摘要
目的以扎根理论为基础,探讨我国医院骗保行为频发的原因并构建医院骗保行为的归因模型,为我国完善医保监管机制提供依据。方法以“医院骗保”“骗保行为”为主题词,在中国知网、万方、维普检索相关文献,最终纳入45篇文献,用NVivo11软件对纳入的文献进行三级编码的提取,归纳医院骗保行为频发的原因。结果经过三级编码,共提取与医院骗保行为相关的初始概念212个,副范畴23个,主范畴9个和4个核心维度。结论医院骗保行为频发是多种直接因素与间接因素共同作用的结果。应从个体归因、组织归因、制度归因、环境归因四条路径出发,探索遏制医院骗保行为的对策。
Objective To explore the causes of frequent occurrence of hospital insurance fraud in China and construct the attributive model based on the grounded theory,and provide references for perfecting the medical insurance supervision mechanism.Methods 45 documents were searched from databases of China knowledge Network,Wanfang and VIP,taking“hospital insurance fraud”and“deceitful behavior”as the subjects,which were analyzed with software of NVivo11.Results Through three-level coding,212 initial concepts,23 sub-categories,9 main categories and 4 core dimensions related to hospital insurance fraud were extracted.Conclusion The frequent occurrence of hospital insurance fraud resulted from many direct and indirect factors.It is suggested to control the hospital insurance fraud from four paths of individual attributions,organizational attributions,institutional attributions and environmental attributions.
作者
范转转
王军永
向乐怡
姚东明
Fan Zhuanzhuan(Jiangxi University of Traditional Chinese Medicine,Nanchang,P.R.China)
出处
《中国卫生事业管理》
北大核心
2020年第6期429-433,共5页
Chinese Health Service Management
基金
2017年国家自然科学基金项目“基于临床路径的慢性病分级诊疗模式评价与优化研究”(71764012)
2016年江西省高校人文科学研究项目“江西省中医药健康养老服务供给、需求与利用研究”(GL161004)
2015年度江西省高校人文社会科学重点研究基地研究项目“江西省健康服务业发展状况研究”(JD15142)。
关键词
扎根理论
骗保行为
医院
归因模型
Grounded Theory
deceitful behavior
hospital
attributive model
