上海医保监管的法治创新与实施成效  

Innovation of Rule by Law and Implementation Effect of Health Insurance Supervision in Shanghai

作　　者：廖祖达 邵建华[1] 陈澍[1] 黄虹[1] 史晔俊 程沛然[1] 

机构地区：[1]复旦大学附属华山医院,上海200040

出　　处：《中国医疗保险》2016年第8期42-45,共4页China Health Insurance

摘　　要：上海市2011年颁布施行的《上海市基本医疗保险监督管理办法》,今天看来仍有多项创新之举:为当时新设立的医保监督检查所赋予实施监管的法定职能、对多部门联合执法给予法治化安排、将实时监控作为落实事中监管的载体、将预算管理纳入定点医院责任条款、对两定机构的法律责任作出了量化规定。这些堪称医保监管法治创新的举措,使多部门联合执法形成拳头,有力打击了重大医保违规违法行为,使基金安全和参保人员利益得以有效维护。In 2011, Shanghai issued and implemented Shanghai Basic Medical Insurance Supervision and Management Measures. Even on today, there are still a number of innovative points,which included statutory function given to the newly established insurance supervision and inspection system, legalization arrangement for multi-sector joint-law-enforcement, using real-time monitoring as an implementing vector, taking the budget management as a liability clause in the designated hospitals, making quantitative requirements for the legal responsibility of the two designated institutions. These measures, which can be taking as innovative measures in medical insurance supervision, have made multi-sector-joint-law-enforcement forming a fi st to strongly beat illegal behaviors in major diseases medical insurance. They have protected the safety of the insurance fund, and the interests of the insured person are effectively maintained.

关 键 词：医疗保险 监督管理 法治创新 实施成效 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]