Abstract
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.
Key words
medical security fund /
unannounced inspection /
third-party institutions
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Thoughts and Suggestions on Improving the Mechanism for Third-party Institutions to Participate in Medical Insurance Unannounced Inspection[J]. China Health Insurance. 2023, 0(4): 61-66 https://doi.org/10.19546/j.issn.1674-3830.2023.4.009
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References
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