天津智能化医保监管的创新之道

An Innovative Way of Intelligent Supervision on Health Insurance in Tianjin

天津市在率先实现全民医保一体化发展的基础上,医保智能化监管改革实现新突破:成功研发1.0版和升级改造的2.0版实时监控系统,组建专业化执法队伍,建立包括专项监督检查、移动式执法终端、警示提醒服务、联合执法打击欺诈骗保在内的部门联合精准执法机制,有效维护了基金安全,为医保可持续发展走出了全新的智能化监管之路,为全国医保系统智能化监管体系建设发挥了引领作用。

Based on the experience in leading the integrating of universal insurance coverage in Tianjin, the reform of intelligent supervision on health insurance has achieved new breakthroughs. The successfully developed version 1.0 and upgraded 2.0 version of real-time monitoring system, the established professional law enforcement team, and multi-department joint precise enforcement mechanism which consisted of special supervision and inspection, mobile terminal law enforcement, warning alert service, and joint law enforcement against insurance fraud and cheating, have effectively protected the safety of insurance fund, and explored a new and intelligent road for the sustainable development of the health insurance. It plays a guiding role in the construction of national intelligent supervision system for health insurance.