基本医疗保险定点医疗机构道德风险及其防范对策

Moral Hazard of Fixed-point Medical Institution for Basic Medical Insurance and Its Preventive Countermeasures

以南方某市为例,从医疗管理角度着手,阐述定点医疗机构目前存在的道德风险问题及其表现形式。及时剖析定点医疗机构违规现象是加强医疗管理、防止基金流失的当务之急。文中从加快医疗机构改革、探索建立医保诚信体系、推进定点医疗机构内控机制的建立、培养复合型医保人才、加快基本医疗保险立法等5个方面提出对策建议。

This paper described the moral hazard and its manifestations for Fixed-point medical institution from the medical management aspect,taking Nanjing as an example.And thought it was emergent to enforce medical management and prevent the flow of medical insurance fund to reveal the phenomenon of Fixed-point medical institution getting out of line in time.In this paper,five suggestions were proposed from accelerating the reform of medical institutions,exploring the establishment of health insurance credit system,promoting the establishment of the internal control mechanism for fixed-point medical institutions,cultivating compound talents of medical insurance and accelerating the basic medical insurance legislation.