医疗保险欺诈问题研究综述  

A Review of Research on Medical Insurance Fraud

作　　者：齐敏 任建明[1] 

机构地区：[1]北京航空航天大学公共管理学院,北京100191

出　　处：《中国医疗保险》2023年第8期5-12,共8页China Health Insurance

摘　　要：医疗保险欺诈不仅给国家带来巨大的经济损失,同时也影响公共医疗服务的质量,日益成为社会医疗保险制度健康发展的桎梏。本文基于中国知网和Web of Science核心合集数据库对医保欺诈文献进行检索,并运用Excel、Endnote、VOSviewer软件对文献进行计量分析,发现国内外学者对医保欺诈进行了丰富的研究,呈现出欺诈主体、手段、影响因素的复杂多样以及治理措施的全面和广泛。但同时,国内关于医保欺诈的研究在概念上需要进一步明确其指向,在影响因素上应进一步聚焦于根本因素和定量分析的研究,在治理措施上需要进一步弥补当前制度和技术的不足,鼓励更多社会个体积极参与医保反欺诈。Medical insurance fraud has not only brought huge economic losses to the country,but also affected the quality of public medical services,which has increasingly become a shackle restricting the healthy development of the social medical insurance system.Based on the databases of China National Knowledge Infrastructure and Web of Science Core Collection to search for medical insurance fraud literature,this article uses Excel,Endnote,and VOSviewer software to conduct quantitative analysis of the literature.It is found that domestic and foreign scholars have conducted extensive research on medical insurance fraud,presenting complex and diverse subjects,means,and influencing factors of fraud,as well as comprehensive and extensive governance measures.The concept of medical insurance fraud in China needs to be further clarified,and as to the influencing factors,we should focus on fundamental factors and quantitative analysis.In terms of governance measures,it is necessary to compensate for the shortcomings of the current system and technology,and encourage more social individuals to actively participate in medical insurance anti-fraud.

关 键 词：医疗保险 欺诈 医保欺诈 研究综述 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]