Research on Influencing Factors and Countermeasures of Basic Medical Insurance Fraud Phenomenon Based on a Fuzzy-set Qualitative Comparative Analysis of 31 Provinces in China
Instances of fraud in basic medical insurance occur from time to time, posing a significant threat to the security of medical insurance funds and exerting pressure on fund supervision while attracting societal attention. This paper adopts a public policy perspective and utilizes the classic policy implementation model as a theoretical foundation. Using the fuzzy-set qualitative comparative analysis( fsQCA) method, it selects typical cases from 31 provincial-level regions published by the national health-care security administration to explore the factors and pathways influencing fraudulent activities in basic medical insurance. The following conclusions are drawn:three configurations contribute to the high incidence of health insurance fraud, namely, the"in-sufficient fund surplus"type, the"economic-regulatory imbalance"type, and the"weak economic development"type. The over-all strategy for governance is to adjust and optimize the level of financial social security. Specific countermeasures for the afore-mentioned configurations include implementing refined management of healthcare insurance funds, strengthening information technology infrastructure, and promoting the development of people's livelihood economy.
basic medical insurancefraudinfluencing factorscountermeasuresfsQCA
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