目的: 推动医疗保障领域信用监管优化,保障医保基金安全高效使用及公民医疗保障合法权益,为全国医保信用监管地方探索提供参考。方法: 以湖南省医保信用监管实践为研究对象,结合政策文件、试点城市验收报告、专项调研数据,从制度、平台、结果应用三方面分析现状,梳理问题并提出对策。结果: 湖南省已建立医保信用管理体系,建成数据共享平台并开展多城市试点,但在事前预防、事中管控、事后处置环节仍存在制度细化不足、信息化支撑薄弱等问题。结论: 需从事前强化制度与教育、事中夯实数据与监管、事后健全奖惩与修复体系三方面完善,以提升医保信用监管科学性与有效性。
Abstract
Objective: The paper attempts to promote the optimization of credit supervision in the field of healthcare security, ensure the safe and efficient use of medical insurance funds and the legitimate rights and interests of citizens' healthcare security, and provide reference for the local exploration of healthcare security credit supervision in China. Methods: Taking the practice of healthcare security credit supervision in Hunan Province as the research object, combined with policy documents, acceptance reports of pilot cities and special investigation data, the current situation was analyzed from three aspects of system, platform and application of results, and the problems were analyzed and countermeasures were proposed. Results: Hunan Province has established a healthcare security credit management system, built a data sharing platform and carried out multi-city pilots, but there are still problems such as insufficient system refinement and weak information support in the links of pre-prevention, in-process control and post-handling. Conclusion: It is necessary to strengthen the system and education before the event, consolidate data and supervision during the event, and improve the reward, punishment and repair system after the event, so as to improve the scientificity and effectiveness of healthcare security credit supervision.
关键词
医疗保障 /
信用监管 /
分级分类监管 /
信用修复
Key words
healthcare security /
credit supervision /
hierarchical and classified supervision /
credit repair
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