我国医保基金监管的核心问题分析——基于社会网络分析法

Analysis of the Core Problems of Medical Insurance Fund Supervision in China——Based on the Social Network Analysis

目的:探讨我国医保基金监管存在的核心问题,为完善医保基金监管提供依据。方法:运用社会网络分析法对检索的文献进行计量分析,找出我国医保基金监管的核心问题。结果:我国医保基金监管存在繁重的监管压力与短缺的人力资源不匹配、监管主体职责划分不清、法律体系不完善、信息化建设滞后、医疗机构存在诱导需求、监管人员专业素养不高等核心问题。结论:完善医疗保障制度需加强医保基金监管法律体系建设,加大监管人力资源投入,提升信息化监管水平,厘清监管主体责权,遏制医疗机构诱导需求。

Objective To explore the core problems existing in the medical insurance fund supervision in China,and to provide a basis for improving the medical insurance fund supervision.Methods Social network analysis was used to measure the retrieved literature and find out the core problems of medical insurance fund supervision.Results There are some core problems of medical insurance fund supervision in China,such as heavy regulatory pressure and shortage of human resources,unclear division of regulatory responsibilities,imperfect legal system,lagging information construction,induced demand of medical institutions,and low professional quality of supervisors.Conclusion In order to improve the medical security system,it is necessary to strengthen the construction of medical insurance fund supervision legal system,increase the investment of regulatory human resources,improve the level of information supervision,clarify the responsibilities and rights of regulatory subjects,and curb the induced demand of medical institutions.