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Modern Management 2023
典型地区医保基金智能监管经验做法及借鉴
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Abstract:
近年来，随着全面建成小康社会的步伐加快，人们对高质量的医疗保障水平的需求日益增强，这同时对医保治理提出了严峻挑战。国家医保局自2018年成立以来，一直是把加强医保基金监管作为首要攻坚任务。2019年启动的“两试点一示范”在智能监管工作取得了显著进展。本文通过梳理成都，南京，厦门等典型地区的主要做法，总结医保基金智能监管工作的经验，为加快构建系统完善的智能监管体系提供参考借鉴，助力新阶段医保基金智能监管高质量发展。
In recent years, with the accelerated pace of building a moderately prosperous society in all respects, people’s demand for high-quality medical security has been increasing, which has posed serious challenges to medical insurance governance. Since its establishment in 2018, the National Medical Insurance Administration has always made strengthening the supervision of medical insurance funds a top priority. The “two pilot projects and one demonstration” launched in 2019 has made significant progress in intelligent supervision work. This article summarizes the experience of intelligent supervision of medical insurance funds by reviewing the main practices in typical regions such as Chengdu, Nanjing, Xiamen, etc., providing reference for accelerating the construction of a comprehensive intelligent supervision system and assisting in the high-quality development of intelligent supervision of medical insurance funds in the new stage.
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