The Importance and Realization Strategy of Credit Management of Designated Medical Institutions in the Supervision of Medical Insurance Fund

Corresponding author: Hu Min, humin@fudan.edu.cn

DOI: 10.12201/bmr.202009.00017

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  Abstract: In China, the safety of medical insurance fund is faced with major challenges, and current medical insurance fund supervision system has some limitations. Therefore, it is proposed to introduce credit management into the supervision of medical insurance fund. The mechanism and function of credit management can form an effective supplement to the existing medical insurance fund supervision system, which can expand the content of medical insurance supervision and require medical institutions to make rational use of medical insurance fund, extend the limitation of medical insurance supervision to ensure the supervision of the fund, supplement medical insurance supervision means and guide medical institutions to voluntarily restrict service behaviors. To maximize the realization of the goal of credit management, it is necessary to construct a set of credit score index system applicable to designated medical institutions and a comprehensive credit monitoring and evaluation system based on multiple index sources. On this basis, the role and process of credit results in the actual supervision of medical institutions should be clarified, so that credit management can play the effect of trustworthy incentive and dishonest punishment, and finally form a perfect medical insurance credit management system to ensure that the credit management system plays the greatest role in the designated medical institutions of medical insurance.

  Key words: health insurance; supervision of medical insurance fund; credit management; social credit system

  Submit time: 15 December 2020

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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