摘要
采取文献分析法梳理国内外欺诈骗取医保基金风险防范的发展及现况,总结和比较打击欺诈骗保对策,以期为我国提供有价值的参考和建议。欺诈骗保行为的表现形式及成因多样,我国可借鉴国际经验,首要是完善相关法律并成立专门机构,利用大数据技术等手段,加强对医疗服务提供方和需求方的监管。
This paper summarized the development and current situation in risk prevention of fraudulent medical insurance at home and abroad by literature analysis.By comparing the countermeasures for fraudulent insurance in different countries,this study aimed to provide valuable reference and suggestions for China,a country embarking a battle against fraudulent medical insurance fund.We found that the manifestations and causes of fraudulent insurance varied greatly across countries.According to the international experience and current situation domestic,China should issue relevant laws and regulations,establish specialized agencies and strengthen supervision on both medical service providers and demanders using big data technology.
作者
李金灿
徐珂琳
於州
魏艳
仇春涓
胡敏
汪荣明
徐望红
Li Jincan;Xu Kelin;Yu Zhou;Wei Yan;Qiu Chunjuan;Hu Min;Wang Rongming;Xu Wanghong(School of Public Health,Fudan University,Key Lab of Health Technology Assessment of National Health Commission,Shanghai 200032,China;School of Data Science and Institute for Big Data,Fudan University,Shanghai 200433,China;Key Laboratory of Advanced Theory and Application in Statistics and Data Science,East China Normal University,Shanghai 200062,China)
出处
《中国卫生法制》
2022年第1期9-15,共7页
China Health Law
基金
国家社科基金重大项目“大数据背景下健康保险的精算统计模型与风险监管研究”(17ZDA091)。
关键词
医疗保险
欺诈骗保
风险防范
国际比较
Medical insurance
Fraud
Risk prevention
International comparison
