医保经办机构内控现状与改革对策——以淄博市为例  

Current Situation and Reform Strategies of Internal Control in Medical Insurance Claim Management and Fund Administration Agency——Taking Zibo City as an Example

作　　者：胡涛 

机构地区：[1]山东省淄博市医疗保障服务中心,淄博255000

出　　处：《中国医疗保险》2024年第10期91-95,共5页China Health Insurance

摘　　要：医疗保障制度是保障人民生命健康、维护社会公平正义的重要机制之一,医疗保障经办机构作为医疗保障制度的执行主体,在落实医保政策待遇、管理使用医保基金、规范定点医药机构行为等方面承担着重要责任。然而,随着社会经济的发展,以及医疗保障制度的持续深入改革,医疗保障经办机构内部控制管理面临着诸多挑战和问题。因此,对医疗保障经办机构内部控制管理现状进行深入探究,并提出相应的改革对策,具有重要的理论和实践意义。Healthcare security system is one of the important mechanisms to ensure people's lives and health,and maintain social fairness and justice.As the main executor of the healthcare security system,medical insurance claim management and fund administration agencies bear important responsibilities in implementing medical insurance policies and benefits,managing the use of medical insurance funds,and regulating the behavior of designated medical institutions and drug stores.However,with the development of the social economy and the continuous deepening reform of the healthcare security system,the internal control management of medical insurance claim management and fund administration agencies still face many challenges and problems.Therefore,conducting in-depth exploration of the current situation of internal control management in medical insurance claim management and fund administration agencies and proposing corresponding reform measures has important theoretical and practical significance.

关 键 词：医疗保障 经办机构 内部控制 管理现状 改革对策 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]