Medical expense examination system in Japan and its inspirations

VernacularTitle:日本医疗费用审核制度及其启示
Author: Kai MENG ; Ling ZHANG
Publication Type:Journal Article
Keywords: Medical insurance system; Medical expense examination; Japan
From: Chinese Journal of Hospital Administration 2010;26(8):637-640
CountryChina
Language:Chinese
Abstract: For medical insurance systems, medical expense examination is a key measure to keep medical expenses under control. In 1948, Japan established an examination authority of legal person status to operate the medical expense examination. Based on years of modifications and improvement in the organizational system and operation mechanism, the system is running smoothly by now. Authors of this paper made a detailed introduction to the specific operations of such a system, and to China's local features as well. On such basis, the study proposed to build in China a third-party medical expense examination institution as a legal entity, and practice the reexamination system and information disclosure system, in an effort to safeguard legitimate rights of insurance organizations and medical institutions.