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近年来,烟台市结合当地实际,不断创新完善稽查方式,加大稽查力度,健全配套制度,使医疗保险费用稽查工作逐步走上了规范化、制度化的轨道。 一、根据住院、门诊的不同特点,采取不同的稽查方式。医疗消费过程不同于其他消费类型,由于医患双方信息的不对称,决定了医疗消费属于被动消费,同时也决定了在稽查工作中,除了对参保人员(需方)存在的道德风险等问题进行稽查外,稽查重点应放在定点医疗机构(供方)。
In recent years, Yantai City, in light of the actual conditions in the region, constantly innovates and perfects the inspection methods, intensifies auditing efforts and completes the supporting system so that the examination of medical insurance expenses gradually takes its place on a standardized and institutionalized track. First, according to the different characteristics of inpatient, outpatient, take a different way of inspection. Medical consumption process is different from other types of consumption, due to the asymmetric information between doctors and patients, determines the medical consumption is passive consumption, but also determines the audit work, in addition to the insured person (demand side) moral hazard and other issues exist Conduct audits, the focus of inspection should be sent to designated medical institutions (providers).