天津医保监督检查体系现代化建设进程

Modernization Process of Tianjin Medical Insurance Supervision and Inspection System

率先实现医保省级统筹和城乡统筹的天津市,顺势而为,通过健全医疗保险立法,建立专门执法机构,开发远程监控系统,强化监督检查。对全市1000万参保人员、1820余家医保定点服务机构、3.5万名医保服务医师(药师)的就医诊疗行为,以及1万种品规的医保药品、5000余种诊疗项目的使用情况,实行"无盲区"实时监控和监督检查。有效遏制了基金支出快速增长的势头,参保人员合法权益得到保障,促进了社会公平正义。

Tianjin, which took the lead in achieving the overall planning of medical Insurance at the provincial and urban-rural level, has consequently implemented ＂no blind area＂ real-time monitoring and inspecting on the medical behavior of 10 million insured urban residents, over 1820 designated medical care service institutes, 35000 physician （pharmacist）, as well as on the use of 10000 kinds of drugs and over 5000 kinds of diagnosis and treatment projects, by improving the medical insurance legislation, establishing special law enforcement agencies, developing remote monitoring system and strengthening supervision and inspection. As a result, it has effectively curbed the rapid growth of fund spending, protected the legitimate rights and interests of the insured persons, and promoted the social equity and justice.