完善上海市医疗保险监管体系的基本思路

How to Improve Medical Insurance Monitoring System of Shanghai

上海市医保监管体系建设在国内处于领先地位,但随着形势的发展,目前监管体系中暴露出人员不足、体制不健全、职责不清等问题。面对医保监管形势的复杂性、监管任务的繁重性和监管工作的新要求,需要理顺医保部门与卫生计生部门、医保行政部门与医保监督检查机构、医保监督检查队伍与劳动监察队伍、医保监督执法队伍与医保经办机构、市级监管与区县级监管等五大关系。完善医保监管体系要做好顶层设计,做实区县医保办,充实医保监管人员。

The medical insurance monitoring system of Shanghai has always been in the leading position of China. However, it is increasing exposed to such problems as staffs shortage, institutional inadequacies, unclear responsibilities,etc. To deal with the increasing difficulty and workloads in the monitoring of medical insurance, five kinds of relationships, such as the relationship between medical insurance department and health and family plan department, the relationship between health insurance administrative departments and health insurance supervision and inspection institutions, the relationship between health insurance supervision and inspection team and the labor inspection team, the relationship between health supervision and law enforcement team and medical insurance agencies, the relationship between the municipal supervision and district level supervision, should be straightened out. Meanwhile, based upon the reality in Shanghai, we put forward some basic ideas and policy path to consolidate the medical insurance monitoring system, which include top-level design, building monitoring agencies at district-level, and increasing monitoring staff teams.