协同治理视角下医保欺诈行为监管效果研究

Study on the Effect of Medical Insurance Fraud Supervision from the Perspective of Collaborative Governance

目的:从政治、经济、法律、社会、协同五个维度构建医保欺诈行为监管效果评价指标体系,运用该体系对三个样本地区的监管效果进行评价。方法:运用文献研究法和专家咨询法构建评价指标体系,运用灰色关联综合评价法进行效果证实评价。结果:样本地区监管效果总体参差不齐,在政治效果、经济效果、协同治理理念等方面取得一定成效,但在社会效果、公众参与、欺诈相关法律法规知晓等方面存在不足。结论:从信用管理体系、公众参与意愿、相关法律法规宣教等方面入手,提高医保欺诈行为监管效果。

Objective To construct an evaluation index system for the supervision effect of medical insurance fraud from five dimensions of politics, economy, law, society and coordination, and evaluate the supervision effect of the three sample regions by using this system. Methods Literature research and expert consultation method were used to construct the evaluation index system,and grey correlation comprehensive evaluation method was used to empirically analyze the effect. Results The overall regulatory effect of the sample areas was uneven, which had made some achievements in political effect, economic effect, and collaborative governance concept, but there were deficiencies in social effect, public participation, and knowledge of fraud-related laws and regulations. Conclusion It is suggested to improve the supervision effect of medical insurance fraud from the aspects of credit management system, public participation willingness and education of relevant laws and regulations.