新规则背景下定点医药机构的监管

Supervision of designated medical institutions under background of new rules

医保基金是人民群众的“救命钱”,一些定点医药机构却一再突破法律红线,通过隐蔽的欺诈骗保行为骗取医保基金。为规范定点医药机构的医疗服务行为,保障医保基金安全,我国积极开展立法并制定相应的行政法规、部门规章。然而,我国医保领域立法尚处初步发展阶段,如何进一步完善定点医药机构的考核制度、健全医保信用体系是我国面临的重要课题。在创新监管方式、健全监管体制的同时,也需要加强监管队伍建设,采取有效措施提高监管人员业务能力。

The medical insurance fund is the“lifeline”of the masses,but the designated medical institutions have repeatedly broken through the red line of the law to defraud medical insurance funds through hidden fraud.In order to regulate the medical service behaviors of the designated medical institutions and ensure the safety of medical insurance funds,China actively carries out the corresponding legislation and formulates corresponding administrative regulations and departmental regulations.However,the legislation in the field of medical insurance in China is still in the initial stage of development.How to further improve the assessment system of designated medical institutions and improve the credit system of medical insurance are important issues in China.While the regulatory methods are innovated and the regulatory system is improved,it is also necessary to strengthen the construction of regulatory teams and take effective measures to improve the professional ability of regulatory personnel.