基于多维尺度分析的我国医保医师监管问题研究

Research on the Supervision of Medical Insurance Physicians in China Based on Multi-dimensional Analysis

目的随着我国医保基金监管要求的不断提高,从源头上对医保医师进行管控,是维护我国医保基金合理使用,医保制度顺利运行的必然要求。方法利用多维尺度分析法对当前我国医保医师监管存在问题统计,总结影响出当前我国医保医师违规行为出现的关键问题维度。结果当前我国医保医师监管存在问题主要包括以下4点:(1)医保机构重视医疗机构监管,忽视医师监管;(2)医疗机构内部医师监管上存在分工职责不清、医保医师奖惩机制不健全;(3)医师诚信机制建立不足;(4)医师监管信息化水平与监管要求不同步。结论急需从全流程对医保医师监管体系进行整改,纵向上中央-地方政府-定点医疗机构需加强对医保医师监管的重视程度,重塑协同机制,横向上信息化建设应贯穿于医师监管体系之中。

Objective With the continuous improvement of the supervision requirements of medical insurance fund in China,it is necessary to control medical doctors from the source,which is the inevitable requirement to maintain the rational use of medical insurance fund and smooth operation of medical insurance system in China.Methods The multi-dimensional analysis method was used to analyze the problems existing in the supervision of medical doctors in China,and to summarize the key problems that affect the current violations of medical doctors in China.Results The main problems of medical doctors supervision in China include the following four aspects:(1)the government attaches importance to hospital supervision and neglects the supervision of doctors;(2)The division of responsibilities exists in the supervision of doctors in medical institutions,and medical insurance physician reward and punishment mechanism is imperfect;(3)The establishment of physician integrity mechanism is insufficient.(4)The level of information-based supervision of doctors is not in line with the supervision requirements.Conclusion It is urgent to rectify the supervision system of medical doctors from the whole process,strengthen the attention of central government-local government-designated medical institutions on the supervision of medical doctors vertically,reshape the coordination mechanism,and horizontally intersect the construction of information into physician supervision system.