淄博市医保基金监管方式改革的实践探索

Practice and Exploration on the Reform of Supervision Mode of Medical Insurance Fund in Zibo

随着医保定点医药机构数量不断增加,医疗保障制度建设由全覆盖向高质量转变。新形势下监管人员不足、监管手段单一、监管模式匮乏等问题严重制约了医保基金监管工作的推进。淄博市医保局以推进医保治理体系和治理能力现代化为目标,突出体制建设,建立全市一体化垂直管理体制,打破了市与区县、区县之间界限,构建了科学分工、业务培训、全面检查、落实责任"四位一体"的网格化监管体系。同时,突出流程再造与精准监控,建立了打击欺诈骗保长效机制。

With the increasing number of medical institutions,the construction of healthcare security system has changed from full coverage to high quality.Under the new situation,the problems of insufficient supervisors,single supervision means and lack of supervision mode seriously restrict the promotion of medical insurance fund supervision.In order to promote the modernization of medical insurance governance system and governance capacity,Zibo Healthcare Security Bureau has established an integrated vertical management system,breaking the boundaries between the city and districts and counties.At the same time,Zibo has also built a grid supervision system of scientifi c division of labor,business training,comprehensive inspection and responsibility implementation.At the same time,highlighting process reengineering and accurate monitoring,Zibo has established a long-term mechanism to combat fraud.