医保行政监督与经办协议管理的边界和协同  

The Boundary and Coordination of Medical Insurance Administrative Supervision and Agency Agreement Management

作　　者：孙淑云 Sun Shuyun(Shanxi University of Finance and Economics,Taiyuan,030006)

机构地区：[1]山西财经大学法学院,太原030006

出　　处：《中国医疗保险》2021年第6期52-55,共4页China Health Insurance

基　　金：教育部规划基金项目“中国多层次医疗保障法律的衔接研究”(19YJA820037)的阶段成果。

摘　　要：医保行政监管与经办协议管理均属于医保行政监督管理的范畴。但是,二者的主体法律地位、监管法律依据、职责权限、被监督主体、监管方式、主要监管途径、对违法行为处理方式等均存在差异。医保行政部门是医保监督管理的政策制定者、组织者、指挥者、协调者,医保经办机构则在医保行政机构领导和监督之下,以定点医药"服务协议"为载体,协同、配合开展医保管理监督工作,承担医保监督管理的日常性、专业性、智能型、基础性工作。医保行政监管与经办协议管理只有协同配合,才能实现监督管理效率。The administrative supervision of medical insurance and the agency agreement management are of the same quality,both of which belong to the scope of administrative supervision and management of medical insurance.However,there are differences in the legal status of the subject,the legal basis of supervision,the responsibility and authority,the subject to be supervised,the way of supervision,the main way of supervision,and the way of handling illegal acts.The medical insurance administrative department is the policy maker,organizer,commander and coordinator of the medical insurance supervision and management.Under the leadership and supervision of the medical insurance administrative department,the medical insurance agency takes the designated medicine service agreement as the carrier to carry out the medical insurance management and supervision,and undertakes the daily,professional,intelligent and basic work of the medical insurance supervision and management.The efficiency of supervision and management can only be realized by the coordination of medical insurance administrative supervision and agency agreement management.

关 键 词：医保行政监督 经办协议管理 职责边界 协同监督 

分 类 号：F840.684[经济管理—保险]