摘要
医疗保障基金的合理使用对于推进公立医院高质量发展起着重要作用,基金监管呈法治化、常态化、专业化、规范化态势,飞行检查工作将成为常态.作者系统分析了医疗保障基金飞行检查的3个主要趋势特征,即力度逐渐加大、手段不断创新、后果愈加严重,并从结果表现形式、严重程度、归属范围、有无主观意愿和监管筛查思路5个维度梳理飞行检查中暴露的问题;从合规意识、组织体系、精细管理和日常监管4个方面出发,探索医疗保障基金飞行检查对于医院管理的启示,提出公立医院应转换角色与站位,健全部门协同配合的工作机制,在政策理解、制度制定、流程设计、信息支撑、数据治理、监管落实、人员培训和绩效配套方面做到精细管理"八个到位",同时应将医院内部模拟飞行检查作为常态化工作.
Abstract
The rational use of medical insurance fund(MIF)plays an important role in promoting the high-quality development of public hospitals,and the supervision of MIF is in a trend of under the rule of law,normalization,professionalization and standardization,and unannounced inspection will become the norm.The authors systematically analyzed three main trends of MIF unannounced inspections,namely,gradually increasing intensity,constantly innovating methods,and increasingly serious consequences.The problems exposed in unannounced inspections were sorted out from five dimensions:form of results,severity,scope of attribution,subjective intention,and regulatory screening ideas.The enlightenment of MIF unannounced inspections to hospital management was explored from four aspects:compliance awareness,organizational system,fine management,and daily supervision.It was proposed that public hospitals should transform their roles and positions,improve the working mechanism of departmental collaboration,and achieve fine management in policy understanding,system formulation,process design,information support,data governance,regulatory implementation,personnel training,and performance matching.At the same time,internal simulated unannounced inspections in hospitals should be regarded as a routine work.
维普
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