Objective: The paper attempts to empirically analyze the illegal use of medical insurance funds in psychiatric medical institutions in Hunan Province, explore the countermeasures, promote the legal compliance of the use of medical insurance funds in psychiatric medical institutions, and enhance the social security benefits of patients with severe mental illness. Methods: We investigates the basic situation of psychiatric medical institutions in Hunan Province, and the investigation and punishment of the illegal use of medical insurance funds by specialized medical insurance in the past. Through big data analysis, case anatomy and other ways, we conducts in-depth analysis of the causes. Results: At present, there are many medical insurance violations in psychiatric specialist medical institutions, and the causes are complex, including the unique features of disease (family and social factors), imperfect fund guarantee mechanism, obvious profit-seeking impulse of private specialist institutions, serious shortage of specialist technical talents, lack of diagnosis and treatment norms, imperfect linkage mechanism among departments and so on. Suggestions: We should strictly regulate the specialized medical services and supervise the illegal problems in health insurance, such as false medical service items, insufficient services and excessive medical treatment, etc. Meanwhile, we should establish a united management mechanisms among department and push forward the reform for relevant mechanisms and systems.
Key words
psychiatric medical institutions /
severe psychosis /
medical insurance /
fund supervision
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