医保基金是人民群众的“救命钱”,党中央、国务院历来高度重视医保基金安全工作,国家医保局组建以来,每年采取飞行检查等监管措施持续巩固打击欺诈骗保高压态势。引入第三方力量参与飞行检查,可以弥补医保部门监管人员数量较少、专业与检查内容不匹配等问题,进一步提高监管专业化水平和监管质效。但在实际检查过程中,第三方机构参与的可持续性、自身人员配置、与检查组的协同配合等方面仍存在一定的不足。下一步应探索对第三方机构开展绩效评价及结果应用,加大财政支持力度,持续优化第三方力量。同时,在利用好第三方力量基础上,继续加强医保部门的监管队伍建设,从而推进飞行检查长效化。

Medical insurance funds are the life-saving money of the people. The Party Central Committee and the State Council have always attached great importance to the safety of medical insurance funds. Since the establishment of the National Healthcare Security Administration, regulatory measures such as unannounced inspections have been taken every year to continuously consolidate the high-pressure situation of cracking down on medical insurance fraud. Introducing third-party forces to participate in unannounced inspections can alleviate issues such as the understaffed regulatory personnel in the medical insurance department and the mismatch between their academic background and the inspection content, further improving the regulatory specialization,quality and efficiency. However, in the actual inspection process, there are still certain shortcomings in the sustainability of third-party institutions' participation, their own personnel allocation, and collaboration with the inspection team. The next step is to explore the performance evaluation and result application of third-party institutions, increase financial support, and continuously optimize third-party forces. At the same time, on the basis of making good use of third-party forces, we will continue to strengthen the construction of the regulatory team of the medical insurance department, in order to promote the long-term effectiveness of unannounced inspections.