Objective: The paper investigates the problems in the use of medical insurance funds in tertiary public hospitals, puts forward suggestions on the use, supervision of hospital medical insurance funds. Methods: The feedback data of the medical insurance flight inspection in2021were reviewed, analyzed, the problems were analyzed based on the literature, interview results. Results: It was found that repeated charges, charges exceeding the standard, drugs beyond the medical insurance payment scope, substitution of items accounted for the highest proportion of medical insurance violations. According to the reason analysis, the violations were divided into profit-seeking behavior, inefficient behavior, deviation behavior.Conclusions: It is recommended to improve relevant laws, regulations, establish relevant systems, dynamically monitor violations, report them in time, strengthen the construction of a talent team, enhance the compatibility of medical insurance policies. Medical institutions should carry out the pilot reform of medical insurance physician system
Key words
supervision of medical insurance fund /
tertiary public hospital /
behavior classification
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