强化医保基金监管应构建微循环有机组织——从基金监管的角度发挥基层组织功能

Micro-circulation Organization Should be Constructed to Strengthen the Supervision of Medical Insurance Fund:to Increase the Functions of Grassroots Organizations from the Perspective of Fund Supervision

我国医保基金支付规模庞大,服务人次以亿为计量单位,医保基金监管长期以来都是一个管理难题。国家建立了专门的医疗保障局,制定了医保监管的行政法规,组建了执法队伍。这些举措虽在一定程度上减少了违规骗保的现象,但没从根本上改变监管过程中监管者与被监管者之间信息不对称的问题。医保基金的使用和监管具有有机组织的特征,需要充分发挥社区、社区医院和家庭医生、工作单位等基层组织的功能,构建以社区为单位的微循环有机组织,实现监管者与被监管者之间信息及时有效沟通,借助信息技术构建医患信用地图,从根本上解决监管过程中产生的信息不对称的难题。

The payment scale of China's medical insurance fund is huge,and the service person times are measured in billion.The supervision of medical insurance fund has been a management problem for a long time.A special medical security bureau has been established to formulate administrative regulations on medi⁃cal insurance supervision,and a law enforcement team has been organized.Although these measures have re⁃duced the phenomenon of illegal insurance fraud to a certain extent,they have not fundamentally changed the problem of information asymmetry between regulators and regulated in the process of supervision.The use and supervision of medical insurance fund has the characteristics of organic organization.It is necessary to fully de⁃velop the functions of communities,community hospitals,family doctors,companies and other grass-roots orga⁃nizations,build a community-based micro-circulation organic organization,realize the timely and effective communication of information between regulators and regulated persons,and build a doctor-patient credit map with the help of information technology,to fundamentally solve the problem of information asymmetry in the process of supervision.