我国医保基金智能监管体系建设的SWOT分析与政策建议  

SWOT analysis and policy suggestions of the construction of intelligent supervision system for healthcare security fund in China

作　　者：黄筱蕾 谭巍[1] 杜琨 HUANG Xiaolei;TAN Wei;DU Kun(School of Management,Beijing University of Chinese Medicine,Beijing 100105,China;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]北京中医药大学管理学院,北京100105 [2]首都医科大学附属北京中医医院,北京100010

出　　处：《卫生软科学》2024年第10期70-73,共4页Soft Science of Health

摘　　要：随着医疗体制改革的稳步推进和“十四五”全民医疗保障规划的实施,医保覆盖人数和医保数据信息大幅增加,传统的人工监管手段已不能满足新形势下的要求,我国医保基金亟需建立规范化、科学化、常态化的监管体系。文章采用SWOT分析法,阐述了我国医保基金智能监管的基本格局以及实践经验,面对医保基金监管中跨部门协同不充分、区域发展不平衡、数据共享不畅等问题,从工作制度建设、新技术手段应用、专业化人才培养等角度提出相应的建议。With the further deepening of the reform of healthcare system and the implementation of the medical security plan for the“14th Five-Year Plan”period,the number of people covered by medical insurance and medical insurance information have increased substantially,and the traditional supervision methods can no longer meet the requirements under the new situation.It is urgent to establish a standardized,scientific and normalized supervision system for china's healthcare security fund.This paper uses SWOT analysis to describe the basic pattern and practical experiences of intelligent supervision of healthcare security fund in China.In the face of problems such as insufficient cross-departmental coordination,unbalanced regional development and poor data sharing in the supervision of healthcare security fund,corresponding suggestions are put forward from the perspectives of the construction of work system,application of new technical means and professional personnel training.

关 键 词：医保基金 监管体系 智能监管 SWOT分析 政策建议 

分 类 号：R197[医药卫生—卫生事业管理]