摘要
目的:探讨医保欺诈公众参与举报的现实窘境及成因。方法:通过现场问卷调查和管理人员访谈收集到相关数据资料,随后构建结构方程模型,对举报窘境成因进行实证分析。结果:政策知晓对公众参与举报产生了负面影响;风险感知并未降低公众参与举报的积极性;公众的欺诈识别能力存在不足,无法及时发现欺诈案件是妨碍其参与举报的又一重要因素。结论:可从优化举报奖励政策、完善举报基础设施、强化反欺诈宣教工作等方面突破医保欺诈公众参与现实窘境。
Objective To explore the realistic dilemma and causes of public’s participation in whistleblowing medical insurance fraud.Methods Relevant data were collected through on-site questionnaire surveys and manager interviews,which were used to construct a structural equation model to empirically analyse the causes of whistleblowing dilemma.Results Policy awareness had a negative impact on the public’s participation in whistleblowing.Risk perception did not reduce the enthusiasm of the public to participate in whistleblowing.The deficiencies in the public’s fraud recognition skills and the inability to detect fraudulent insurance practices in time were other important factors to prevented them from participating in whistleblowing.Conclusion The dilemma of the public’s participation in social medical insurance fraud can be overcome by optimizing the whistleblowing reward policy,improving the whistleblowing infrastructure and strengthening anti-fraud education.
作者
王丹丹
詹长春
Wang Dandan(School of Administration,Jiangsu University,Zhenjiang,P.R.China)
出处
《中国卫生事业管理》
北大核心
2022年第12期912-916,共5页
Chinese Health Service Management
基金
国家社会科学基金项目“协同治理视角下社会医疗保险欺诈行为监测与反欺诈机制研究”(19BGL200)
2021年江苏省研究生科研创新计划项目“协同治理视角下社会医疗保险欺诈行为群众举报效果研究”(KYCX21_3318)。
关键词
欺诈骗保行为
举报
公众参与
窘境
成因
fraudulent insurance practices
whistleblowing
public’s participation
dilemma
causes
