Exploration of Compliance Management Path for Medical Insurance in Designated Medical Institutions Based on SPO Model
In order to effectively crack down the illegal and fraudulent use of medical insurance fund by designated medical institutions in China,this article proposes the construction of a designated medical institution medical insurance compliance management system with"structure-process-outcome"as the core,with the SPO model.In terms of the structural management,it is suggested to establish regulations and organizational structures for designated medical institutions to comply with medical insurance regulations.In terms of the refined process management,it is suggested to improve the full process compliance operation mechanism of medical insurance,including"pre-notification,in-process supervision,and post analysis".In terms of outcome management,it is suggested to establish a feedback mechanism of medical insurance supervision platform data and the satisfaction survey of medical insurance use between doctors and patients.The paper shows that establishing a compliance management mechanism for medical insurance in designated medical institutions can promote the combination of passive supervision and active compliance in the management of medical insurance fund,which is conducive to ensuring the safety and stability of medical insurance fund in China.
designated medical institutionsmedical insurance fraudmedical insurance compliance managementSPO model
万方数据
维普
