多中心主体参与医保基金监管策略研究
Research on the Strategy of Multi-center Subjects Participating the Supervision of Medical Insurance Funds
蔡滨 1周罗晶 1史力群 1王静成 1毛向阳 1张莹 1汤佳1
作者信息
- 1. 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
- 折叠
摘要
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.
Abstract
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.
关键词
多中心治理/医保基金/欺诈骗保/信息不对称Key words
multi-center governance/medical insurance fund/insurance fraud/information asymmetry引用本文复制引用
基金项目
江苏省教育厅高等学校哲学社会科学基金(2023)(2023SJYB2056)
国家社会科学基金一般项目(2019)(19BSH068)
江苏省社会科学基金青年项目(2018)(18GLC005)
出版年
2024
NETL
NSTL
万方数据