加强医保基金使用常态化监管的特定目标和主要路径  

Strengthening the Specific Goals and Main Paths of the Regular Supervision of the Use of Medical Insurance Funds

作　　者：张卿 

机构地区：[1]中国政法大学法与经济学研究院,北京100088

出　　处：《中国医疗保险》2023年第9期27-31,共5页China Health Insurance

基　　金：国家社科基金重大项目“完善医疗保障基金监管法律制度研究”的阶段性成果。

摘　　要：加强医保基金使用常态化监管可以提高对违法、违约使用医保基金行为的发现率,但本文认为其特定目标应在于以较低的监管执法成本实现对违法、违约使用医保基金行为的有效震慑,在有限的执法资源下最大程度提高守法和守约程度。现阶段,我国医保基金监管仍然存在执法资源有限、监管能力建设有待加强等问题。本文通过对医保基金使用常态化监管的内涵、特定目标进行阐述论证,认为可以运用以下三个路径来实现上述目标,即加强并完善医保基金智能监管,创新、优化和综合使用多种监管方式,加强定点医药机构自我管理以及合规不处罚等制度创新。Strengthening the regular supervision of the medical insurance funds use will improve the detection rate of illegal use and defaulting of medical insurance funds,but this paper believes that its specific goal should be effectively deter the illegal behaviors and defaulting above with less supervision and law enforcement costs,so as to maximize the law-abiding and compliance with the limited law enforcement resources.At this stage,China's medical insurance fund supervision still has problems such as limited law enforcement resources and supervision capacity.This paper elaborates on the connotation and specific goals of regular supervision of the use of medical insurance funds,and believes that the following three paths can be used to achieve the goals above,i.e.strengthening and improving intelligent supervision of medical insurance funds,innovating,optimizing,and comprehensively using various regulatory methods,strengthening self-management of designated medical institutions and pharmacies,and innovating systems such as no penalty in case of compliance.

关 键 词：医疗保障基金 常态化监管 优化监管方式 监管目标 实施路径 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]