和申诉权”得分3.96±0.834。（4）影响因素。自变量性别、婚姻状况、年龄、家庭月收入、医疗保险类型、就医情况对门诊就医权益没有影响；年龄、婚姻状态、医保类型，家庭月收入是住院就医权益的影响因素。（5）门诊和住院差异比较。10项指标有显著性差，除了“缴交预交金”，其他9项指标住院得分都高于门诊。结论：参保人就医权益评价指标信效度佳，能反映医院的就医权益水平，可应用于参保人就医权益量化评价和医保关注问题分析。关键词：参保人就医权益；评价指标建立；信效度检验；实证研究

Objectives: （1） To establish the insurer medical right evaluation indicators through qualitative and quantitative research methods. （2） Through empirical research, explore the current situation of insurer medical rights of outpatients and inpatients. （3） To explore the impact of general demographic factors and enabling resources on the insurer medical rights of outpatient. （4） To explore the impact of general demographic factors and enabling resources on the insurer medical rights of hospitalization. （5） Comparative analysis of the difference in the rights of outpatient and inpatient insurer medical rights.Methods: （1） Review and sort out domestic and foreign patient evaluation tools by using literature analysis method, and develop evaluation indicators by induction and deduction in combination with the specific needs of medical insurance.（2） Apply expert evaluation method to collect expert opinions, and calculate the content validity of evaluation indicators, modify the indicators, and develop a questionnaire.（3） Use the questionnaire survey method to carry out the survey, and conduct the reliability and validity test through statistical methods.（4） Use EXCEL2016 and SPSS 29, use descriptive statistics, independent sample t test and binary Logistic regression and other methods were used to describe the current situation of outpatient and inpatient insurer medical rights, and to conduct difference analysis and influencing factor analysis.Results: （1） Establish of evaluation indicators. According to the general steps of scale development, two sets of evaluation indicators and questionnaires for the insurer medical right in outpatient and inpatient treatment were established, including basic information items and evaluation of the insurer medical right. （2） Reliability and validity. The Cronbach α coefficient of the total outpatient scale was 0.910, and the Cronbach α coefficient of each subscale ranged from 0.794 to 0.941. The correlation coefficient between each subscale and the whole was ＞0.4. The Cronbach α coefficient of the total hospitalization scale was 0.916, and the Cronbach α coefficient range of each subscale was 0.715-0.949, and the correlation coefficient between each subscale and the total scale was ＞0.4. The content validity and construct validity are good. （3） Score. In terms of outpatient clinics, the total score was 3.97±0.618, the score of “service experience and result” was 4.22±0.648, the score of “service process and accessibility” was 3.53±0.913, and the score of “right to know and appeal” was 3.88±0.873. In terms of hospitalization, the total score was 4.24±0.618, the score of “service experience and result” was 4.52±0.582, the score of “service process and accessibility” was 3.78±0.967, and the score of “right to know and appeal” was 3.96±0.834. （4） Influencing factors. gender, marital status, age, monthly family income, type of medical insurance, and medical treatment have no effect on the right to the insurer medical right of outpatient; age, marital status, type of medical insurance, and monthly family income are the influencing factors on the right to the insurer medical right of inpatient. （5） Comparison of outpatient and inpatient differences. 10 indicators are significantly different, except for ＂payment of advance payment＂, other indicators are higher than outpatient.Conclusion: The insurer medical right evaluation indicators has good reliability and validity, which can reflect the level of hospitals‘ medical rights and interests, and can be applied to the quantitative evaluation of the insurer medical right and the analysis of medical insurance concerns.Key words: The insurer medical rights; Establishment of evaluation indicators; Reliability and validity test; Empirical research