大数据背景下农村居民医疗保险骗保问题的对策研究

Countermeasure research on medical insurance fraud of rural residents in the background of big data

当前农村居民医疗保险制度依然存在着欺诈、骗取、套取医疗保险基金的现象。随着大数据时代的到来为骗保问题的解决提供了新的思路,文章基于农村居民医疗保险各参与方参保农民、定点医疗服务机构以及医疗保险经办机构三个主体之间为实现各自利益最大化而做出的不同利己的行为选择进行分析,并从大数据信息化层面提出相应的制衡策略。

At present,the medical insurance system of rural residents still exists the phenomenon of fraud,fraud and arbitrage of medical insurance funds.With the arrival of the era of big data,it provides a new way to solve the problem of fraud insurance.Based on the analysis of the different selfish behavior choices made by the participants of rural residents’medical insurance,namely,the participating farmers,the designated medical service institutions and the medical insurance agencies to maximize their respective interests,this paper makes an analysis of the different selfish behavior choices made by the participants of rural residents’medical insurance.The corresponding checks and balances strategy is put forward from the information level of big data.