摘要
医保基金涉及患方、院方与保方利益,在实际运行中往往监管不力。本文以医保基金监管机制为研究对象,结合镇江市医保反欺诈"亮剑"行动,认为当前医保基金运行监管存在法律法规不健全、宣传不到位、参保人对个人账户认知偏差、信息化建设滞后等问题,进而提出可行的解决策略,为医保基金的有效监管提供参考。
The medical insurance fund involves the interests of the patient,the hospital,and the insurance party,and is often under-regulated in actual operation.This article took the medical insurance fund supervision mechanism as the research object,combined with the Zhenjiang City medical insurance anti-fraud'light sword'action.We found following problems in the current medical insurance fund operation supervision:imperfect laws and regulations,propaganda out of place,account cognitive bias among the insured personal,information construction lag and other issues.The paper proposed a feasible solution strategy to provide reference for the effective supervision of medical insurance funds.
作者
尹庄
YIN Zhuang(Jiangsu Fourth People's Hospital of Zhenjiang City,Zhenjiang Jiangsu 212001,China)
关键词
医疗保险基金
监管
镇江市
medical insurance fund
supervision
zhenjiang City
