黑龙江省和山东省公众医保基金骗保行为的原因分析

Analysis of Causes of Fraudulent Behavior of Public Medical Insurance Funds in Heilongjiang and Shandong Province

目的:对公众医保基金骗保行为进行分析,探讨公众使用医保基金中存在骗保行为的深层次原因,为促进公众合理使用医保基金提供参考。方法:基于头脑风暴、文献分析和专家咨询等方法设计的调查问卷对黑龙江省和山东省的公众进行调查,并结合因子分析法对公众医保基金骗保行为的原因进行研究。结果:经过因子分析,共提取由16个条目组成的3个公因子,分别为公众认知局限影响因子、公众逐利心理因子和医保制度不完善因子,累计方差贡献率为73.596%。结论:公众医保基金骗保行为由多种原因耦合作用下发生。其中公众医保相关知识匮乏、对医保相关知识主动获取的意愿不强是产生骗保行为的关键原因;公众在使用医保基金中存在“逐利心理”是其产生骗保行为的主要促使动机;医保制度不完善是公众使用医保基金“失序”的环境因素。

Objective:To analyze the fraudulent behavior of public medical insurance funds,and to explore the deep-seated causes of fraudulent behavior in the use of medical insurance funds by the public,so as to provide references for promoting the rational use of medical insurance funds by the public.Methods:A survey was conducted among the public in Heilongjiang and Shandong province by the questionnaire based on the methods of brainstorming,literature analysis and expert consultation,and the causes of public medical insurance fraud were studied by factor analysis.Results:Through factor analysis,3 common factors composed of 16 items were extracted,which were the influencing factor of public cognition limitation,the psychological factor of public profit-seeking and the imperfect factor of medical insurance system.The cumulative variance contribution rate was 73.596%.Conclusion:Public medical insurance fund fraud occurs due to a coupling of multiple causes.Among them,the public's lack of related knowledge of medical insurance and their low willingness to actively acquire related knowledge of medical insurance are the key reasons for the fraudulent behavior.The existence of a"profit-seeking mentality"in the use of medical insurance funds by the public is the main motivation for fraudulent behavior.The imperfection of medical insurance system is the environmental factor of"disorder"of public use of medical insurance fund.