基本医疗保险监管效率评价研究

Research on the Regulation Efficiency of Basic Medical Insurance

医保违规行为损害了我国医保公平、可持续发展,提高医保监管效率可以加强医保基金的安全性。研究中选取湖北省某市为研究对象,分析其医保监管的工作内容及效果,剖析其监管效果不理想的原因。并在博弈分析的基础上,提出应提高监测违规行为能力、加大对违规行为处罚力度、提高定点医疗机构违规行为成本的政策建议。

Medicare irregularities damaged the equity and sustainable development of medical insurance in China. Promoting theregulation efficiency of medical insurance could enhance the security of medical insurance fund. It selected a city in Hubei as the re-search object, analyzed the content and effects of the work medical insurance regulation and the reason for non-ideal regulation ef-fects. Based on the gaming analysis, it presented some policy recommendations such as improving the ability to monitor violations, in-creasing penalties for violations and increasing the irregularity costs of designated medical institutions.