The trend, problems discovered, and enlightenment to hospital management of medical insurance fund unannounced inspection
10.3760/cma.j.cn111325-20230809-00061
- VernacularTitle:医疗保障基金飞行检查的趋势和发现问题分析及其对医院管理的启示
- Author:
Chen XIE
1
;
Yutong WANG
;
Weiguo ZHU
;
Xueqin SUN
;
Rui DONG
;
Ding HAN
Author Information
1. 中国医学科学院北京协和医院医疗保险管理处，北京 100730
- Keywords:
Hospital management;
Medical insurance fund;
Unannounced inspection;
High-quality development
- From:
Chinese Journal of Hospital Administration
2024;40(1):42-46
- CountryChina
- Language:Chinese
-
Abstract:
The rational use of medical insurance fund(MIF) plays an important role in promoting the high-quality development of public hospitals, and the supervision of MIF is in a trend of under the rule of law, normalization, professionalization and standardization, and unannounced inspection will become the norm. The authors systematically analyzed three main trends of MIF unannounced inspections, namely, gradually increasing intensity, constantly innovating methods, and increasingly serious consequences. The problems exposed in unannounced inspections were sorted out from five dimensions: form of results, severity, scope of attribution, subjective intention, and regulatory screening ideas. The enlightenment of MIF unannounced inspections to hospital management was explored from four aspects: compliance awareness, organizational system, fine management, and daily supervision. It was proposed that public hospitals should transform their roles and positions, improve the working mechanism of departmental collaboration, and achieve fine management in policy understanding, system formulation, process design, information support, data governance, regulatory implementation, personnel training, and performance matching. At the same time, internal simulated unannounced inspections in hospitals should be regarded as a routine work.
