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多中心主体参与医保基金监管策略研究

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目的:加强医保基金监管,实现医保基金可持续、高质量运行.方法:以多中心治理理论为支撑,基于国家相关统计年鉴及政策披露情况,分析了医保基金监管面临的困境,对"欺诈骗保"违法犯罪行为情况进行了分类.结果:信息不对称、医院控费内生动力不足等因素导致"欺诈骗保"屡禁不止.结论:基于多中心治理理论,从政府、医院、群众3个层面提出了强化医保基金监管的路径策略.
Research on the Strategy of Multi-center Subjects Participating the Supervision of Medical Insurance Funds
Objective:Strengthen the supervision of medical insurance funds,in order to achieve sustainable and high-quality operation of medical insurance funds.Methods:Supported by the theory of multi-center governance,based on the relevant national statistical yearbooks,it analyzes the difficulties faced by the supervision of medical insurance funds,and classifies the illegal and criminal behaviors of"defrauding health insurance".Results:Information asymmetry,insufficient hospital fee-control endogenous incentive,and other factors lead to"insurance fraud"is unceasing.Conclusion:Based on the theory of multi-center governance,it puts forward the path selection of strengthening the supervision of medical insurance funds from the the levels of government,hospitals and the residents.

multi-center governancemedical insurance fundinsurance fraudinformation asymmetry

蔡滨、周罗晶、史力群、王静成、毛向阳、张莹、汤佳

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扬州大学临床医学院·扬州大学医院管理研究院 江苏 扬州 225000

多中心治理 医保基金 欺诈骗保 信息不对称

江苏省教育厅高等学校哲学社会科学基金(2023)国家社会科学基金一般项目(2019)江苏省社会科学基金青年项目(2018)

2023SJYB205619BSH06818GLC005

2024

中国卫生经济
中国卫生经济学会,卫生部卫生经济研究所

中国卫生经济

CSTPCDCHSSCD北大核心
影响因子:1.524
ISSN:1003-0743
年,卷(期):2024.43(4)
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