公众参与医保基金监管的意愿及影响因素分析

Analysis of Public Intention and Influencing Factors in the Supervision of Health Insurance Fund

目的:对公众参与医保基金监管的意愿进行综合评价,找出其影响因素,提升公众参与医保基金监管的意识。方法:采用分层抽样的方法,通过对黑龙江和山东两个省份的公众展开问卷调查。运用卡方检验与二元logistic回归方程,对公众参与医保基金监管的意愿及影响因素进行分析研究。结果:公众参与医保基金监管的主观意愿与不合规使用医保基金的客观事实相违背;文化程度和对骗保行为的界定负向影响公众参与医保基金监管的意愿。医保政策知晓度、对骗保行为涉及资金规模大小的感知度与对骗保行为产生危害的严重程度这三点影响因素正向影响公众参与医保基金监管的意愿。结论:医保基金不合规使用现象普遍,为进一步提升公众参与医保基金监管意愿,应完善举报人保护制度,促进文化程度高的公众参与监管。此外,让公众认知骗保行为属于违法行为、提高医保政策的知晓度、提升公众对医保基金骗保行为产生危害的认知,构建合理使用医保基金的良好风尚。

Objective:To conduct a comprehensive evaluation of the public’s willingness to participate in the supervision of medical insurance funds,find out the influencing factors,and enhance the public’s sense of ownership of participating in the supervision of medical insurance funds.Methods:By stratified sampling,the public in Heilongjiang and Shandong provinces were investigated by questionnaire.By using chi-square test and binary logistic regression equation,the willingness and influencing factors of public participation in the supervision of medical insurance fund are analyzed and studied.Results:The subjective will of the public to participate in the supervision of the health insurance fund is contrary to the objective fact that the health insurance fund is not used in accordance with the law,and the degree of education and the definition of fraud negatively affect the public’s willingness to participate in the supervision of medical insurance funds.The three influencing factors of health insurance policy awareness,the perception of"fraud involves the size of funds"and the severity of"fraud"positively affect the public’s willingness to participate in the supervision of health insurance funds.Conclusion:The phenomenon of irregular use of medical insurance fund is common.In order to further enhance the public’s willingness to participate in the supervision of medical insurance fund,it needs to perfect the whistleblower protection system and promote the high education level of public participation in supervision.In addition,let the public recognize that the fraud is illegal,improve the awareness of medical insurance policy,enhance the public’s awareness of the harm of medical insurance fund fraud,and build a good fashion for the rational use of medical insurance funds.