目的: 明确医保支付资格记分规则的适用边界,构建科学的责任认定体系。方法: 基于比例原则与制度目标协调视角,论证记分范围,提出记分触发阈值;从主观过错、原因力强度等维度构建四要件归责体系。结果: 记分范围泛化和责任认定不清是主要挑战,阈值设定可防止责任泛化,四要件体系可区分主要、重要及一般责任。结论: 精准追责有助于提升基金监管效能与制度公信力。

Objective: The paper attempts to clarify the application range of the scoring rules for healthcare security payment eligibility and establish a scientific responsibility recognition system. Methods: Based on the principle of proportionality and the perspective of coordinating institutional goals, the paper demonstrates the scoring range and proposes a scoring trigger threshold, meanwhile, it constructs a four-element attribution system from the dimensions of subjective fault, causative potency, etc. Results: The main challenges are the generalization of scoring scope and unclear identification of responsibilities. Threshold setting can prevent the generalization of responsibilities, and the four-element system can distinguish between primary, important, and general responsibilities. Conclusion: Precise accountability can help improve the efficiency and institutional credibility of medical insurance fund supervision.