Quality Research on the Dilemma of Supervision of Medical Insurance Funds and Response Strategies un-der Differential Medical Care
- VernacularTitle:异地就医下医保基金监管困境及应对策略的质性研究
- Author:
Jingran HE
1
;
Zheng KANG
;
Fangting CHEN
Author Information
1. 哈尔滨医科大学卫生管理学院 黑龙江哈尔滨 150081
- Keywords:
differential medical care;
medical insurance fund;
supervision;
qualitative research
- From:
Chinese Hospital Management
2024;44(4):23-28
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the dilemma of medical insurance fund regulation under cross-location medical treatment in China,and put forward coping strategies to provide theoretical reference and reference for enhancing the efficiency of cross-location medical treatment regulation in China.Methods A systematic search was conducted to retrieve the literature related to the regulation of health insurance funds under off-site medical care from the time of database construction to December 2023 NVivo 12 Plus software was used to code and analyse the included litera-ture.Results 38 Articles were finally retained for qualitative research through searching and screening.Fifty-three ini-tial concepts,18 initial categories and 5 main categories were extracted,and the dilemma nodes of the supervision of cross-district medical fund in the dimensions of incomplete supervision mechanism,imperfect supervision law,single supervision means,insufficient capacity of supervision subject and moral risk of supervision object and moral risk of supervision object were obtained,insufficient capacity of the regulatory body and moral risk of the regulatory object.Conclusion The supervision of medical insurance fund under the cross-location medical care is constrained by many factors,and the soundness of the supervision mechanism is the core issue;the completeness and effectiveness of the supervision law is the important basis for supervision;the innovation of the supervision means and the promotion of the improvement of the effectiveness of the supervision are the important means of the supervision of the medical insurance fund under the cross-location medical care;and the restriction of the moral hazards of the institutions in the place of medical care and of the insured persons is the key link of the super-vision process.
