国内外医疗保险欺诈研究现状分析

An analysis on medical insurance fraud researches in the domestic and overseas market

医疗保险欺诈问题已引起各国政府的高度重视,不少学者对此也进行了研究。本文就此对国内外医疗保险欺诈的研究现状进行分析,主要从医疗保险欺诈的相关概念、医疗保险欺诈风险分析、风险识别与度量及反欺诈等方面总结比较,在此基础上探讨目前研究中存在的不足及未来的研究趋势。

The medical insurance fraud problem has attracted great attention of various governments, and many scholars have also researched on this issue. This article analyzed the current researches on this topic by domestic and international scholars, mainly from the aspects of concepts of medical insurance fraud ,fraud risk analysis, detec- tion and measurement methods and anti-fraud mechanisms. And on the basis of the analysis, the paper pointed out the inadequacies of the current research and future trends.