公益诉讼解决医疗保险争议的可适性论证  

Applicability of public interest litigation to resolve health insurance disputes

作　　者：黄梅 张雪晖[2] Huang Mei;Zhang Xuehui(School of Public Health,Fujian Medical University,Fuzhou 350122,China;School of Health Management,Fujian Medical University,Fuzhou 350122,China)

机构地区：[1]福建医科大学公共卫生学院,福州350122 [2]福建医科大学卫生管理学院,福州350122

出　　处：《中华医院管理杂志》2023年第9期705-709,共5页Chinese Journal of Hospital Administration

基　　金：福建省社科规划青年项目 (FJ2021C032)。

摘　　要：医保经办机构以协议方式管理医疗机构提供的医保服务是使用最广泛的管理方式之一,医保基金的安全使用依托于医保服务协议的正确履行。为提高医保协议管理行为的规范性与准确性,保障医疗机构及广大参保人的利益,作者从理论与实践两个层面论证在医保协议管理方面应用公益诉讼的可行性与必要性,并提出通过拓宽线索渠道、严格启动标准以及保持公益诉讼谦抑性等促进医保争议的有效化解。Medical insurance services provided by medical institutions are managed by medical insurance agencies via agreements,one of the most popular means of management.Hence the safe use of medical insurance funds depends on the correct performance of medical insurance service agreements.To improve the standardization and accuracy of medical insurance agreement management behavior,and protect the interests of medical institutions and the insured at large,the authors demonstrated the feasibility and necessity of public interest litigation in medical insurance agreement management from both theoretical and practical perspectives.They also proposed to promote the effective resolution of medical insurance disputes by expanding clues sources,strictly the initiating thresholds,and maintaining the modesty of public interest litigation.

关 键 词：医疗保险 医保经办机构 医疗机构 外部监督 公益诉讼 争议 

分 类 号：R197[医药卫生—卫生事业管理]