摘要
宁夏回族自治区于2012年起探索实施医保监控制度以来,立足于基础数据的管理和完善,逐渐建立起了内涵丰富的医学知识数据库,并以医保结算源头数据为抓手,加强基础数据规范,推进监管精细化。通过专项整治,5年间,追回医保违规基金5000余万元,查处协议机构900余家(次),暂停了32名医保医师资格。随着医疗支付和医保违规问题的日益复杂,医保监控基础数据也面临着极大的考验,本文立足于宁夏医保基金监管的现实需求,对当前监控数据体系不完善、源头数据质量薄弱、数据应用存在制约等现实问题进行了分析,对进一步完善基础数据提出了建议。
Based on the management and improvement of basic data, Ningxia Hui Autonomous Region has explored and implemented the medical insurance monitoring system since 2012, and has gradually established a rich database. And based on the source data of medical insurance settlement, we should promote regulatory refi nement. Over the past 5 years, more than 50 million yuan has been recovered, and more than 900 institutions have been investigated and dealt with, and 32 medical insurance doctors have been suspended. With the increasing complexity of medical payment and medical insurance violations, the basic data of medical insurance monitoring is also facing great challenges. Based on the actual needs of Ningxia medical insurance fund supervision, this paper analyzes the current problems and puts forward some suggestions.
作者
李明
包慧军
Li Ming;Bao Huijun(Ningxia Hui Autonomous Region Social Insurance Administration, Yinchuan, 750001)
出处
《中国医疗保险》
2018年第5期32-35,共4页
China Health Insurance
关键词
医疗保险
监控
基础数据
medical insurance, supervision, basic data
