通讯作者: 胡敏, humin@fudan.edu.cn

DOI：10.12201/bmr.202009.00017

The Importance and Realization Strategy of Credit Management of Designated Medical Institutions in the Supervision of Medical Insurance Fund

• 摘要：我国医保基金安全面临重大挑战，而当前的医保基金监管体系存在局限性，对此，我国提出将信用管理引入医保基金监管。信用管理的机制和作用可对现有医保基金监管体系形成有效补充，其能够拓展医保监管内容，要求医疗机构合理使用医保基金；延伸医保监管时效，保证基金监管力度；补充医保监管手段，引导医疗机构自觉约束服务行为。为最大化实现信用管理的目标，需构建起一套适用于定点医疗机构的信用评分指标体系，以及综合多指标来源的信用监测及评价体系，并在此基础上明确信用结果在医疗机构监管中的作用和流程，使信用管理起到守信激励和失信惩戒的效力，最终形成完善的医保信用管理制度体系，保障信用管理体系对定点医疗机构发挥最大作用。

  关键词： 医疗保险; 医保基金监管; 信用管理; 社会信用体系

   

  Abstract: In China, the safety of medical insurance fund is faced with major challenges, and current medical insurance fund supervision system has some limitations. Therefore, it is proposed to introduce credit management into the supervision of medical insurance fund. The mechanism and function of credit management can form an effective supplement to the existing medical insurance fund supervision system, which can expand the content of medical insurance supervision and require medical institutions to make rational use of medical insurance fund, extend the limitation of medical insurance supervision to ensure the supervision of the fund, supplement medical insurance supervision means and guide medical institutions to voluntarily restrict service behaviors. To maximize the realization of the goal of credit management, it is necessary to construct a set of credit score index system applicable to designated medical institutions and a comprehensive credit monitoring and evaluation system based on multiple index sources. On this basis, the role and process of credit results in the actual supervision of medical institutions should be clarified, so that credit management can play the effect of trustworthy incentive and dishonest punishment, and finally form a perfect medical insurance credit management system to ensure that the credit management system plays the greatest role in the designated medical institutions of medical insurance.

  Key words: health insurance; supervision of medical insurance fund; credit management; social credit system

  提交时间：2020-12-15

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2020-09-21	bmr.202009.00017V1	下载

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