Medical insurance anti-fraud mechanism from the perspective of cooperative governance: In-ternational experience and implications
10.3969/j.issn.1674-2982.2017.10.006
- VernacularTitle:合作治理视角下的医疗保险反欺诈机制:国际经验与启示
- Author:
Ju SUN
1
;
yan Yin GAN
Author Information
1. 武汉大学政治与公共管理学院 湖北武汉 430072
- Keywords:
Social health insurance;
Anti-fraud;
International experience;
Implication
- From:
Chinese Journal of Health Policy
2017;10(10):28-34
- CountryChina
- Language:Chinese
-
Abstract:
With the rapid development of China's social insurance,the phenomenon of medical insurance fraud is also increasing,which seriously threatens the comprehensive operation of health insurance funds and medical insur-ance system. Because of the cooperation between the government and the market,Europe & US have accumulated a lot of experience and achieved considerable success in anti-medical fraud as the"harder-hit area"in insurance fraud. This paper discusses the anti-fraud mechanism of foreign medical insurance to establish medical anti-fraud agencies within the government,and give full play to the complementary role of non-profit organizations to strengthen the con-trol and supervision of medical insurance and health care institutions and uses modern information technology to im-prove anti-fraud level.
