摘要
目的:探索欺诈骗保现象频发的关键因素,并建立归因模型,为医保反欺诈治理工作提供参考。方法:基于程序化扎根理论,利用NVivo11软件的词频分析、编码分析功能对纳入的42篇文献进行三级编码。结果:提取与欺诈骗保有关的初始概念47个、范畴19个、主范畴5个、核心范畴1个。结论:欺诈骗保是多因素综合作用的结果,包括四条归因路径——监管者归因路径、被监管者归因路径、产品特殊性归因路径以及制度机制归因路径。
Objective To explore the key factors of the frequent occurrence of insurance fraud in basic medical insurance,and to establish an attribution model,so as to provide policy suggestions for promoting anti-fraud governance.Methods Based on proceduralised grounded theory,the word frequency analysis and coding analysis of NVivo 11 software were used to encode 42 included articles at three levels.Results Related to medicare fraud,a total of 47 initial concepts,19 categories,5 main categories and 1 core category were extracted.Conclusion Medicare fraud is the result of multiple factors,which can be summarized into four typical paths,including regulator attribution path,regulated attribution path,product particularity attribution path and institutional mechanism attribution path.
作者
陈清华
刘青
吴海波
CHEN Qinghua;LIU Qin;WU Haibo(School of Economics and Management,Jiangxi University of Traditional Chinese Medicine,Nanchang Jiangxi 330004,China;不详)
关键词
欺诈骗保
程序化扎根理论
归因路径
medicare fraud
proceduralised grounded theory
attribution path
