摘要
欺诈骗保行为严重影响了医保基金使用的效率与公平,而医保基金监管制度的不健全是加剧此现象的原因之一。前期我国部分城市关于建立医保基金信用监管体系的实践探索各有亮点,但仍不同程度地存在法律保障缺失、评价指标体系缺乏科学性与合理性、第三方参与不足以及缺少联合惩戒措施等问题。本文通过文献综述法,总结国内外建立医保基金信用监管体系的学术观点与实践探索,旨在分析实践经验,为我国探索建立医保基金信用监管体系提供政策建议。
Fraud and fraudulent insurance has seriously affected the efficiency and fairness of the use of medical insurance funds,and the imperfect supervision system of medical insurance funds is one of the reasons for exacerbating this phenomenon.In the early stage of some cities in my country,the practice of establishing a credit supervision system for medical insurance funds has its own bright spots,but there are still problems such as lack of legal protection,lack of scientific and rational evaluation index system,lack of third-party participation,and lack of joint disciplinary measures.Through the literature review method,this paper summarizes the academic viewpoints and practical explorations of establishing a medical insurance fund credit supervision system at home and abroad,aiming to analyze the practical experience and provide policy suggestions for the exploration and establishment of a medical insurance fund credit supervision system in our country.
作者
张秀梅
岳凌宇
牟凌霄
刘嘉慧
时涛
ZHANG Xiumei;YUE Lingyu;MOU Lingxiao;LIU Jiahui;SHI Tao(School of Medical Insurance,Shandong First Medical University(Shandong Academy of Medical Sciences),Jinan,Shandong Province,250117 China)
出处
《中国卫生产业》
2022年第18期128-130,136,共4页
China Health Industry
基金
国家级大学生创新创业训练计划项目(202110439010)
教育部产学合作协同育人项目(202102484005)
省级大学生创新创业训练计划项目(S202210439006)
山东省社会科学规划项目(21AWTJ08)
山东省教育教学研究重点项目(2021JXZ006)
济南市医疗保障局委托项目(202101)。
关键词
医保基金
信用管理
基金监管
医保改革
Medical insurance fund
Credit management
Fund supervision
Medical insurance reform
