[1]王煜昊,王丽娜,梁丽蕙,等.跨省异地就医的医保基金监管路径研究[J].卫生经济研究,2023,40(4):61-65，69.
　WANG Yuhao,WANG Lina,LIANG Lihui,et al.Research on the Supervision Path of Medical Insurance Fund for Cross-provincial Medical Treatment[J].Journal Press of Health Economics Research,2023,40(4):61-65，69.
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跨省异地就医的医保基金监管路径研究
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卫生经济研究[ISSN:1004-7778/CN:33-1056/F]

卷:
40
期数:
2023年4期
页码:
61-65，69
栏目:
医疗保障
出版日期:
2023-04-03

文章信息/Info

Title:
Research on the Supervision Path of Medical Insurance Fund for Cross-provincial Medical Treatment
作者:
王煜昊1; 王丽娜1; 梁丽蕙1; 路娜娜1; 徐 伟1
1.中国药科大学国际医药商学院，江苏 南京 211198
Author(s):
WANG Yuhao;  WANG Lina;  LIANG Lihui;  LU Nana;  XU Wei
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing Jiangsu 211198, China
关键词:
跨省异地就医; 医保基金; 监管路径
Keywords:
cross-provincial medical treatment;  medical insurance fund;  supervision path
分类号:
F840.684；R197.1
文献标志码:
A
摘要:
目前，跨省异地就医的医保基金监管未能匹配就医需求的增长，存在伪造变造票据材料、医保报销“信息差”、冒用他人身份、过度诊疗等欺诈骗保风险。对此，设计了基于客观数据、引入智能审核、规范各方权责、加强部门联动的跨省异地就医医保基金监管路径，以期提高医保基金使用效率。
Abstract:
At present, the supervision of medical insurance fund for cross-provincial medical treatment in different places has not been able to match the rapid growth of medical needs, there are the risks of insurance fraud such as forged and altered bill materials, poor information in cross-provincial medical insurance reimbursement, fraudulent use of others' identities, and excessive diagnosis and treatment. This paper designs the supervision path of cross-provincial medical insurance fund, based on objective data, introducing intelligent auditing, standardizing the rights and responsibilities of all parties, and strengthening departmental linkages, in order to improve the supervision and the efficiency of medical insurance fund.

参考文献/References:

[1] 周萍，黄华波.跨省异地就医住院费用直接结算进展评价及绩效分析[J].中国医疗保险，2018（7）：34-37.
[2] 吕大伟，李力，尹婷，等.长三角门诊费用跨省直接结算政策实施效果初探——以上海数据为例[J].中国医疗保险，2021（7）：43-50.
[3] 石连忠，梅彦，余震，等.杭州市DRG中医支付政策的实践探索[J].卫生经济研究，2021，38（12）：16-19.

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更新日期/Last Update: 1900-01-01