Objective:This study aims to systematically analyze the practical dilemmas in the construction of Shanghai City's medical insurance credit supervision system, and to explore the principles and implementation mechanisms for addressing these dilemmas. Methods:Based on a systematic review of relevant policies and regulations, indicator system research, and local practices in the field of medical insurance credit supervision, combined with case studies of credit supervision practices in Shanghai City, this paper identifies the prominent problems in current regulatory operations. Results:The study finds that medical insurance credit supervision in Shanghai City faces practical dilemmas such as complex indicator design, limited deterrent effect, and difficulties in implementation. In response, this paper proposes a credit supervision framework guided by the principles of risk control first, prudence and feasibility, and penalties commensurate with offenses. The framework consists of four core mechanisms: a closed-loop information collection mechanism based on mapping, a scientific and dynamic credit evaluation mechanism, an application mechanism for evaluation results that balances incentives and constraints, and a procedurally complete relief and repair mechanism. Conclusions:The proposed medical insurance credit supervision system, which prioritizes dishonesty deterrence, focuses on fund security, and balances operational feasibility with institutional extensibility, can systematically address the credit supervision goals of guiding institutional self-discipline, optimizing resource allocation, and promoting social co-governance.