医疗保险机构在公立医院外部监管中的作用、困境及对策研究

Advantages,Difficulties and Countermeasures of Industry Association in the External Supervision of Public Hospitals

分析医疗保险机构在公立医院外部监管中的作用,发现问题了医疗保险监管立法层次不够、相关管理规范有待完善、监管人才缺乏、监管信息系统不完善等问题。提出了完善医疗保险机构监管法律法规体系,加强医疗保险机构人才队伍建设,确保监管信息系统建立,建立考核奖惩办法,创新医疗保险监管模式等应对措施。

In order to meet the requirements of health care reform, healthcare industry associations involved in the public hospital regulation becomes inevitable, and compound regulatory mode in public hospital is formed. Through the analysis of ad- vantages and problems existed in external regulatory of the public hospital by medical industry association, aiming at the problems existed in the regulation by the industry association including insufficient attention of government, lacking of legal environment, lacking of regulatory independence, unclear associations functions and imperfect internal construction, countermeasures were pro- posed including speeding up the legislation, straightening out relations, a clear range of regulatory functions and strengthening self - construction.