医保基金有效监管的机制创新——以镇江市医保反欺诈“亮剑”行动为例
|
摘要
医保基金涉及患方、院方与保方利益,在实际运行中往往监管不力。本文以医保基金监管机制为研究对象,结合镇江市医保反欺诈"亮剑"行动,认为当前医保基金运行监管存在法律法规不健全、宣传不到位、参保人对个人账户认知偏差、信息化建设滞后等问题,进而提出可行的解决策略,为医保基金的有效监管提供参考。
The medical insurance fund involves the interests of the patient,the hospital,and the insurance party,and is often under-regulated in actual operation. This article took the medical insurance fund supervision mechanism as the research object,combined with the Zhenjiang City medical insurance anti-fraud"light sword"action. We found following problems in the current medical insurance fund operation supervision: imperfect laws and regulations,propaganda out of place,account cognitive bias among the insured personal,information construction lag and other issues. The paper proposed a feasible solution strategy to provide reference for the effective supervision of medical insurance funds.
The medical insurance fund involves the interests of the patient,the hospital,and the insurance party,and is often under-regulated in actual operation. This article took the medical insurance fund supervision mechanism as the research object,combined with the Zhenjiang City medical insurance anti-fraud"light sword"action. We found following problems in the current medical insurance fund operation supervision: imperfect laws and regulations,propaganda out of place,account cognitive bias among the insured personal,information construction lag and other issues. The paper proposed a feasible solution strategy to provide reference for the effective supervision of medical insurance funds.
引文
[1]谢军.关于医疗保险基金监管问题分析与建议[J].企业改革与管理,2015(8):195.
[2]支济祥.大数据背景下我国医保基金风险防控研究[J].中国卫生产业,2017(8):12.
[3]刘格华.医疗保险基金欺诈形式分析及对策研究[J].中国总会计师,2015(6):49-52.
[4]王静文,安伟娟,李宏超,等.我国医保基金监管现状分析[J].人才资源开发,2017(20):78-79.
[5]张功震.医保分肥与监管体制的变革[J].中国卫生事业管理,2017(3):169-171.
[6]张再生,李亚男.中国医疗保险法律体系的发展与改革[J].中国卫生政策研究,2015(4):35-40.
[7]李怡梅.协调三方利益完善医保管理实现三方共赢[J].知识经济,2014(10):11-12.
[8]方子,谢俏丽,张凤帆,等.我国现代医院管理制度中的运行监管与行业监管策略[J].中国医院管理,2015(1):7-9.
[2]支济祥.大数据背景下我国医保基金风险防控研究[J].中国卫生产业,2017(8):12.
[3]刘格华.医疗保险基金欺诈形式分析及对策研究[J].中国总会计师,2015(6):49-52.
[4]王静文,安伟娟,李宏超,等.我国医保基金监管现状分析[J].人才资源开发,2017(20):78-79.
[5]张功震.医保分肥与监管体制的变革[J].中国卫生事业管理,2017(3):169-171.
[6]张再生,李亚男.中国医疗保险法律体系的发展与改革[J].中国卫生政策研究,2015(4):35-40.
[7]李怡梅.协调三方利益完善医保管理实现三方共赢[J].知识经济,2014(10):11-12.
[8]方子,谢俏丽,张凤帆,等.我国现代医院管理制度中的运行监管与行业监管策略[J].中国医院管理,2015(1):7-9.