绍兴市医保基金信用评价应用模式探索

Exploration on the Application Model of Credit Evaluation of Medical Insurance Fund in Shaoxing City

经过1年多的医保信用体系建设,绍兴市按照国家医保局《关于开展医保基金监管“两试点一示范”工作的通知》精神,结合浙江省医保局试点工作具体要求,以定点零售药店为突破口,打造“1 + 3 + 1”医保基金监管信用体系。通过不断探索创新应用模式,在“医保信用 + 便民服务”、“医保信用 + 金融”、“医保信用 + 政务服务”等方面进行实践探索,并取得一定成效,为构建科学完善的医保基金长效监管机制中结果应用模式提供借鉴与参考。

After more than one year of the construction of medical insurance credit system, Shaoxing City, in accordance with the spirit of the National Medical Insurance Administration’s “Notice on Carrying out the ‘Two Pilots and One Demonstration’ Work for supervision system for the healthcare security fund”, and combined with the specific requirements of the work of the Zhejiang Medical Insurance Bureau, with designated retail pharmacies as a breakthrough point, to create a “1 + 3 + 1” supervision system for the healthcare security fund. Through continuous exploration of innovative application models, practical explorations have been made in the areas of “medical insurance credit + convenient services”, “medical insurance credit + finance”, “medical insurance credit + government services”, etc., and has achieved a certain degree of success. It provides the model and the reference for the establishment of a scientific and complete medical insurance fund long-term supervision mechanism.