Analysis and prevention of integrity risks in the use of medical insurance funds in a hospital
10.3760/cma.j.cn111325-20230817-00090
- VernacularTitle:某院医保基金使用的廉洁风险梳理与防控实践
- Author:
Fang YANG
1
;
Haihuan FENG
;
Tianjun LI
;
Hua YANG
;
Yuntian LI
Author Information
1. 四川大学华西医院医保办公室，成都 610041
- Keywords:
Medical institutions;
Use of medical insurance funds;
Integrity risks;
Prevention and control practices
- From:
Chinese Journal of Hospital Administration
2024;40(1):47-52
- CountryChina
- Language:Chinese
-
Abstract:
Medical insurance fund is the foundation for the healthy operation of the medical insurance system, which is related to the well-being of the people and social stability. Medical institutions, as important entities in the implementation of medical insurance policies and the use of medical insurance funds, should continuously improve and optimize their self-management, and strengthen the prevention and control of clean risks in the use of medical insurance funds. This is not only a necessary response measure in the context of strict supervision of national medical insurance funds, but also an inevitable choice for hospitals under the trend of high-quality development. This article took a certain hospital as an example to illustrate the practice of sorting out the relevant authority directory for the use of medical insurance funds, analyze the integrity risk points of doctors, patients, and medical insurance reimbursement auditors; And introduced the practice of using a clean risk prevention and control grid to strengthen the hospital′s medical insurance fund, including improving the medical insurance management system, cultivating a sustainable culture of integrity, optimizing process design, improving information system construction, and improving medical insurance service modes, so as to provide reference for other medical institutions.
