医院医保骗保行为监管对策探究

Research on the Countermeasures of Fraud Insurance in Hospital Medicare Insurance

目的打击各种骗保行为,监管诊疗就医行为,维护医保基金安全稳定。方法结合天津市卫计委正在开展的"百日行动",选取本市3家三级综合医院,从2018年2月26日—3月30日,对医务人员和患者进行问卷调查。结果通过统计学方法分析,对"百日行动"持肯定的占比89.1%,认为社保监督所对打击骗保发挥作用最大的占比76.2%,认为医院职能科室发挥作用最大的占比68.3%。结论通过医保监管,规范患者的实名制就医管理,获得了人民群众的点赞,杜绝了患者骗保行为,强化了医生的责任意识,维护了医保基金的安全。

Objective To combat all kinds of fraudulent behaviors,to supervise the behavior of medical treatment,and to maintain the safety and stability of medical insurance funds.Methods In combination with the ＂Hundred Days Action＂ being carried out by the Tianjin Municipal Health and Family Planning Commission,three tertiary general hospitals in the city were selected.From February 26 to March 30,2018,medical staff and patients were surveyed.Results Through statistical analysis,the affirmation of the ＂Hundred Days Action＂ accounted for 89.1% of the total,accounting for 76.2% of social security supervision agencies＇ greatest role in cracking down on fraudulent protection,and the largest proportion of hospital functioning departments accounted for 68.3%.Conclusion Through medical insurance regulation,the patient＇s real name management system is standardized,and the received praise from the people.The patient＇s behavior of fraudulent protection is eliminated,the awareness of the doctor＇s responsibility is strengthened,and the safety of the medical insurance fund is maintained.